{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T12:35:40Z","timestamp":1786710940383,"version":"build-2736575974"},"reference-count":9,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Hosp Pharm"],"abstract":"\n Background:<\/jats:title>\n Alcohol withdrawal syndrome (AWS) is a common and potentially severe complication of abrupt alcohol cessation. Benzodiazepines (BZD) guided by the Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) scale are commonly used to manage alcohol withdrawal, but objective alternatives may improve outcomes. Phenobarbital (PB) guided by the Richmond Agitation-Sedation Scale (RASS) has emerged as a potential alternative. This study aimed to compare clinical outcomes in hospitalized patients with AWS receiving CIWA-Ar-guided BZD versus RASS-guided PB therapy.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This retrospective cohort study included adults hospitalized with AWS across a multicenter health system in the Upper Midwest of the United States. Patients treated under the CIWA-Ar-guided BZD therapy from June 1, 2024 until August 31, 2024, were compared with those treated under the RASS-guided PB therapy from June 1, 2025 to August 31, 2025. Primary outcomes were mechanical ventilation and non-invasive ventilation (NIV) requirements. Secondary outcomes included hospital length of stay (LOS), need for intensive care unit (ICU) care, and ICU LOS.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n A total of 125 patients were included (BZD, n\u2009=\u200946; PB, n\u2009=\u200979). Mechanical ventilation and NIV requirements were infrequent and were not statistically significantly different between groups (mechanical ventilation: 4.3% vs 1.3%,\n P<\/jats:italic>\n \u2009=\u2009.554; NIV: 2.2% vs 5.1%,\n P<\/jats:italic>\n \u2009=\u2009.651). RASS-guided PB therapy was associated with a shorter hospital LOS compared with CIWA-Ar-guided BZD therapy (median 3.5\u2009days [interquartile range (IQR) 2-6.75] vs 3\u2009days [IQR 2-4];\n P<\/jats:italic>\n \u2009=\u2009.025). Patients receiving BZD were more likely to require ICU care than those receiving PB (47.8% vs 26.6%,\n P<\/jats:italic>\n \u2009=\u2009.016). Among patients requiring ICU care, ICU LOS did not differ between groups (median 2\u2009days [IQR 1-3.75] vs 2\u2009days [IQR 1-3];\n P<\/jats:italic>\n \u2009=\u2009.97).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n RASS-guided PB therapy in hospitalized patients with AWS was associated with a shorter hospital stay and a lower need for ICU care compared with CIWA-Ar-guided BZD therapy. In contrast, ICU LOS and respiratory outcomes were comparable between groups. These results suggest that RASS-guided PB therapy may be associated with reduced escalation to ICU-level care without evidence of increased adverse respiratory events.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/00185787261475128","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T12:15:06Z","timestamp":1786450506000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar)-Guided Benzodiazepine Versus Richmond Agitation-Sedation Scale (RASS)-Guided Phenobarbital Management for Alcohol Withdrawal Syndrome in Hospitalized Patients"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3409-1768","authenticated-orcid":false,"given":"Han","family":"Tran","sequence":"first","affiliation":[{"name":"Essentia Health-Fargo, ND, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5818-1007","authenticated-orcid":false,"given":"Tatianna N.","family":"Pollak","sequence":"additional","affiliation":[{"name":"Essentia Health-Fargo, ND, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2333-4398","authenticated-orcid":false,"given":"Ashraf A.","family":"Amadou","sequence":"additional","affiliation":[{"name":"Essentia Health-Fargo, ND, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Haugen","sequence":"additional","affiliation":[{"name":"Essentia Health-Fargo, ND, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Richter","sequence":"additional","affiliation":[{"name":"North Dakota State University, Fargo, ND, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert","family":"Iaderosa","sequence":"additional","affiliation":[{"name":"Essentia Health-Fargo, ND, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.10574"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1770"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2306511"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1108\/MIJ-02-2020-0002"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14911"},{"key":"e_1_3_3_7_2","unstructured":"Prabhu S Harinivaas S Geetha G et al Phenobarbital Versus Lorazepam for the Management of Alcohol Withdrawal Syndrome (AWS) in Hospitalized Patients \u2013 A Retrospective Cohort Study. Gavin Publishers. Published May 4 2023. Accessed July 1 2025. https:\/\/www.gavinpublishers.com\/article\/view\/phenobarbital-versus-lorazepam-for-the--management-of-alcohol-withdrawal-syndrome--aws-in-hospitalized-patients--a-retrospective-cohort-study"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2018745"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/npr2.12347"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.33695"}],"container-title":["Hospital Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00185787261475128","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00185787261475128","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00185787261475128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T11:55:03Z","timestamp":1786708503000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00185787261475128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":9,"alternative-id":["10.1177\/00185787261475128"],"URL":"https:\/\/doi.org\/10.1177\/00185787261475128","relation":{},"ISSN":["0018-5787","1945-1253"],"issn-type":[{"value":"0018-5787","type":"print"},{"value":"1945-1253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]},"article-number":"00185787261475128"}}