{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:18:44Z","timestamp":1777853924267,"version":"3.51.4"},"reference-count":26,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"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":["J Intensive Care Med"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study directly compares outcomes of phenobarbital and dexmedetomidine as adjuncts to symptom-triggered benzodiazepine treatment for alcohol withdrawal syndrome (AWS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective cohort analysis at a single tertiary referral institution in a major urban center in the United States. In hospitalized patients above 18 years with AWS between May 1, 2018, and July 31, 2021 we compared the hospital length of stay (LOS), ICU LOS, mechanical ventilation incidence and duration of patients who received dexmedetomidine versus phenobarbital as adjuncts to lorazepam-based treatment. Patients were divided into two cohorts based on treatment they received \u2013 dexmedetomidine\/lorazepam (DEX) versus phenobarbital\/lorazepam (PHENO). The use of phenobarbital or dexmedetomidine was left to the discretion of the treating bedside physician.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One hundred fifty-six patients met inclusion criteria with 102 patients (65%) in the DEX group and 54 patients (35%) in the PHENO group. The PHENO group had a lower probability of intubation (OR 0.33, 95% CI 0.15-0.70, p\u2009=\u20090.005) and shorter hospital LOS (IRR 0.45, 95% CI 0.31-0.64, p\u2009&lt;\u20090.001), and ICU LOS (IRR 0.58, 95% CI 0.34-1.00, p\u2009=\u20090.050). For both hospital and ICU LOS, the PHENO group had shorter LOS than dexmedetomidine at lower doses of lorazepam (&lt;3 mg), but this protective effect diminished at higher doses of lorazepam, at a rate of 10% (hospital LOS, IRR 1.10, 95% CI 1.05-1.16, p &lt; 0.001) and 6% (ICU LOS, IRR 1.06, 95% CI 0.99-1.13, p\u2009=\u20090.074) per milligram increase in lorazepam.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A symptom- triggered lorazepam regimen including early phenobarbital administration for severe alcohol withdrawal syndrome is associated with lower hospital LOS and need for intubation compared to a symptom triggered lorazepam regimen with dexmedetomidine adjunct.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08850666251328881","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T04:10:55Z","timestamp":1743221455000},"page":"948-955","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Phenobarbital Addition to Alcohol Withdrawal Treatment Offers Better Outcomes than Dexmedetomidine in Hospitalized Patients"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1357-2302","authenticated-orcid":false,"given":"Mary","family":"Matecki","sequence":"first","affiliation":[{"name":"George Washington University, Department of Surgery, Center for Trauma and Critical Care, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Noureldin","sequence":"additional","affiliation":[{"name":"George Washington University, Department of Surgery, Center for Trauma and Critical Care, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riad","family":"Akkari","sequence":"additional","affiliation":[{"name":"George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary","family":"Cohen","sequence":"additional","affiliation":[{"name":"George Washington University, School of Medicine and Health Sciences, School of Medicine, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"McMullan","sequence":"additional","affiliation":[{"name":"George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9124-8025","authenticated-orcid":false,"given":"Katrina","family":"Hawkins","sequence":"additional","affiliation":[{"name":"George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Williams","sequence":"additional","affiliation":[{"name":"George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azuka","family":"Nwude","sequence":"additional","affiliation":[{"name":"George Washington University Hospital, Pharmacy, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5101-2162","authenticated-orcid":false,"given":"David","family":"Yamane","sequence":"additional","affiliation":[{"name":"George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6247-3004","authenticated-orcid":false,"given":"Babak","family":"Sarani","sequence":"additional","affiliation":[{"name":"George Washington University, Department of Surgery, Center for Trauma and Critical Care, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean M.","family":"Lee","sequence":"additional","affiliation":[{"name":"George Washington University, School of Medicine and Health Sciences, School of Medicine, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4688-1523","authenticated-orcid":false,"given":"Susan","family":"Kartiko","sequence":"additional","affiliation":[{"name":"George Washington University, Department of Surgery, Center for Trauma and Critical Care, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"Alcohol use disorder (AUD) in the United States: Age groups and demographic characteristics. 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