2026 Eastern States Conference

Title: Phenobarbital versus Lorazepam for Treatment of Alcohol Withdrawal Syndrome in the Intensive Care Unit
Authors: Sara Clarke, PharmD; Amy Cook, PharmD, BCPS
Background: Alcohol Withdrawal Syndrome (AWS) is a life-threatening medical condition that can present with a range of symptoms including mild agitation, nausea, seizures, hallucinations, coma, and even death. Patients with AWS often experience suboptimal outcomes due to inconsistent management and lack of evidence-based care provided across care settings. First-line treatment for AWS is symptom-triggered benzodiazepines based on Clinical Instrument Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scores and phenobarbital is considered a second-line treatment option.
Objective: The primary objective of this study was to evaluate the difference in phenobarbital and lorazepam on intensive care unit (ICU) length of stay when utilized for alcohol withdrawal treatment. Secondary objectives include hospital length of stay, time on mechanical ventilation, dexmedetomidine use, midazolam use, propofol use, and CIWA-Ar scores in ICU / trauma patients.
Methods: This was a retrospective, observational, cohort study that reviewed electronic health records at a single-center,340-bed community hospital in Richmond, Virginia with 24 ICU beds from January 1, 2025 through July 10, 2025. Patients were included if they were 18 years or older, had a diagnosis of alcohol use disorder with concerns for alcohol withdrawal syndrome, admitted to the ICU, and had orders for phenobarbital or lorazepam. Patients were excluded if they were pregnant or CIWA-Ar scores were not documented. Baseline characteristics were collected for age, sex, race/ethnicity, and comorbidities. CIWA-Ar scores, length of stay (ICU and hospital), ventilator days, dexmedetomidine use, midazolam use, propofol use, and sedation scores were also collected. 
Results: Research in progress.
Conclusion: Research in progress.