Phenobarbital Use as Adjunct to Benzodiazepines in the Treatment of Severe Alcohol Withdrawal Syndrome

Severe AWS （alcohol withdrawal syndrome） and AWD （alcohol withdrawal associated delirium） are common indications for intensive care unit admissions. Approximately 25% of patients with severe alcohol withdrawal require prolonged critical care hospital courses, often complicated by respiratory failure, need for mechanical ventilation due to administration of sedative continuous infusions and development of nosocomial infections. Although benzodiazepines are the mainstay of therapy for alcohol withdrawal, some patients exhibit benzodiazepine-refractory alcohol withdrawal. The use of phenobarbital as adjunct to benzodiazepines has been shown in studies to be effective in enhancing therapeutic responsiveness to benzodiazepines and reducing the need for mechanical ventilation. The objective of this study is to evaluate whether severe alcohol withdrawal treatment based on combining symptom-triggered benzodiazepine therapy with adjunctive phenobarbital will result in decreased mechanical ventilation rates, decreased use of continuous sedative infusions, decreased time to withdrawal symptom resolution and decreased length of stay in the intensive care unit. Chart reviews were utilized to determine total amount of benzodiazepine and phenobarbital use, need for mechanical ventilation, requirement of continuous lorazepam, dexmedetomidine or propofol infusions, average intensive care unit length of stay and incidence of adverse effects.

Hypochlorous Acid for Septic Abdominal Processes Using a Unique Negative Pressure Wound Therapy System:A Pilot Study

Background: Septic open abdomens occur in trauma, burn and surgery. Currently, multiple concentrations of hypochlorous acid solutions have effectively decreased the microbiotic burden in wounds. We hypothesized that Vashe?, a neutral hypochlorous acid solution (V-HOCL), would be safe as an intraperitoneal irrigation or washout disinfectant for septic open abdomens utilizing negative pressure wound therapy. Methods: This is a retrospective observational review of patients who required delayed abdominal closures after exploratory laparotomies. Group A (n = 8) had cyclical V-HOCL irrigation to their open abdomens combining AbtheraTM and V.A.C. Dressing System for negative pressure wound therapy with irrigation (NPWT-i) and Group B (n = 9) had intra-abdominal V-HOCL washouts. Results: Fifty percent of both groups had either septic or hemorrhagic shock on admission. Compared to Group B, Group A patients were older (median 50 vs 37 years), and had a median hospitalization of 28 vs 8 days, 4 times as many operations, more acute renal failure and co-morbidities. No statistically significant differences were detected be-tween the two treatment methods with the V-HOCL delivery and removal. Conclusion: There were no episodes of electrolyte imbalance, hypotension, hypertension, anaphylaxis, hemorrhage, visceral injury or systemic toxicity. V-HOCL with/without NPWT-i irrigation was a safe modality and tolerated well in this study.