Volume 1 • Issue 1 • 1000105 27 Madridge J Clin Res. ISSN: 2638-3535 Madridge Journal of Clinical Research Research Article Open Access A Pharmacist designed Protocol for the management of Acute Alcohol Withdrawal Syndrome (AAWS) in the Intensive Care Unit: A Pilot Study Roaa Matouq Khinkar 1 *, Ruchit Marfatia 2 and Nicole Clark 2 1 Department of Clinical Pharmacy, College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia 2 Hallmark Health System, Medford, MA, USA Article Info *Corresponding author: Roaa Matouq Khinkar Department of Clinical Pharmacy College of Pharmacy King Abdulaziz University Jeddah Saudi Arabia E-mail: rkhinkar@kau.edu.sa rmkhinkar@gmail.com Received: September 29, 2017 Accepted: October 24, 2017 Published: October 30, 2017 Citation: Khinkar RM, Marfatia R, Clark N. A Pharmacist designed Protocol for the management of Acute Alcohol Withdrawal Syndrome (Aaws) in the Intensive Care Unit: A Pilot Study. Madridge J Clin Res. 2017; 1(1): 27-30. doi: 10.18689/mjcr-1000105 Copyright: © 2017 The Author(s). This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Published by Madridge Publishers Abstract Background: Many cases of acute alcohol withdrawal syndrome are refractory to benzodiazepines. The demand for an appropriate protocol to manage such cases is on the rise. Previous studies done on phenobarbital have shown its superiority to benzodiazepines in terms of managing acute alcohol withdrawal syndrome. By other means, phenobarbital decreases the use of benzodiazepines, need for intubation, and ICU length of stay (ICU LOS). Objectives: This study was conducted to evaluate a new alcohol detoxification protocol i.e. using phenobarbital monotherapy as an alternative to benzodiazepines monotherapy. Methods: Design: Prospective cohort study in which study group was compared to control group taken prior to intervention. Primary endpoints: number of ventilation free days. Secondary endpoints: total dose of benzodiazepines used, and ICU length of stay (ICU LOS). Inclusion criteria: Physicians utilized phenobarbital protocol when managing severe cases of alcohol detoxification resistant to benzodiazepines. Physicians evaluated if a patient is an appropriate candidate for phenobarbital protocol using protocol parameters and available patient data. Statistical analysis: a two-sample t-test was conducted on continuous data. Chi-square statistic was used for discrete variables. Results: The primary end point was not statistically significant. The number of ventilation free days was 6 days for pre-intervention group and 8 days for post-intervention group p=0.27. The secondary endpoints were not statistically significant. The total dose of benzodiazepines used equivalent to lorazepam was 235 mg for pre-intervention group and 41 mg for post-intervention group p=0.21. The total ICU length of stay (ICU LOS) was 6 days for pre-intervention group and 3 days for post-intervention group; p=0.05. Conclusion: This study did not find anything significant but descriptive data suggest that the phenobarbital protocol may provide a useful alternative to benzodiazepines. The findings of descriptive data resemble the outcomes of the previous studies done on phenobarbital for the management of acute alcohol withdrawal syndromes refractory to benzodiazepines. However future study is needed with larger sample size. Keywords: Acute alcohol withdrawal syndrome (AAWS); Benzodiazepines, ICU length of stay (ICU LOS); Phenobarbital; Pharmacy; Ventilation free days. Abbreviations: AAWS: Acute Alcohol Withdrawal Syndrome; AWS: Alcohol Withdrawal Syndrome; AUD: Alcohol Use Disorder; ICU: Intensive Care Unit; ICU LOS: ICU Length of Stay; ED: Emergency Department; DT: Delirium Tremens; MICU: Medical Intensive Care Unit; CIWA: Clinical Institute Withdrawal Assessment; PO: Oral; IM: Intramuscular; CC: Critical Care; ER: Emergency Room; MD: Medical Doctors; ICD-10: The 10th revision of the International Statistical Classification of Diseases and Related Health Problems; HHS: Hallmark Health System; PGY1: Post-Graduate Year 1. ISSN: 2638-3535