Evidence map›Paper›PMID 42277965›Full record

ArticlePilot and feasibility studies2026

Phenobarbital as an Adjuvant to benzodiazepines when compared to Single-agent benzodiazepine Treatment (usual care) for Alcohol withdrawal syndrome in the intensive care unit (PASTA): a study protocol.

Haustine Patt Panganiban, Samuel G Ricciardone, Tess Evans, Melissa J Ankravs, Timothy N Fazio, Nicolas Clark, Aneil Avasthi, Christopher M MacIsaac, Jeffrey J Presneill, Emily J See and 3 more

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Article in Pilot and feasibility studies, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Haustine Patt Panganiban *Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
Samuel G Ricciardone *Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
Tess EvansDepartment of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
Melissa J AnkravsDepartment of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
Timothy N FazioElectronic Medical Records (EMR) Team, The Royal Melbourne Hospital, Melbourne, Australia.
Nicolas ClarkDepartment of Addiction Medicine, The Royal Melbourne Hospital, Melbourne, Australia.
Aneil AvasthiDepartment of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
Christopher M MacIsaacDepartment of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
Jeffrey J PresneillDepartment of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
Emily J SeeDepartment of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
Matthew W SemlerVanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Centre, Nashville, USA.
Theodore J IwashynaDepartment of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, USA.
Adam M DeaneDepartment of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia. Adam.deane@unimelb.edu.au.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAbrupt cessation of alcohol consumption following hospital admission can induce alcohol withdrawal syndrome. This syndrome is challenging to manage and is associated with considerable morbidity and mortality. Current management of alcohol withdrawal syndrome in Australia is generally titrated benzodiazepine administration. In some regions, phenobarbital is preferred but evidence to support its superiority is weak.

methodsWe will conduct a single-center, three-arm, open-label, parallel-group, randomized clinical trial. Our primary objective is to determine the feasibility of embedding a randomized clinical trial within an electronic medical record to compare phenobarbital to single-agent benzodiazepine for patients with alcohol withdrawal. We will screen and randomize 45 patients using the Epic electronic medical record system. Patients will receive either low- or standard-dose intravenous phenobarbital (4 or 8 mg per kilogram), or usual care (benzodiazepine regimen). The primary outcomes to assess feasibility are usability, screening rates, enrollment rates, and compliance. Secondary outcomes are exploratory and include alcohol withdrawal scale scores, dose of benzodiazepine administered, health utilization, adjuvant drug treatments, and patient outcomes. DISCUSSION: There are limited high quality data evaluating the use of phenobarbital administration for alcohol withdrawal syndrome. Additionally, there is limited data evaluating the embedding of screening, randomization, and administration of a sedative drug within the electronic medical record. Our feasibility trial will establish whether this is possible within our health care system. In this protocol paper we detail how we will embed this trial within the electronic medical record Epic.

trial registrationThe study (RMH2024.320 v2 06/01/2025) is registered with Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12625000320459 . Registered on 17 April 2025. Trial Sponsor: The Royal Melbourne Hospital.

Indexed as

Alcohol withdrawal syndromeBenzodiazepinesClinical Decision Support SystemsCritical illnessElectronic medical recordsEmbedded researchPhenobarbitalRandomized controlled trial

Identifiers

PMID42277965
PMCPMC13483696

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.