SynthesisPharmacotherapy2026
Phenobarbital Versus Benzodiazepine-Based Pathways for Alcohol Withdrawal Syndrome in Critically Ill Adults: A Systematic Review and Meta-Analysis.
Synthesis in Pharmacotherapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo compare outcomes of phenobarbital-based versus benzodiazepine-based pathways for alcohol withdrawal syndrome (AWS) in critically ill adults and evaluate whether pathway design and timing of phenobarbital use affect treatment outcomes. DATA SOURCES: A librarian-led search of MEDLINE, Embase, Cochrane Central, CINAHL, Web of Science, Scopus, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform was conducted through July 2024, with updates in December 2024, August 2025, and December 2025. Search concepts included phenobarbital, benzodiazepines, and alcohol withdrawal. STUDY SELECTION AND DATA EXTRACTION: Comparative studies of adults admitted or transferred to an intensive care unit (ICU) with AWS and treated with phenobarbital-based versus benzodiazepine-based pathways were included. Sixteen nonrandomized studies were included in the qualitative synthesis, and 12 treatment-oriented studies were included in the primary meta-analysis. Multiple reviewers independently screened studies, extracted data, and assessed risk of bias using Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I). DATA SYNTHESIS: Phenobarbital-based pathways were not associated with significantly different intubation (11 studies; odds ratio (OR), 0.62; 95% confidence interval (CI), 0.20-1.87; I RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: This review distinguishes phenobarbital-first, protocolized ICU pathways from adjunctive or mixed phenobarbital strategies, suggesting that implementation design may influence outcomes.
conclusionsAlthough evidence remains very low certainty, these findings suggest that phenobarbital's role in ICU AWS may be pathway dependent. Front-loaded, protocolized phenobarbital-first pathways may be associated with favorable outcomes in exploratory analyses, but these findings should be considered hypothesis-generating and require confirmation in prospective randomized trials.
trial registrationCRD42024595819.
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