Phenobarbital for weaning continuous sedative agents in critically ill patients: a report of two cases

Background: Phenobarbital, a long-acting barbiturate, possesses unique pharmacokinetic properties that contribute to its diverse clinical applications. Its utility as a long-acting sedative has been explored in certain areas of emergency medicine and critical care, such as management of alcohol withdrawal syndrome. However, there is a paucity of evidence supporting the use of phenobarbital taper as a strategy to facilitate the weaning of continuous sedative medications. Case Description: In this report, we present two cases of critically ill patients with a history of opiate and benzodiazepine dependence, highlighting the difficulties encountered during the weaning process of continuous analgesic and sedative medications. Despite resolution of the underlying disease states, both patients required prolonged durations of therapy on these medications. However, through the implementation of an individualized phenobarbital taper plan, we successfully facilitated the weaning of continuous sedative medications, ultimately leading to their discharge from the intensive care unit (ICU). Conclusions: Current practice guidelines do not have recommendations for weaning continuous analgesic and sedative medications). Phenobarbital taper could potentially eliminate the need for prolonged administration of these medications, facilitating ICU discharge and potentially reducing the costs associated with extended ICU stays, if there are no other indications for ICU level of care.