Alcohol-Related Admissions to an Inner City Hospital Intensive Care Unit

Marik, Patricia; Mohedin, B

doi:10.1093/oxfordjournals.alcalc.a008168

Cited by 57 publications

(29 citation statements)

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“…Alcohol consumption increases the risk of intensive care admission and of hospital death in men [9], and is directly related to the admission in 21 to 28% of ICU patients [10,11,12]. Drinking problems have been reported in 37.9% of ICU patients [4], and alcohol-related conditions described in 44 to 51% of gastroenterology inpatients [13,14].…”

Section: Introductionmentioning

confidence: 99%

Depression, Anxiety and Alcohol Abuse in a Gastroenterology Intensive Care Unit: Prevalence and Detection

Cardoso¹,

Alexandre²,

Rosa³

2010

CPEMH

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Abstract:Objectives: To assess depression, anxiety, and alcohol abuse in a Gastroenterology ICU, and the level of its detection by the staff.Method: All patients consecutively admitted to the ICU during a six-month period, 18 or above, and staying 24 hours, were assessed with the Hospital Anxiety and Depression Scale (HADS) and the CAGE. Doctors and nurses assessed the type and severity of patients' morbidity. Data were analyzed with Student's t-test, Pearson's and Spearman's correlations for ordinal variables, chi-square for nominal variables, and multiple logistic regression.Results: The 65 patients assessed had a mean age of 57, and were predominantly male (58.5%), married (72.3%), and retired (53.8%); 27.7% had a psychiatric history, 24.6% were on psychotropic drugs, and 32.3% had an alcohol intake above standards. Anxiety and depression HADS scores 8 were present in 29.2% and 35.4% of the patients, respectively; 20%, mainly men, scored positive on the CAGE. Women had significantly higher anxiety scores (=.012) than men but did not differ in depression. A psychiatric history was significantly associated with higher anxiety (p<.001) and depression (p=.007) scores, as well as being on psychotropic drugs regularly (p<.001; p=.03, respectively).Doctors diagnosed somatic illness in 48.8%, and somatic illness with psychiatric co-morbidity in 51%; for nurses the rates were, respectively, 41.5% and 58.6%. Doctors' and nurses' detection of psychiatric disorders were significantly associated with the HADS anxiety scores (p=.013; p=.001, respectively), and doctor's detection with depression (p=.046) scores. There were no significant associations between nurses' detection of psychiatric disorders and depression, and between both professional groups detection and alcohol abuse.Conclusion: High prevalence of depression, anxiety, and alcohol abuse in Gastroenterology ICU was confirmed. However, the level of detection by the staff was low and mainly when anxiety symptoms were present.

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Section: Introductionmentioning

confidence: 99%

Depression, Anxiety and Alcohol Abuse in a Gastroenterology Intensive Care Unit: Prevalence and Detection

Cardoso¹,

Alexandre²,

Rosa³

2010

CPEMH

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“…An analysis of the Intensive Care National Audit and Research Centre (ICNARC) database demonstrated that admissions to intensive care [6]. Previous studies assessing the effect of alcohol on admissions to ICUs have been single-centred studies or database reviews, or have studied a population that is not comparable to that of Scotland [7][8][9][10]. We therefore undertook the first prospective national study to ascertain the impact of alcohol-related admissions to ICUs.…”

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confidence: 99%

A national service evaluation of the impact of alcohol on admissions to Scottish intensive care units*

et al. 2012

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SummaryAlcohol-related disease adversely affects the outcome of critically ill patients. The burden of this in Scotland is higher than elsewhere in the United Kingdom. In a prospective observational study of all patients admitted to the 24 intensive care units in Scotland we assessed the proportion of admissions in which alcohol-related disease was implicated. Of 771 admissions, 642 (83.3%) were unplanned and 196 (25.4%) were related to alcohol. There was a significantly higher proportion of men in the alcohol-related admissions group (140 (71.4%) vs 291 (50.6%), p = 0.009). This group was also significantly younger with median (IQR [range]) ages of 51 (38-63 [16-89]) vs 63 (48-73 [16-92] Accepted: 21 May 2012The World Health Organization has estimated that alcohol consumption accounted for 3.2% of global mortality and 4.0% of the global burden of disease [1]. Alcohol consumption in the UK has grown steadily, with the amount per capita rising from the equivalent of 5 l of pure alcohol per year in 1963 to over 10 l per year in 2006 [2]. This has been associated with an increasing burden on health. Between 1992 and 2008 the mortality rate directly caused by alcohol more than doubled from 6.9 to 12.8 per 100 000 [3,4]. The associated mortality in Scotland is particularly high; for men it reached as high as 63.1 per 100 000 in 2003, with up to 105 per 100 000 in some areas [5].There is increasing alcohol-related morbidity and mortality and a significant difference between Scotland and the rest of the UK. An analysis of the Intensive Care National Audit and Research Centre (ICNARC) database demonstrated that admissions to intensive care Anaesthesia 2012Anaesthesia , 67, 1132Anaesthesia -1137Anaesthesia doi:10.1111Anaesthesia /j.1365Anaesthesia -2044Anaesthesia .2012 Figure 1 shows the percentage of ICU admissions related to alcohol according to each geographical Health Board regions. Assessment of patients by geographical area ranked by the SIMD demonstrated that those from a worse socio-economic area were more likely to have an alcohol-related intensive care admission (Fig. 2) (p < 0.001). 1133We found a significantly higher proportion of men in the alcohol-related admissions group (Table 1) There was no significant difference in crude ICU and hospital mortality or length of stay between the nonalcohol-and alcohol-related admissions. We did find a significantly higher number of ventilator days associated with the alcohol-related admissions group (Table 2).Of the 75 patients for whom data were missing, three were less than 16 years old, seven had been transferred between units, and three had required transfer for specialist intensive care such as neurosurgery or liver transplantation. The remaining 62 patients' information was missed during local data collection. DiscussionIn this national prospective cohort study we identified that a quarter of all admissions to ICUs in Scotland were for alcohol-related conditions, with one fifth of all admissions having chronic alcohol-related disease. The ICU and hospit...

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“…Alcoholism accounted for 21% of all admissions to a medical ICU in one study, with AWS being the most common alcoholism-related diagnosis (8). These patients are typically more difficult to manage than those in detoxification units or wards as they require massive doses of benzodiazepines or other drugs for treatment of alcohol withdrawal.…”

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confidence: 99%

A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*

Gold

Rimal

Nolan

et al. 2007

Critical Care Medicine

158

164

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Objective-Patients with severe alcohol withdrawal and delirium tremens are frequently resistant to standard doses of benzodiazepines. Case reports suggest that these patients have a high incidence of requiring intensive care and many require mechanical ventilation. However, few data exist on treatment strategies and outcomes for these subjects in the medical intensive care unit (ICU). Our goal was a) to describe the outcomes of patients admitted to the medical ICU solely for treatment of severe alcohol withdrawal and b) to determine whether a strategy of escalating doses of benzodiazepines in combination with phenobarbital would improve outcomes. Design-Retrospective cohort study.Setting-Inner-city municipal hospital.Patients-Subjects admitted to the medical ICU solely for the treatment of severe alcohol withdrawal. Interventions-Institution of guidelines emphasizing escalating doses of diazepam in combination with phenobarbital.Measurements and Main Results-Preguideline (n = 54) all subjects were treated with intermittent boluses of diazepam with an average total and maximal individual dose of 248 mg and 32 mg, respectively; 17% were treated with phenobarbital. Forty-seven percent required intubation due to inability to achieve adequate sedation and need for constant infusion of sedative-hypnotics. Intubated subjects had longer length of stay (5.6 vs. 3.4 days; p = .09) and higher incidence of nosocomial pneumonia (42 vs. 21% p = .08). Postguideline (n = 41) there were increases in maximum individual dose of diazepam (32 vs. 86 mg; p = .001), total amount of diazepam (248 vs. 562 mg; p = .001), and phenobarbital use (17 vs. 58%; p = .01). This was associated with a reduction in the need for mechanical ventilation (47 vs. 22%; p = .008), with trends toward reductions in ICU length of stay and nosocomial pneumonia.Conclusions-Patients admitted to a medical ICU solely for treatment of severe alcohol withdrawal have a high incidence of requiring mechanical ventilation. Guidelines emphasizing escalating bolus doses of diazepam, and barbiturates if necessary, significantly reduced the need for mechanical ventilation and showed trends toward reductions in ICU length of stay and nosocomial infections.

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Alcohol-Related Admissions to an Inner City Hospital Intensive Care Unit

Cited by 57 publications

References 7 publications

Depression, Anxiety and Alcohol Abuse in a Gastroenterology Intensive Care Unit: Prevalence and Detection

Depression, Anxiety and Alcohol Abuse in a Gastroenterology Intensive Care Unit: Prevalence and Detection

A national service evaluation of the impact of alcohol on admissions to Scottish intensive care units*

A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*

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