Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract

Spies, Claudia; Nordmann, Alain; Brummer, G.; Marks, Christian; Conrad, Christian; Berger, G.; Runkel, N.; Neumann, Tim; Müller, Christian; Rommelspacher, Hans; Specht, M.; Hannemann, L.; Striebel, H. W.; Schaffartzik, Walter

doi:10.1111/j.1399-6576.1996.tb04505.x

Cited by 161 publications

(98 citation statements)

References 28 publications

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“…In one study, five of six subjects with benzodiazepine resistance, as defined previously, required intubation (9). Once patients are admitted to the ICU, numerous studies document the course and treatment of surgical patients who develop AWS postoperatively and/or posttrauma (3,13,14). In these subjects, symptom-triggered therapy results in lower rates of complications and improved outcomes, although nearly 65% required reinstitution of mechanical ventilation (14).…”

mentioning

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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mentioning

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

View full text Add to dashboard Cite

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“…German and Danish studies have typically conducted detailed assessments of patients' drinking to identify those who drank over 60 grams of alcohol daily [4-7, 11-13, 51, 52], or those who drank over 60 grams of alcohol daily and screened positive on standardized screening questionnaires such as the MAST [53] or CAGE [15,16,54,55]. A large Spanish study of hospital-acquired infections used a structured questionnaire to assess alcohol consumption above 72 grams per day [56] and a recent German study showed that the 10-item AUDIT identified a much higher prevalence of alcohol misuse than anesthesiologists who usually asked nonstandard questions about alcohol consumption [57].…”

Section: Discussionmentioning

confidence: 99%

Alcohol Misuse Prevalence and Associations with Post-Operative Complications in US Surgical Patients: A Review

Harris¹,

Frey²,

DeBenedetti³

et al. 2009

TOSJ

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Abstract:We conducted a standardized review of research on the prevalence of alcohol use or misuse (including alcohol use disorders), and the association of alcohol use or misuse with post-operative surgical complications among US patients. Twenty seven studies that included a preoperative measure of alcohol use or misuse and included at least 50 US surgical patients were identified using a standardized search strategy (1950( -April 2007. Twenty-two of the studies reported prevalence of alcohol use or misuse, which was highest in major otolaryngology surgeries (mostly for cancer and injuries: 22-88.5%) and thoracic surgery (lung transplant and cancer resections: 29-33%) and ranged from 8-28% in the remaining studies. Nineteen studies examined the association between pre-operative alcohol consumption and post-operative complications suggesting positive associations between alcohol use or misuse and risk for post-operative delirium, pneumonia, cognitive decline, overall complications, and death. Most identified studies had methodological limitations, especially the widespread use of drinking assessment methods that cannot distinguish alcohol use from misuse.

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“…6 Spies et al have reported a 16 % incidence of AWS after surgery while there was 31% incidence in post-trauma patients. 7 Imdahl et al have shown that in 70% of 672 surgical patient's prophylactic treatment was administered based mostly on a combination of benzodiazepines chlormethimazole, haloperidol, clonidine or ethanol. 6 Benzodiazepines including lorazepam, diazepam and midazolam are the most commonly used and recommended agents for AWS.…”

Section: Disscusionmentioning

confidence: 99%

Add on dexmedetomidine in the treatment of severe alcohol withdrawal in a patient of emergency laparotomy

Shende¹,

Ambare²,

Bachewar³

et al. 2015

Int J Res Med Sci

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Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract

Cited by 161 publications

References 28 publications

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

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

Alcohol Misuse Prevalence and Associations with Post-Operative Complications in US Surgical Patients: A Review

Add on dexmedetomidine in the treatment of severe alcohol withdrawal in a patient of emergency laparotomy

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