Abstract
BackgroundExperience suggests that patients with alcohol and other drug use disorders (AOD) are commonly cared for in our intensive care units (ICU's) and require more sedation. We sought to determine the impact of AOD on sedation requirement and mechanical ventilation (MV) duration.MethodsRetrospective review of randomly selected records of adult patients undergoing MV in the medical ICU. Diagnoses of AOD were identified using strict criteria in Diagnostic and Statistical Manual of Mental Disorders, and through review of medical records and toxicology results.ResultsOf the 70 MV patients reviewed, 27 had AOD (39%). Implicated substances were alcohol in 22 patients, cocaine in 5, heroin in 2, opioids in 2, marijuana in 2. There was no difference between AOD and non-AOD patients in age, race, or reason for MV, but patients with AOD were more likely to be male (21 versus 15, p < 0.0001) and had a lower mean Acute Physiology and Chronic Health Evaluation II (22 versus 26, p = 0.048). While AOD patients received more lorazepam equivalents (0.5 versus 0.2 mg/kg.day, p = 0.004), morphine equivalents (0.5 versus 0.1 mg/kg.day, p = 0.03) and longer duration of infusions (16 versus 10 hours/day. medication, p = 0.002), they had similar sedation levels (Richmond Agitation-Sedation Scale (RASS) -2 versus -2, p = 0.83), incidence of agitation (RASS ≥ 3: 3.0% versus 2.4% of observations, p = 0.33), and duration of MV (3.6 versus 3.9 days, p = 0.89) as those without AOD.ConclusionThe prevalence of AOD among medical ICU patients undergoing MV is high. Patients with AOD receive higher doses of sedation than their non-AOD counterparts to achieve similar RASS scores but do not undergo longer duration of MV.
Highlights
Experience suggests that patients with alcohol and other drug use disorders (AOD) are commonly cared for in our intensive care units (ICU's) and require more sedation
Unlike patients without AOD, evidence suggests that patients with AOD on mechanical ventilation (MV) may develop withdrawal syndromes if undersedated or with early withdrawal of sedation, and sedative agents have been found to reduce the duration of alcohol withdrawal delirium [12,13]
Three hundred fifty-three patients requiring MV were admitted to the medical ICU between October 2002 and June 2003
Summary
Experience suggests that patients with alcohol and other drug use disorders (AOD) are commonly cared for in our intensive care units (ICU's) and require more sedation. Sedative and opioid agents are routinely administered to critically ill patients to treat agitation and facilitate mechanical ventilation (MV) [1]. Appropriate use of these agents is important as severe agitation is associated with prolonged MV and increased risk of self-extubation [2]. Alcohol and other drug use disorders (AOD) affect 9.4% of the American population, and prevalence of these disorders in intensive care units (ICU's) ranges from 5 to 30% [8,9,10,11]. The sedative requirements of patients with AOD have not been studied extensively
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