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Nissilä E, Hynninen M, Reinikainen M, Bendel S, Suojaranta R, Korhonen A, Suvela M, Loisa P, Kaminski T, Hästbacka J. Prevalence and impact of hazardous alcohol use in intensive care cohort: A multicenter, register-based study. Acta Anaesthesiol Scand 2021; 65:1073-1078. [PMID: 33840090 DOI: 10.1111/aas.13828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/12/2021] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reports of the prevalence and impact of hazardous alcohol use among intensive care unit (ICU) patients are contradictory. We aimed to study the prevalence of hazardous alcohol use among ICU patients and its association with ICU length of stay (LOS) and mortality. METHODS Finnish ICUs have been using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) to evaluate and record patients' alcohol use into the Finnish Intensive Care Consortium's Database (FICC). We retrieved data from the FICC from a 3-month period. We excluded data from centers with an AUDIT-C recording rate of less than 70% of admissions. We defined hazardous alcohol use as a score of 5 or more for women and 6 or more for men from a maximum score of 12 points. RESULTS Two thousand forty-five patients were treated in the 10 centers with an AUDIT-C recording rate of 70% or higher. AUDIT-C was available for 1576 (77%) patients and indicated hazardous alcohol use for 334 (21%) patients who were more often younger (median age 55 [interquartile range 42-65] vs 67 [57-74] [P < .001]) and male (78.1% vs 61.3% [P < .001]) compared to other patients. We found no difference in LOS or hospital mortality between hazardous and non-hazardous alcohol users. Among the non-abstinent, risk of death within a year increased with increasing AUDIT-C scores adjusted odds ratio 1.077 (95% confidence interval, 1.006-1.152) per point. CONCLUSION The prevalence of hazardous alcohol use in Finnish ICUs was 21%. Patients with hazardous alcohol use were more often younger and male compared with non-hazardous alcohol users.
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Affiliation(s)
- Eliisa Nissilä
- Department of Anaesthesiology, Intensive Care and Pain Medicine Intensive Care Units University of HelsinkiHelsinki University Hospital Helsinki Finland
| | - Marja Hynninen
- Department of Anaesthesiology, Intensive Care and Pain Medicine Intensive Care Units University of HelsinkiHelsinki University Hospital Helsinki Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care Kuopio University HospitalUniversity of Eastern Finland Kuopio Finland
| | - Stepani Bendel
- Department of Anaesthesiology and Intensive Care Kuopio University HospitalUniversity of Eastern Finland Kuopio Finland
| | - Raili Suojaranta
- Department of Cardiac Surgery, Heart and Lung Center University of HelsinkiHelsinki University Hospital Helsinki University Hospital Helsinki Finland
| | - Anna‐Maija Korhonen
- Department of Anaesthesiology, Intensive Care and Pain Medicine Intensive Care Units University of HelsinkiHelsinki University Hospital Helsinki Finland
| | - Markku Suvela
- Intensive Care Unit North Karelia Central Hospital Joensuu Finland
| | - Pekka Loisa
- Intensive Care Unit Päijät‐Häme Central Hospital Lahti Finland
| | - Tadeusz Kaminski
- Intensive Care Unit Central Ostrobothnia Central Hospital Kokkola Finland
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine Intensive Care Units University of HelsinkiHelsinki University Hospital Helsinki Finland
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Tollisen KH, Hadley CL, Bjerva M, Dahl GT, Högvall LM, Sandvik L, Andersen GØ, Heyerdahl F, Jacobsen D. Clinical impact of chronic substance abuse in a Norwegian ICU-population. Acta Anaesthesiol Scand 2021; 65:515-524. [PMID: 33340102 DOI: 10.1111/aas.13766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/18/2020] [Accepted: 12/05/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The clinical impact of chronic substance abuse of alcohol and drugs-referred to as substance use disorders (SUD)-is often overlooked in the intensive care (ICU) setting. The aims of the present study were to identify patients with SUD-regardless of cause of admission-in a mixed Norwegian ICU-population, and to compare patients with and without SUD with regard to clinical characteristics and mortality. METHODS Cross-sectional prospective study of a mixed medical and surgical ICU-population aged ≥18 years in Oslo, Norway. Data were collected consecutively, using a questionnaire including the AUDIT-C test, medical records and toxicology results. Patients classified with SUD were divided into the subgroups alcohol use disorders (AUD) and drug use disorders (DUD). RESULTS Overall, 222 (26%) of the 861 patients included were classified with SUD; 137 (16%) with AUD and 85 (10%) with DUD. 130/222 (59%) of the SUD-patients had substance abuse-related cause of ICU-admission. Compared to non-SUD patients, DUD-patients were younger (median age 42 vs 65 years) and had lower SAPS II scores (41 vs 46), while AUD-patients had higher SOFA scores (8.0 vs 7.3). Overall, age-adjusted logistic regression analysis showed similar hospital mortality for SUD-patients and non-SUD patients, but AUD was associated with increased mortality among medical patients and in patients with sepsis (OR 1.7 (95% CI 1.0-2.8), and OR 2.6 (95% CI 1.1-6.2)). CONCLUSION One in four ICU-patients had SUD regardless of cause of admission. Alcohol use disorder was associated with increased mortality in medical patients and in patients with sepsis.
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Affiliation(s)
- K H Tollisen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - C L Hadley
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - M Bjerva
- Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - G T Dahl
- Department of Anesthesiology, Diakonhjemmet Hospital, Oslo, Norway
| | - L M Högvall
- Department of Postoperative and Intensive care, Oslo University Hospital, Oslo, Norway
| | - L Sandvik
- Department of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - G Ø Andersen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - F Heyerdahl
- Division of Prehospital Services, Oslo University Hospital, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - D Jacobsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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Uljas E, Jalkanen V, Kuitunen A, Hynninen M, Hästbacka J. Prevalence of risk-drinking in critically ill patients, screened with carbohydrate-deficient transferrin and AUDIT-C score: A retrospective study. Acta Anaesthesiol Scand 2020; 64:216-223. [PMID: 31541613 DOI: 10.1111/aas.13484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/19/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022]
Abstract
Background Studies demonstrate that up to one-third of intensive care unit (ICU) admissions are directly or indirectly related to alcohol. Screening for alcohol use is not routine. This study examined the prevalence of elevated %CDT (carbohydrate-deficient transferrin) and above risk-level AUDIT-C (Alcohol Use Disorders Identification Test, Consumption) in patients admitted to ICU. Methods We conducted a retrospective analysis of clinical and laboratory data from a single ICU where %CDT and AUDIT-C were included in routine assessment. After excluding readmissions, 2532 adult patients from a 21-month period were included. Admission values of %CDT were available for 2049 patients, and AUDIT-C was available for 1617 patients. The association of %CDT and AUDIT-C with short- and long-term outcome was studied by using univariate and multivariate logistic regression analysis. Results %CDT was above the reference value in 23.7% (486/2048) of patients with available %CDT. Of patients with available AUDIT-C, 33% (544/1617) had a risk-level AUDIT-C score. Patients with a risk-level AUDIT-C score were significantly younger than those with a lower score (51 vs 64 years, P < .0001). Increased %CDT was associated with higher severity of illness. AUDIT-C was associated independently with increased risk of long-term mortality in multivariate analysis (P = .007). Conclusion One in three of ICU patients are risk-level alcohol users as measured with AUDIT-C score, and one in four are analysed with %CDT. The prevalence varies according to the method used and any method alone may be insufficient to detect risk-level consumption reliably. Editorial Comment Alcohol overconsumption is associated with need for ICU admission and with less favorable outcomes. Diagnosis of alcohol overconsumption though is problematic due to low sensitivity in screening. In a pilot study, a biomarker and a screening tool are compared. The finding is that multiple tools are needed to achieve an adequate sensitivity for detection.
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Affiliation(s)
- Eliisa Uljas
- Division of Intensive Care Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Ville Jalkanen
- Department of Intensive Care University of Tampere Tampere University Hospital Tampere Finland
| | - Anne Kuitunen
- Department of Intensive Care University of Tampere Tampere University Hospital Tampere Finland
| | - Marja Hynninen
- Division of Intensive Care Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Johanna Hästbacka
- Division of Intensive Care Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
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Secombe PJ, Stewart PC. The impact of alcohol-related admissions on resource use in critically ill patients from 2009 to 2015: an observational study. Anaesth Intensive Care 2018; 46:58-66. [PMID: 29361257 DOI: 10.1177/0310057x1804600109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Excessive alcohol use is associated with increased health care utilisation and increased mortality. This observational study sought to identify the proportion of patients admitted with a critical illness in which alcohol misuse contributed, and to examine the resource use for this group. We performed an observational retrospective database review of all admissions to the Alice Springs Hospital intensive care unit (ICU) between 1 January 2009 and 31 December 2015. The Alice Springs Hospital ICU is a ten-bed unit located in Central Australia, with approximately 600 admissions annually. The per capita consumption of alcohol in Central Australia is approximately 1.5 times the national average. The primary aim was to determine the proportion of admissions to intensive care in which alcohol misuse was identified as a contributing cause. Secondary aims examined resource utilisation including ICU and hospital length of stay, need for and duration of mechanical ventilation, and ICU re-admission. There were 3,768 admissions involving 2,670 individual patients. Of these admissions 947 (25%) were associated with alcohol misuse. Admissions associated with alcohol were significantly more likely to require mechanical ventilation (30% versus 20%, <i>P</i> <0.01), and had a significantly longer ICU length of stay (2.1 versus 1.9 days, <i>P</i> <0.05). The proportion of admissions in which alcohol misuse was implicated is amongst the highest in the published literature. The results of this study should drive further policy change directed at harm minimisation, and warrant more detailed epidemiological work at both a local and national level.
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Affiliation(s)
- P J Secombe
- Lecturer, School of Medicine, Flinders University, Adelaide, South Australia
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Rastegar DA, Applewhite D, Alvanzo AAH, Welsh C, Niessen T, Chen ES. Development and implementation of an alcohol withdrawal protocol using a 5-item scale, the Brief Alcohol Withdrawal Scale (BAWS). Subst Abus 2017; 38:394-400. [PMID: 28699845 DOI: 10.1080/08897077.2017.1354119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The standard of care for management of alcohol withdrawal is symptom-triggered treatment using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). Many items of this 10-question scale rely on subjective assessments of withdrawal symptoms, making it time-consuming and cumbersome to use. Therefore, there is interest in shorter and more objective methods to assess alcohol withdrawal symptoms. METHODS A 6-item withdrawal scale developed at another institution was piloted. Based on comparison with the CIWA-Ar, this was adapted into a 5-item scale named the Brief Alcohol Withdrawal Scale (BAWS). The BAWS was compared with the CIWA-Ar and a withdrawal protocol utilizing the BAWS was developed. The new protocol was implemented on an inpatient unit dedicated to treating substance withdrawal. Data was collected on the first 3 months of implementation and compared with the 3 months prior to that. RESULTS A BAWS score of 3 or more predicted CIWA-Ar score ≥8 with a sensitivity of 85.3% and specificity of 65.8%. The demographics of the patients in the 2 time periods were similar: the mean age was 45.9; 70.6% were male; 30.9% received concurrent treatment for opioid withdrawal; and 14.2% were receiving methadone maintenance. During the BAWS phase, patients received significantly less diazepam (mean dose 81.4 vs. 60.3 mg, P < .001). There was no significant difference in length of stay. No patients experienced a seizure, delirium, or required transfer to a higher level of care during any of the 664 admissions in either phase. CONCLUSIONS This simple protocol utilizing a 5-item withdrawal scale performed well in this setting. Its use in other settings, particularly with patients with concurrent medical illnesses or more severe withdrawal, needs to be explored further.
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Affiliation(s)
- Darius A Rastegar
- a Center for Chemical Dependence , Johns Hopkins Bayview Medical Center , Baltimore , Maryland , USA
| | - Dinah Applewhite
- b Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Anika A H Alvanzo
- c Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Christopher Welsh
- d Department of Psychiatry , University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - Timothy Niessen
- c Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Edward S Chen
- e Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
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Sutton LJ, Jutel A. Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management. Crit Care Nurse 2017; 36:28-38. [PMID: 26830178 DOI: 10.4037/ccn2016420] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Management of alcohol withdrawal in critically ill patients is a challenge. The alcohol consumption histories of intensive care patients are often incomplete, limiting identification of patients with alcohol use disorders. Abrupt cessation of alcohol places these patients at risk for alcohol withdrawal syndrome. Typically benzodiazepines are used as first-line therapy to manage alcohol withdrawal. However, if patients progress to more severe withdrawal or delirium tremens, extra adjunctive medications in addition to benzodiazepines may be required. Sedation and mechanical ventilation may also be necessary. Withdrawal assessment scales such as the Clinical Institute of Withdrawal Assessment are of limited use in these patients. Instead, general sedation-agitation scales and delirium detection tools have been used. The important facets of care are the rapid identification of at-risk patients through histories of alcohol consumption, management with combination therapies, and ongoing diligent assessment and evaluation. (Critical Care Nurse. 2016;36[1]:28-39).
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Affiliation(s)
- Lynsey J Sutton
- Lynsey Sutton is an associate charge nurse manager of a level 3 intensive care unit, Capital and Coast District Health Board, Wellington Regional Hospital, Riddiford, Wellington, New Zealand. She is a guest teaching assistant in the postgraduate nursing program at Victoria University of Wellington, New Zealand.Annemarie Jutel works at Victoria University of Wellington. She is also a locum emergency nurse in Central Otago, New Zealand.
| | - Annemarie Jutel
- Lynsey Sutton is an associate charge nurse manager of a level 3 intensive care unit, Capital and Coast District Health Board, Wellington Regional Hospital, Riddiford, Wellington, New Zealand. She is a guest teaching assistant in the postgraduate nursing program at Victoria University of Wellington, New Zealand.Annemarie Jutel works at Victoria University of Wellington. She is also a locum emergency nurse in Central Otago, New Zealand
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Ycaza-Gutierrez MC, Wilson L, Altman M. Bedside Nurse-Driven Protocol for Management of Alcohol/Polysubstance Abuse Withdrawal. Crit Care Nurse 2017; 35:73-6. [PMID: 26628550 DOI: 10.4037/ccn2015194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Maria Christina Ycaza-Gutierrez
- Maria Christina Ycaza-Gutierrez and Laurie Wilson are charge nurses in the medical intensive care unit at Maimonides Medical Center, New York, New York
| | - Laurie Wilson
- Maria Christina Ycaza-Gutierrez and Laurie Wilson are charge nurses in the medical intensive care unit at Maimonides Medical Center, New York, New York
| | - Marian Altman
- Marian Altman is a clinical practice specialist, American Association of Critical- Care Nurses, Aliso Viejo, California.
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McPeake J, Forrest E, Quasim T, Kinsella J, O'Neill A. Health and social consequences of an alcohol-related admission to critical care: a qualitative study. BMJ Open 2016; 6:e009944. [PMID: 27048633 PMCID: PMC4823434 DOI: 10.1136/bmjopen-2015-009944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital environment. DESIGN In-depth, semistructured interviews with participants (patients) 3-7 months post intensive care discharge. SETTING The setting for this study was a 20-bedded mixed intensive care unit (ICU), in a large teaching hospital in Scotland. On admission, patients were allocated to one of the three alcohol groups: low risk, harmful/hazardous and alcohol dependency. PARTICIPANTS 21 participants who received mechanical ventilation for greater than 3 days were interviewed between March 2013 and June 2014. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience, support for activities of daily living, social support and cohesion and the impact of alcohol use disorders on recovery. Participants also discussed the importance of personalised goal setting and appropriate and timely rehabilitation for alcohol-related behaviours during the critical care recovery period. CONCLUSIONS There is a significant interplay between alcohol misuse and recovery from critical illness. This study has demonstrated that at present, there is a haphazard approach to rehabilitation for patients after ICU. A more targeted rehabilitation pathway for patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, requires to be generated.
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Affiliation(s)
- Joanne McPeake
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, School of Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Tara Quasim
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, School of Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - John Kinsella
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, School of Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Anna O'Neill
- University of Glasgow, School of Medicine, Glasgow Royal Infirmary, Glasgow, UK
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Mehta AJ. Alcoholism and critical illness: A review. World J Crit Care Med 2016; 5:27-35. [PMID: 26855891 PMCID: PMC4733453 DOI: 10.5492/wjccm.v5.i1.27] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/07/2015] [Accepted: 12/04/2015] [Indexed: 02/06/2023] Open
Abstract
Alcohol is the most commonly used and abused drug in the world, and alcohol use disorders pose a tremendous burden to healthcare systems around the world. The lifetime prevalence of alcohol abuse in the United States is estimated to be around 18%, and the economic consequences of these disorders are staggering. Studies on hospitalized patients demonstrate that about one in four patients admitted to critical care units will have alcohol-related issues, and unhealthy alcohol consumption is responsible for numerous clinical problems encountered in intensive care unit (ICU) settings. Patients with alcohol use disorders are not only predisposed to developing withdrawal syndromes and other conditions that often require intensive care, they also experience a considerably higher rate of complications, longer ICU and hospital length of stay, greater resource utilization, and significantly increased mortality compared to similar critically ill patients who do not abuse alcohol. Specific disorders seen in the critical care setting that are impacted by alcohol abuse include delirium, pneumonia, acute respiratory distress syndrome, sepsis, gastrointestinal hemorrhage, trauma, and burn injuries. Despite the substantial burden of alcohol-induced disease in these settings, critical care providers often fail to identify individuals with alcohol use disorders, which can have significant implications for this vulnerable population and delay important clinical interventions.
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McPeake JM, Shaw M, O'Neill A, Forrest E, Puxty A, Quasim T, Kinsella J. Do alcohol use disorders impact on long term outcomes from intensive care? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:185. [PMID: 25899245 PMCID: PMC4440292 DOI: 10.1186/s13054-015-0909-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/02/2015] [Indexed: 12/31/2022]
Abstract
Introduction There is limited evidence regarding the impact of alcohol use disorders on long term outcomes from intensive care. The aims of this study were to analyse the nature and complications of alcohol related admissions to intensive care and determine whether alcohol use disorders impact on survival at six months post ICU discharge. Method This was an 18 month prospective observational cohort study in a 20 bedded mixed ICU, in a large teaching hospital in Scotland. On admission patients were allocated to one of three alcohol groups: low risk, harmful/hazardous, or alcohol dependency. Results 34.4% of patients were admitted with an alcohol use disorder. Those with an alcohol related admission (either harmful/hazardous or alcohol dependent) had an increased odds of developing septic shock during their admission, compared with the low risk group (OR 1.67; 95% CI 1.13-2.47, p = 0.01). After adjustment for all lifestyle factors which were significantly different between the groups, alcohol dependence was associated with more than a twofold increased odds of ICU mortality (OR 2.28; 95% CI 1.2-4.69, p = 0.01) and hospital mortality (OR 2.43; 95% CI 1.28-4.621, p = 0.004). After adjustment for deprivation category and age, alcohol dependence was associated with an almost two fold increased odds of mortality at six months post ICU discharge (HR 1.86; CI 1.30-2.70, p = 0.001). Conclusion Alcohol use disorders are a significant risk factor for the development of septic shock in intensive care. Further, alcohol dependency is independently associated with poorer long term outcomes from intensive care. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-0909-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joanne M McPeake
- University of Glasgow, School of Medicine, Glasgow Royal Infirmary, New Lister Building, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK.
| | - Martin Shaw
- Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK.
| | - Anna O'Neill
- University of Glasgow, School of Medicine, Glasgow Royal Infirmary, New Lister Building, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK. anna.o'
| | - Ewan Forrest
- Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK.
| | - Alex Puxty
- Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK.
| | - Tara Quasim
- University of Glasgow, School of Medicine, Glasgow Royal Infirmary, New Lister Building, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK.
| | - John Kinsella
- University of Glasgow, School of Medicine, Glasgow Royal Infirmary, New Lister Building, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK.
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Abstract
It is widely argued in policy circles and academic research that the health and social care needs of people with multiple and complex needs are greatly enhanced through a shared commitment to inter-professional practice and transformational learning. We take this assumption to task by examining a ‘community of practice’ (a working group for high-impact users facilitated by a large inner-city GP surgery), which brings together frontline practitioners and statutory commissioners working at the interface between homelessness, health and substance use. We then go on to identify four areas: (1) knowledge exchange and critical reflection; (2) networks of intervention; (3) inequality in relations and resources and (4) competition and congruence – that demand critical attention if we are to understand more fully the potential role of ‘communities of practice’ in acting as bridgeheads to health and social care integration.
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Affiliation(s)
- Martin Whiteford
- Research Associate, Health Services Research, University of Liverpool, UK
| | - Paula Byrne
- Lecturer, Health Services Research, University of Liverpool, UK
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Albarran J, Scholes J. What's in this issue? Nurs Crit Care 2014; 18:161-3. [PMID: 23782108 DOI: 10.1111/nicc.12036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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