Prevalence and impact of alcohol and other drug use disorders on sedation and mechanical ventilation: A retrospective study

被引：39

作者：

de Wit M. ^{[1
,2
]}

Wan S.Y. ^{[3
]}

Gill S. ^{[1
]}

Jenvey W.I. ^{[1
,2
]}

Best A.M. ^{[4
]}

Tomlinson J. ^{[5
]}

Weaver M.F. ^{[1
,5
]}

机构：

[1] Virginia Commonwealth University, Department of Internal Medicine, Richmond, VA

[2] Virginia Commonwealth University, Division of Pulmonary and Critical Care Medicine, Richmond, VA

[3] University of Miami, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Miami, FL

[4] Virginia Commonwealth University, Department of Biostatistics, Richmond, VA

[5] Virginia Commonwealth University, Department of Psychiatry, Division of Addiction Psychiatry, Richmond, VA

来源：

BMC Anesthesiology | / 7卷 / 1期

关键词：

Cocaine; Mechanical Ventilation; Heroin; Sequential Organ Failure Assessment; Alcohol Withdrawal Syndrome;

D O I：

10.1186/1471-2253-7-3

中图分类号：

学科分类号：

摘要：

Background: 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. We sought to determine the impact of AOD on sedation requirement and mechanical ventilation (MV) duration. Methods: Retrospective review of randomly selected records ofadult 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. Results: Of 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. Conclusion: The 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. © 2007 de Wit et al; licensee BioMed Central Ltd.

引用

共 31 条

[1]

Arroliga A., Frutos-Vivar F., Hall J., Esteban A., Apezteguia C., Soto L., Anzueto A., Use of sedatives and neuromuscular blockers in a cohort of patients receiving mechanical ventilation, Chest, 128, pp. 496-506, (2005)

[2]

Woods J.C., Mion L.C., Connor J.T., Viray F., Jahan L., Huber C., McHugh R., Gonzales J.P., Stoller J.K., Arroliga A.C., Severe agitation among ventilated medical intensive care unit patients: Frequency, characteristics and outcomes, Intensive Care Med, 30, pp. 1066-1072, (2004)

[3]

Kollef M.H., Levy N.T., Ahrens T.S., Schaiff R., Prentice D., Sherman G., The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation, Chest, 114, pp. 541-548, (1998)

[4]

Kress J.P., Pohlman A.S., O'Connor M.F., Hall J.B., Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation, N Engl J Med, 342, pp. 1471-1477, (2000)

[5]

Brook A.D., Ahrens T.S., Schaiff R., Prentice D., Sherman G., Shannon W., Kollef M.H., Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation, Crit Care Med, 27, pp. 2609-2615, (1999)

[6]

De Jonghe B., Bastuji-Garin S., Fangio P., Lacherade J.C., Jabot J., Appere-De-Vecchi C., Rocha N., Outin H., Sedation algorithm in critically ill patients without acute brain injury, Crit Care Med, 33, pp. 120-127, (2005)

[7]

MacLaren R., Plamondon J.M., Ramsay K.B., Rocker G.M., Patrick W.D., Hall R.I., A prospective evaluation of empiric versus protocol-based sedation and analgesia, Pharmacotherapy, 20, pp. 662-672, (2000)

[8]

Results from the 2004 National Survey on Drug Use and Health: National Findings, (2005)

[9]

Baldwin W.A., Rosenfeld B.A., Breslow M.J., Buchman T.G., Deutschman C.S., Moore R.D., Substance abuse-related admissions to adult intensive care, Chest, 103, pp. 21-25, (1993)

[10]

Moss M., Parsons P.E., Steinberg K.P., Hudson L.D., Guidot D.M., Burnham E.L., Eaton S., Cotsonis G.A., Chronic alcohol abuse is associated with an increased incidence of acute respiratory distress syndrome and severity of multiple organ dysfunction in patients with septic shock, Crit Care Med, 31, pp. 869-877, (2003)

← 1 2 3 4 →