More than 300,000 patients receive mechanical ventilation during intensive care per year in the United States, even though the hospital mortality rate for ventilated patients can approach 50 percent. New findings indicate that medical patients with an alcohol-use disorder (AUD) are more likely to require mechanical ventilation, and/or need it for a longer period of time.
"Mechanical ventilation is associated with a high economic burden, costing a median $32,000 to $56,000 per patient, with younger patients having higher expenses compared to older patients," said Marjolein de Wit, assistant professor of medicine at Virginia Commonwealth University, and corresponding author for the study.
She added that the majority of medical patients with a critical illness have multiple comorbidities such as diabetes, renal failure, heart failure, cirrhosis of the liver, and chronic obstructive lung disease. These comorbidities make it more difficult to recover from critical illness. Furthermore, said de Wit, certain critical illnesses such as acute respiratory distress syndrome carry a high mortality largely because of limited treatment availability.
In addition, noted de Wit, AUDs are very common in patients who require admission to the intensive-care unit. "The rates of AUD are region dependent and thus vary from hospital to hospital," she said. "At my institution, we estimate that more than 40 percent of our medical intensive-care unit patients have AUDs. Other researchers have reported a rate of more than 30 percent in their medical intensive-care unit."
De Wit and her colleagues examined data from the Nationwide Inpatient Sample, a large, all-payer inpatient database representing approximately 1,000 hospitals. For this particular study, researchers analyzed all adult patients with one of the six most common diagnoses associated with admission to the intensive-care unit -- pneumonia, sepsis (severe infections), gastrointestinal hemorrhage, asthma, COPD, and respiratory failure -- for the years 2002 to 2003.
"Medical patients who have an AUD are more likely to develop a critical illness resulting in the need for lifesaving mechanical ventilation," said de Wit. More specifically, of the 785,602 patients who were diagnosed with one of the six medical diagnoses examined, 65,071 (8.3%) required mechanical ventilation. Those with an AUD (26,577) appeared to have an increased risk of requiring mechanical ventilation, while those who developed alcohol withdrawal (3,967) appeared to need mechanical ventilation for a longer duration.
"Whereas other studies have focused on single-disease entities such as pneumonia, sepsis, and acute respiratory distress syndrome," said de Wit, "this study supports and extends previous findings to a heterogeneous group of medical illnesses. So, excessive alcohol consumption not only causes serious adverse events such as alcohol intoxication and accidents, but also increases the chances of developing life-threatening medical illnesses such as pneumonia, asthma, chronic obstructive lung disease, infections and respiratory failure."
De Wit recommended that clinicians screen all medical intensive-care patients for the presence of AUDs. "Being mindful that patients with AUDs may develop complications -- such as alcohol withdrawal, ventilator-associated pneumonia, and possibly acute respiratory distress syndrome -- may help to identify when preventative measures are necessary." Likewise, she added, "patients should inform their healthcare providers about their alcohol consumption or if they have developed symptoms of alcohol withdrawal or delirium tremens. This can help healthcare providers tailor patient care more appropriately."
Results are published in the July issue of Alcoholism: Clinical & Experimental Research.
Co-authors of the ACER paper, "Alcohol Use Disorders Increase the Risk for Mechanical Ventilation in Medical Patients," were: Al M. Best and Chris Gennings of the Department of Biostatistics at Virginia Commonwealth University in Richmond, Virginia; and Ellen L. Burnham and Marc Moss of the Division of Pulmonary Sciences and Critical Care Medicine at the University of Colorado at Denver, and the Health Sciences Center of Denver. The study was funded by the National Institutes of Health.
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