Alcohol use disorders increase the risk for mechanical ventilation in medical patients.
BACKGROUND
Annually, more than 300,000 patients receive mechanical ventilation in an intensive care unit in the United States. The hospital mortality for ventilated patients may approach 50%, depending on the primary diagnosis. In trauma and surgical patients, a diagnosis of alcohol use disorder (AUD) is common and is associated with a prolonged duration of mechanical ventilation. The objective of this study is to determine whether the presence of AUD and the development of alcohol withdrawal are associated with an increased use and duration of mechanical ventilation in patients with medical disorders that commonly require intensive care unit admission.


METHODS
We performed a retrospective cohort study using the Nationwide Inpatient Sample, a large all-payer inpatient database representing approximately 1,000 hospitals. For the years 2002 to 2003, adult patients with 1 of the 6 most common diagnoses associated with medical intensive care unit admission were included in the study. Both univariate analysis and multivariable logistic regression were performed to determine whether AUD and alcohol withdrawal were independently associated with the use and duration of mechanical ventilation in these patients.


RESULTS
There were a total 785,602 patients who fulfilled 1 of the 6 diagnoses, 26,577 (3.4%) had AUD, 3,967 (0.5%) had alcohol withdrawal, and 65,071 (8.3%) underwent mechanical ventilation (53% <96 hours, 47%> or =96 hours). Independent of the medical diagnosis, AUD was associated with an increased risk of requiring mechanical ventilation (13.7 vs 8.1%, odds ratio=1.49, 95% confidence interval [1.414; 1.574], p<0.0001) but was not associated with a prolonged duration of mechanical ventilation. However, the presence of alcohol withdrawal was associated with a longer duration of mechanical ventilation (57 vs 47%> or =96 hours, odds ratio=1.48, 95% confidence interval [1.266; 1.724], p<0.0001).


CONCLUSIONS
In patients with medical diagnoses associated with intensive care unit admission, AUD increases the risk for mechanical ventilation while the development of alcohol withdrawal is associated with a longer duration of mechanical ventilation.
de Wit
Marjolein
M
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA 23298-0050, USA. mdewit@vcu.edu
Best
Al M
AM
Gennings
Chris
C
Burnham
Ellen L
EL
Moss
Marc
M
D000367:Age Factors; D000368:Aged; D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D000437:Alcoholism / Q000453:epidemiology; D015897:Comorbidity; D016638:Critical Illness / Q000453:epidemiology; D019992:Databases as Topic / Q000706:statistics & numerical data; D000431:Ethanol / Q000009:adverse effects; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology; D014481:United States
D000431:Ethanol