title: Drug withdrawal, cocaine and sedative use disorders increase the need for mechanical ventilation in medical patients.
abstract: OBJECTIVE
  Alcohol use disorders increase the need for mechanical ventilation (MV) in critically ill medical, surgical and trauma patients. Studies examining other drug use disorders (DUD) in trauma patients have not demonstrated heightened rates of intensive care unit (ICU) complications. Patients with asthma and concurrent cocaine or heroin use disorders have an increased need for MV. The objective of this study is to determine if the presence of DUD and drug withdrawal syndromes are associated with increased need for MV in medical patients.
  
  
  METHODS
  Analysis of a national database.
  
  
  METHODS
  The Nationwide Inpatient Sample, the largest all-payer in-patient database was utilized for the years 2002-2004.
  
  
  METHODS
  Adult patients with one of the six common diagnoses associated with medical ICU admission were included.
  
  
  METHODS
  None.
  
  
  METHODS
  Univariate analysis and multivariate logistic regression were performed to determine if DUD and drug withdrawal were associated independently with the use of MV.
  
  
  RESULTS
  A total 1 218 875 patients fulfilled one of the six diagnoses; 22 827 (1.9%) had DUD, and 102 841 (8.4%) underwent MV. Independent of the medical diagnosis, DUD was associated with an increased risk for requiring MV by univariate analysis (relative risk = 1.50, P < 0.0001). By multivariate analyses, sedative and cocaine use disorders remained associated with increased need for MV. Independent of medical diagnosis and substance, drug withdrawal was associated with increased odds of MV by both univariate and multivariate analysis (odds ratio = 2.94, P < 0.0001).
  
  
  CONCLUSIONS
  DUD are associated with increased need for MV in medical patients. This study demonstrates the importance of screening all medical patients for DUD.
authors.affiliation: Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA. mdewit@mcvh-vcu.edu
authors.forename: Marjolein
authors.initials: M
authors.lastname: de Wit
authors.forename: Chris
authors.initials: C
authors.lastname: Gennings
authors.forename: Marya
authors.initials: M
authors.lastname: Zilberberg
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Burnham
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
authors.forename: Robert L
authors.initials: RL
authors.lastname: Balster
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019970:Cocaine-Related Disorders / Q000150:complications*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000139:chemically induced*; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000150:complications*
chemical_list: D006993:Hypnotics and Sedatives