title: Impact of harmful use of alcohol on the sedation of critical patients on mechanical ventilation: A multicentre prospective, observational study in 8 Spanish intensive care units.
abstract: OBJECTIVE
  To evaluate the impact of a history of harmful use of alcohol (HUA) on sedoanalgesia practices and outcomes in patients on mechanical ventilation (MV).
  
  
  METHODS
  A prospective, observational multicentre study was made of all adults consecutively admitted during 30 days to 8 Spanish ICUs. Patients on MV >24h were followed-up on until discharge from the ICU or death. Data on HUA, smoking, the use of illegal (IP) and medically prescribed psychotropics (MPP), sedoanalgesia practices and their related complications (sedative failure [SF] and sedative withdrawal [SW]), as well as outcome, were prospectively recorded.
  
  
  RESULTS
  A total of 23.4% (119/509) of the admitted patients received MV >24h; 68.9% were males; age 57.0 (17.9) years; APACHE II score 18.8 (7.2); with a medical cause of admission in 53.9%. Half of them consumed at least one psychotropic agent (smoking 27.7%, HUA 25.2%; MPP 9.2%; and IP 7.6%). HUA patients more frequently required PS (86.7% vs. 64%; p<0.02) and the use of >2 sedatives (56.7% vs. 28.1%; p<0.02). HUA was associated to an eightfold (p<0.001) and fourfold (p<0.02) increase in SF and SW, respectively. In turn, the duration of MV and the stay in the ICU was increased by 151h (p<0.02) and 4.4 days (p<0.02), respectively, when compared with the non-HUA group. No differences were found in terms of mortality.
  
  
  CONCLUSIONS
  HUA may be associated to a higher risk of SF and WS, and can prolong MV and the duration of stay in the ICU in critical patients. Early identification could allow the implementation of specific sedation strategies aimed at preventing these complications.
authors.affiliation: Vall d́Hebron University Hospital, Barcelona, Spain. Electronic address: albertosandiumenge@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Sandiumenge
authors.affiliation: Intensive Care Department, Bellvitge University Hospital, Barcelona, Spain.
authors.forename: H
authors.initials: H
authors.lastname: Torrado
authors.affiliation: Intensive Care Department, Cruces University Hospital, San Vicente de Barakaldo, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Muñoz
authors.affiliation: Intensive Care Department del Tajo University Hospital, Madrid, Spain.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Alonso
authors.affiliation: Intensive Care Department Clinico San Carlos University Hospital, Madrid, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Jiménez
authors.affiliation: Intensive Care Department, Vall d́Hebron University Hospital, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Intensive Care Department, Infanta Sofia University Hospital, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Pardo
authors.affiliation: Intensive Care Department, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Chamorro
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology; D004347:Drug Interactions; D000431:Ethanol / Q000009:adverse effects* / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D013287:Illicit Drugs / Q000493:pharmacokinetics; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D012121:Respiration, Artificial; D012907:Smoking / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D013375:Substance Withdrawal Syndrome / Q000209:etiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D017211:Treatment Failure
chemical_list: D006993:Hypnotics and Sedatives; D013287:Illicit Drugs; D011619:Psychotropic Drugs; D000431:Ethanol
keywords: Consumo enólico de riesgo; Difficult sedation; Fracaso terapéutico de la sedación; Harmful use of alcohol; Mechanical ventilation; Privación de la sedación; Sedación difícil; Sedation therapeutic failure; Sedative withdrawal; Ventilación mecánica