Alcohol-use disorders in the critically ill patient

Area of Science:

• Critical care medicine
• Addiction medicine
• Public health

Background:

• Alcohol-use disorders (AUDs) affect millions globally and are prevalent in hospitalized populations, with up to 40% of patients having AUDs.
• AUDs are associated with increased illness severity, contrasting with acute alcohol intoxication effects.
• Existing guidelines for managing critically ill patients with AUDs are limited despite their high prevalence.

Purpose of the Study:

• To review the development and progression of critical illness in patients with alcohol-use disorders (AUDs).
• To highlight the challenges in managing critically ill patients with AUDs, including sedation and withdrawal.
• To emphasize the need for systematic identification of AUDs to improve patient outcomes.

Main Methods:

• Literature review focusing on the impact of AUDs on critical illness.
• Analysis of studies examining surgical, trauma, and burn patient outcomes with AUDs.
• Discussion of challenges in sedation, withdrawal management, and behavioral issues in intensive care units (ICUs).

Main Results:

• Patients with AUDs experience higher rates of postoperative complications (hemorrhage, cardiac issues, sepsis) and require repeat surgeries.
• AUDs are linked to increased severity of community-acquired and nosocomial pneumonia and sepsis.
• Managing sedation and diagnosing withdrawal in critically ill patients with AUDs presents significant challenges, alongside risks of agitation and violence.

Conclusions:

• Alcohol-use disorders are underdiagnosed in hospitalized patients and are associated with worse outcomes in critical illness.
• Specific management guidelines for critically ill patients with AUDs are lacking.
• Systematic and accurate identification of AUDs is a critical first step toward improving care and outcomes for this population.