Risk of Alcohol Withdrawal Syndrome in Hospitalized Trauma Patients: A National Data Analysis

Injury ◽  
2021 ◽  
Author(s):  
Nasim Ahmed ◽  
YenHong Kuo
Keyword(s):  
Data Analysis ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Trauma Patients ◽  
National Data

Pulmonary Complications of Alcohol Withdrawal Syndrome in Trauma Patients. A Matched Analysis From a National Trauma Database

2021 ◽  
pp. 000313482110415
Author(s):  
Nasim Ahmed ◽  
Yen-Hong Kuo
Keyword(s):  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Fold Increase ◽  
Pulmonary Complications ◽  
Trauma Patients ◽  
Improvement Program ◽  
National Trauma ◽  
Propensity Matching ◽  
Baseline Characteristics

Background Alcohol withdrawal syndrome (AWS) is associated with increased occurrence of pneumonia and longer hospital stay. The purpose of the study is to find a national estimate of pulmonary complications in AWS patients using the National Trauma Quality Improvement Program (TQIP) database. Methods We accessed the TQIP database focusing on the calendar years 2013-2016 and included all adult admitted trauma patients. The two groups (AWS and no AWS) were compared on baseline characteristics, injury, comorbidities, and outcomes. We performed univariate analysis followed by propensity matching. Results Out of 534 880 patients who qualified for the study, 6929 (1.29%) patients had developed AWS. The propensity matching balanced the two groups on all the baseline characteristics, injury severity, and comorbidities and created 6929 pairs. One-to-one pair-matched analysis showed a significantly increased occurrence of pneumonia (12% vs 4.3%), acute respiratory distress syndrome (ARDS) (2.7% vs 1%), and sepsis (2.4% vs 1.1%) in AWS patients when compared with the patients without the AWS. Conclusion The study showed approximately a 3-fold increase in ARDS and pneumonia and a more than two-fold increase in sepsis in AWS patients. Early intervention in high-risk AWS patients may reduce the complications.

Alcohol withdrawal syndrome in admitted trauma patients

2014 ◽  
Vol 208 (5) ◽  
pp. 781-787 ◽  
Author(s):  
Randeep S. Jawa ◽  
Joseph C. Stothert ◽  
Valerie K. Shostrom ◽  
Diane L. Yetter ◽  
Heather R. Templin ◽  
...  
Keyword(s):  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Trauma Patients

Phenobarbital Monotherapy for the Management of Alcohol Withdrawal Syndrome in Surgical-Trauma Patients

2020 ◽  
pp. 106002802094913
Author(s):  
Mahmoud A. Ammar ◽  
Abdalla A. Ammar ◽  
Jordan Rosen ◽  
Hagar S. Kassab ◽  
Robert D. Becher
Keyword(s):  
Respiratory Depression ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Alternative Therapy ◽  
Alcohol Withdrawal Syndrome ◽  
Fixed Dose ◽  
Surgical Trauma ◽  
Trauma Patients ◽  
First Line Therapy

Background Benzodiazepine is first-line therapy for alcohol withdrawal syndrome (AWS), and phenobarbital is an alternative therapy. However, its use has not been well validated in the surgical-trauma patient population. Objective To describe the use of fixed-dose phenobarbital monotherapy for the management of patients at risk for AWS in the surgical-trauma intensive care unit. Methods Surgical-trauma critically ill patients who received phenobarbital monotherapy, loading dose followed by a taper regimen, for the management of AWS were included in this evaluation. The effectiveness of phenobarbital monotherapy to treat AWS and prevent development of AWS-related complications were evaluated. Safety end points assessed included significant hypotension, bradycardia, respiratory depression, and need for invasive mechanical ventilation. Results A total of 31 patients received phenobarbital monotherapy; the majority of patients were at moderate risk for developing AWS (n = 20; 65%) versus high risk (n = 11; 35%). None of the patients developed AWS-related complications; all patients were successfully managed for their AWS. Nine patients (29%) received nonbenzodiazepine adjunct therapy for agitation post–phenobarbital initiation. Three patients (10%) experienced hypotension, and 3 (10%) were intubated. None of the patients had clinically significant bradycardia or respiratory depression. Conclusion and Relevance Fixed-dose phenobarbital monotherapy appears to be well tolerated and effective in the management of AWS. Further evaluation is needed to determine the extent of benefit with the use of phenobarbital monotherapy for management of AWS.

Treatment of the Acute Alcohol-Withdrawal Syndrome

1958 ◽  
Vol 19 (1) ◽  
pp. 118-124 ◽  
Author(s):  
Lincoln Godfrey ◽  
Martin D. Kissen ◽  
Thomas M. Downs
Keyword(s):  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome

scholarly journals Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tessa L. Steel ◽  
Shewit P. Giovanni ◽  
Sarah C. Katsandres ◽  
Shawn M. Cohen ◽  
Kevin B. Stephenson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Patient Characteristics ◽  
Response To Treatment ◽  
Alternative Measure ◽  
Icu Patients ◽  
Verbal Responses

Abstract Background The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate. Objectives To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics. Methods The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression. Results After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black. Conclusions CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.

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