1
|
Hietanen S, Kaakinen T, Ala-Kokko T, Herajärvi J, Auvinen J, Niittyvuopio M, Liisanantti J. Alcohol consumption is associated with a later need for ICU admission: a Northern Finland Birth Cohort 1966-study. J Public Health (Oxf) 2021; 43:551-557. [PMID: 32561923 DOI: 10.1093/pubmed/fdaa085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/27/2020] [Accepted: 05/26/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Alcohol-related problems are common in intensive care unit (ICU) admitted patients. The aim of the present study is to assess the impact of alcohol consumption on the need of intensive care in 19 years follow-up period. METHODS The study population consists of Northern Finland Birth Cohort 1966 participants, who responded alcohol-related questions at 31 years of age and Intensive Care Unit (ICU admissions from 1997 to 2016. RESULTS There were a total of 8379 assessed people and 136 (1.6%) of them were later admitted to ICU. A total of 44 (32.4%) of the ICU-admitted persons had their alcohol consumption at the highest quartile of the cohort (P = 0.047). These patients had a lower number of malignancy-related admissions (3.6% versus 14.0%, P = 0.027), neurological admissions (14.3 versus 30.6%, P = 0.021), and were more often admitted due to poisonings (12.5% versus 5.0%, P = 0.07). There were no differences in 28-day post-ICU mortality but long-term mortality of ICU-admitted patients with lower alcohol consumption was higher than non-ICU-admitted population. CONCLUSION Among ICU-admitted population, there was higher alcohol consumption at age of 31 years. People in the lower alcohol consumption quartiles were more often admitted to ICU due to malignancy-related causes and they had higher long-term mortality.
Collapse
Affiliation(s)
- Siiri Hietanen
- Central Osthrobotnian Hospital, Department of Cardiology, 67200 Kokkola, Finland.,Oulu University Hospital, Department of Anesthesiology, 90029 Oulu, Finland
| | - Timo Kaakinen
- Oulu University Hospital, Department of Anesthesiology, 90029 Oulu, Finland.,MRC Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, University of Oulu, 90220 Oulu Finland
| | - Tero Ala-Kokko
- Oulu University Hospital, Department of Anesthesiology, 90029 Oulu, Finland.,MRC Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, University of Oulu, 90220 Oulu Finland
| | - Johanna Herajärvi
- MRC Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, University of Oulu, 90220 Oulu Finland
| | - Juha Auvinen
- Center for Life Course Health Researc, University of Oulu, 90220 Oulu, Finland.,Oulunkaari Health Center, 91100 Ii, Finland
| | - Miikka Niittyvuopio
- Oulu University Hospital, Department of Anesthesiology, 90029 Oulu, Finland.,MRC Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, University of Oulu, 90220 Oulu Finland
| | - Janne Liisanantti
- Oulu University Hospital, Department of Anesthesiology, 90029 Oulu, Finland.,MRC Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, University of Oulu, 90220 Oulu Finland
| |
Collapse
|
2
|
Sasaki K, Obinata H, Yokobori S, Sakamoto T. Alcohol does not increase in-hospital mortality due to severe blunt trauma: an analysis of propensity score matching using the Japan Trauma Data Bank. Acute Med Surg 2021; 8:e671. [PMID: 34262778 PMCID: PMC8254651 DOI: 10.1002/ams2.671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
Aim Alcohol‐related problems, including trauma, are a great burden on global health. Alcohol metabolism in the Japanese population is genetically inferior to other races. This study aimed to evaluate the effects of alcohol use among a Japanese severe blunt trauma cohort. Methods This retrospective observational study analyzed the data of trauma patients registered in the Japan Trauma Data Bank between 2004 and 2019. The primary outcome of this study was in‐hospital mortality. The lengths of hospital and intensive care unit stay were the secondary outcomes. Propensity score matching was used to adjust the anatomical severity and patient background to reduce the potential alcohol use bias. Results We analyzed 46,361 patients categorized into nondrinking (n = 37,818) and drinking (n = 8,543) groups. After a 1:1 propensity score matching (n = 8,428, respectively), despite the Glasgow Coma Scale and Revised Trauma Score scores being significantly lower in the drinking group (14 vs. 13 and 7.84 vs. 7.55, P < 0.001, respectively) and intensive care unit length of stay being significantly longer in the drinking group (6 vs. 7 days, P = 0.002), in‐hospital mortality was significantly lower in the alcohol group (11.8% vs. 9.0%, P < 0.001) and there were no differences in the duration of hospital stay (19 vs. 19 days, P = 0.848). Conclusion Despite increasing physiological severity on admission, after adjusting for anatomical severity, alcohol consumption could be beneficial in severe blunt trauma patients as regards in‐hospital mortality.
Collapse
Affiliation(s)
- Kazuma Sasaki
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Hirofumi Obinata
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan.,Shock and Trauma Center Nippon Medical School Chiba Hokusoh Hospital Chiba Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Taigo Sakamoto
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan.,Shock and Trauma Center Nippon Medical School Chiba Hokusoh Hospital Chiba Japan
| |
Collapse
|
3
|
Wright C, McAnulty GR, Secombe PJ. The effect of alcohol policy on intensive care unit admission patterns in Central Australia: A before-after cross-sectional study. Anaesth Intensive Care 2021; 49:35-43. [PMID: 33508954 DOI: 10.1177/0310057x20977503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Alcohol misuse is a disproportionately large contributor to morbidity and mortality in the Northern Territory. A number of alcohol harm minimisation policies have been implemented in recent years. The effect of these on intensive care unit (ICU) admissions has not been fully explored. A retrospective before-after cross-sectional study was conducted at the Alice Springs Hospital ICU between 1 October 2017 and 30 September 2019. The primary outcome was the proportion of admissions in which alcohol misuse was a contributing factor in the 12 months before (pre-reforms phase) versus the 12 months following (post-reforms phase) implementation of alcohol legislation reforms. Secondary outcomes were measures of critical care resource use (length of stay, need for and duration of mechanical ventilation). After exclusions, 1323 ICU admissions were analysed. There was a reduction in the proportion of admissions associated with alcohol misuse between the pre-reforms and post-reforms phases (18.8% versus 11.7%, P < 0.01). This was true for both acute (10.6% versus 3.6%, P < 0.01) and chronic misuse (13.3% versus 9.6%, P = 0.03). Rates of mechanical ventilation were unchanged during the post-reforms phase (18.3% versus 14.7%). Admissions with a primary diagnosis of trauma were lower (10.5% versus 4.7%, P < 0.01). This study demonstrated a reduction in ICU admissions associated with alcohol misuse following the implementation of new alcohol harm minimisation policies. This apparent reduction in alcohol-related harm is suggestive of the effectiveness of the Northern Territory's integrated alcohol harm reduction framework.
Collapse
Affiliation(s)
- Carly Wright
- Intensive Care Unit, Alice Springs Hospital, Alice Springs, Australia
| | - Greg R McAnulty
- Intensive Care Unit, Alice Springs Hospital, Alice Springs, Australia
| | - Paul J Secombe
- Intensive Care Unit, Alice Springs Hospital, Alice Springs, Australia.,School of Medicine, Flinders University, Bedford Park, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell, Australia
| |
Collapse
|
4
|
Secombe P, Campbell L, Brown A, Bailey M, Pilcher D. Alcohol Misuse and Critical Care Admissions in the Northern Territory. Intern Med J 2021; 51:1433-1440. [DOI: 10.1111/imj.15212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/11/2020] [Accepted: 12/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Paul Secombe
- Intensive Care Unit Alice Springs Hospital Alice Springs NT
- School of Medicine Flinders University Bedford Park SA
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine Monash University Melbourne Vic
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, 277 Camberwell Road Camberwell Vic
| | - Lewis Campbell
- School of Medicine Flinders University Bedford Park SA
- Intensive Care Unit Royal Darwin Hospital Darwin NT
| | - Alex Brown
- Aboriginal Health Equity South Australian Health and Medical Research Institute (SAHMRI)
- Faculty of Health and Medical Sciences University of Adelaide
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine Monash University Melbourne Vic
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine Monash University Melbourne Vic
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, 277 Camberwell Road Camberwell Vic
- Department of Intensive Care The Alfred Hospital, Commercial Road, Prahran Melbourne Vic
| |
Collapse
|
5
|
Abstract
This integrative review presents the most recent and relevant critical care nursing research publications in the United States. A comprehensive search identified publications on the topics of delirium; early mobility; communication; palliative care; tele-intensive care unit; care bundle implementation; and prevention, detection, and early management of infection. The evidence is summarized for each of these topics, as well as other research, with suggestions and guidance for end users.
Collapse
Affiliation(s)
- Sheila A Alexander
- Acute and Tertiary Care, School of Nursing, Critical Care Medicine, School of Medicine, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
| |
Collapse
|
6
|
Culhane J, Silverglate B, Freeman C. Alcohol is a predictor of mortality in motor vehicle collisions. JOURNAL OF SAFETY RESEARCH 2019; 71:201-205. [PMID: 31862031 DOI: 10.1016/j.jsr.2019.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/09/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION It is well recognized that driving while intoxicated increases the probability of a motor-vehicle collision (MVC). The effect of alcohol on the chance of surviving the MVC is less clear. METHOD Using data from the Fatality Analysis Reporting System (FARS) we conducted analyses for the outcome of mortality using alcohol and other variables as predictors. We also selected alcohol positive (AP) and alcohol negative (AN) persons from the same MVC and vehicle to control for confounding characteristics. RESULTS The odds ratio (OR) for mortality for alcohol positive drivers was 2.57, (p < 0.001 for all the following OR). Other harmful predictive factors were age OR 1.01 per year, vehicle age OR 1.05 per year, male sex OR 1.23, avoidance maneuver OR 1.09, speed related OR 2.89, rollover mechanism OR 2.75, and collision with a fixed object OR 6.70. Protective factors were proper restraint use - OR 0.19 and collision with another moving vehicle, OR 0.21. In the multivariate analysis the OR of mortality for AP vs AN was 1.46. Proper restraint use (OR 0.27) remained protective along with collision with another moving vehicle. When AP and AN persons from the same MVC and the same vehicle were compared, the adjusted OR's for mortality were 1.46 and 2.08, respectively. CONCLUSIONS Alcohol is an independent predictor of mortality in an MVC. Proper restraint use is the strongest protective factor. This finding allows a more complete understanding of the risks of driving while intoxicated, not only a higher probability of an MVC, but decreased survival once the MVC occurs. Practical Applications: Identification of alcohol as an independent predictor of mortality in an accident may improve risk assessment and influence drivers to avoid driving while intoxicated.
Collapse
Affiliation(s)
- John Culhane
- Saint Louis University, Department of Trauma, 3635 Vista Ave., St. Louis, MO 63110, USA.
| | - Bret Silverglate
- Saint Louis University, Department of Trauma, 3635 Vista Ave., St. Louis, MO 63110, USA.
| | - Carl Freeman
- Saint Louis University, Department of Trauma, 3635 Vista Ave., St. Louis, MO 63110, USA.
| |
Collapse
|
7
|
Hosokawa K, Su F, Taccone FS, Post EH, Creteur J, Vincent JL. Effects of acute ethanol intoxication in an ovine peritonitis model. BMC Anesthesiol 2018; 18:70. [PMID: 29921225 PMCID: PMC6009814 DOI: 10.1186/s12871-018-0537-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/30/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Acute ethanol intoxication has been shown to have contrasting effects on outcomes in sepsis. The aim of this study was to explore the effects of acute ethanol intoxication on hemodynamics, renal function, brain perfusion and lactate/pyruvate in an ovine sepsis model. METHODS Anesthetized, mechanically ventilated female sheep were randomized to an ethanol group (n = 7), which received 1 g/kg ethanol diluted in intravenous (i.v.) saline infusion or a control group (n = 7), which received the same volume of i.v. saline. Both groups received the treatment for a period of 2 h prior to induction of sepsis by intraperitoneal injection of feces. Other treatment included fluid resuscitation but no vasopressors or antibiotics. Global hemodynamics, renal blood flow, brain cortex laser Doppler flowmetry and microdialysis analyses were recorded hourly. RESULTS In the ethanol group, blood ethanol concentrations were 137 ± 29 mg/dL at the time of feces injection and decreased to become undetectable by 12 h. Arterial hypotension occurred earlier in the ethanol than in the control group (8 [7-12] vs. 14 [11-20] hours, p = 0.03). Lactate levels increased to > 2 mmol/L earlier in the ethanol group. Renal dysfunction (9 [6-13] vs. 13 [12-15] hours, p = 0.05) and oliguria (urine output < 0.5 mL/kg/h; 10 [7-12] vs. 13 [12, 13] hours, p = 0.01) developed earlier in the ethanol than in the control group. Brain blood flow and lactate/pyruvate were unaffected. There was no significant difference in survival time. CONCLUSIONS Acute ethanol intoxication in this model of peritonitis resulted in earlier development of shock and renal dysfunction but did not alter brain perfusion and metabolism or short-term survival.
Collapse
Affiliation(s)
- Koji Hosokawa
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Fuhong Su
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Emiel Hendrik Post
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
8
|
Secombe PJ, Stewart PC. The impact of alcohol-related admissions on resource use in critically ill patients from 2009 to 2015: an observational study. Anaesth Intensive Care 2018; 46:58-66. [PMID: 29361257 DOI: 10.1177/0310057x1804600109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Excessive alcohol use is associated with increased health care utilisation and increased mortality. This observational study sought to identify the proportion of patients admitted with a critical illness in which alcohol misuse contributed, and to examine the resource use for this group. We performed an observational retrospective database review of all admissions to the Alice Springs Hospital intensive care unit (ICU) between 1 January 2009 and 31 December 2015. The Alice Springs Hospital ICU is a ten-bed unit located in Central Australia, with approximately 600 admissions annually. The per capita consumption of alcohol in Central Australia is approximately 1.5 times the national average. The primary aim was to determine the proportion of admissions to intensive care in which alcohol misuse was identified as a contributing cause. Secondary aims examined resource utilisation including ICU and hospital length of stay, need for and duration of mechanical ventilation, and ICU re-admission. There were 3,768 admissions involving 2,670 individual patients. Of these admissions 947 (25%) were associated with alcohol misuse. Admissions associated with alcohol were significantly more likely to require mechanical ventilation (30% versus 20%, <i>P</i> <0.01), and had a significantly longer ICU length of stay (2.1 versus 1.9 days, <i>P</i> <0.05). The proportion of admissions in which alcohol misuse was implicated is amongst the highest in the published literature. The results of this study should drive further policy change directed at harm minimisation, and warrant more detailed epidemiological work at both a local and national level.
Collapse
Affiliation(s)
- P J Secombe
- Lecturer, School of Medicine, Flinders University, Adelaide, South Australia
| | | |
Collapse
|
9
|
Zakharov S, Pelclova D, Urban P, Navratil T, Nurieva O, Kotikova K, Diblik P, Kurcova I, Belacek J, Komarc M, Eddleston M, Hovda KE. Use of Out-of-Hospital Ethanol Administration to Improve Outcome in Mass Methanol Outbreaks. Ann Emerg Med 2016; 68:52-61. [PMID: 26875060 DOI: 10.1016/j.annemergmed.2016.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 12/29/2015] [Accepted: 01/05/2016] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE Methanol poisoning outbreaks are a global public health issue, with delayed treatment causing poor outcomes. Out-of-hospital ethanol administration may improve outcome, but the difficulty of conducting research in outbreaks has meant that its effects have never been assessed. We study the effect of out-of-hospital ethanol in patients treated during a methanol outbreak in the Czech Republic between 2012 and 2014. METHODS This was an observational case-series study of 100 hospitalized patients with confirmed methanol poisoning. Out-of-hospital ethanol as a "first aid antidote" was administered by paramedic or medical staff before the confirmation of diagnosis to 30 patients; 70 patients did not receive out-of-hospital ethanol from the staff (12 patients self-administered ethanol shortly before presentation). RESULTS The state of consciousness at first contact with paramedic or medical staff, delay to admission, and serum methanol concentration were similar among groups. The median serum ethanol level on admission in the patients with out-of-hospital administration by paramedic or medical staff was 84.3 mg/dL (interquartile range 32.7 to 129.5 mg/dL). No patients with positive serum ethanol level on admission died compared with 21 with negative serum ethanol level (0% versus 36.2%). Patients receiving out-of-hospital ethanol survived without visual and central nervous system sequelae more often than those not receiving it (90.5% versus 19.0%). A positive association was present between out-of-hospital ethanol administration by paramedic or medical staff, serum ethanol concentration on admission, and both total survival and survival without sequelae of poisoning. CONCLUSION We found a positive association between out-of-hospital ethanol administration and improved clinical outcome. During mass methanol outbreaks, conscious adults with suspected poisoning should be considered for administration of out-of-hospital ethanol to reduce morbidity and mortality.
Collapse
Affiliation(s)
- Sergey Zakharov
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic.
| | - Daniela Pelclova
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Pavel Urban
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Tomas Navratil
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic; Department of Biomimetic Electrochemistry, J. Heyrovsky Institute of Physical Chemistry of the AS CR, Prague, Czech Republic
| | - Olga Nurieva
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Katerina Kotikova
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, General University Hospital, Prague, Czech Republic
| | - Ivana Kurcova
- Department of Toxicology and Forensic Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Jaromir Belacek
- Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Martin Komarc
- Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Michael Eddleston
- Pharmacology, Toxicology, and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Knut Erik Hovda
- Norwegian CBRNe Center of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|