Mechanical Ventilation in Medical Inpatients With Alcohol Use Disorders

Whether alcohol use disorders increase the need for and duration of mechanical ventilation in hospitalized medical patients is unknown. Using a national inpatient database, researchers retrospectively measured the association between mechanical ventilation and alcohol use disorders and alcohol withdrawal in 785,602 adult inpatients with 1 or more of 6 medical diagnoses: pneumonia, sepsis, gastrointestinal hemorrhage, asthma, chronic obstructive pulmonary disease, and respiratory failure.

Findings from analyses adjusted for potential confounders (e.g., age, severity of illness) include the following:

• Three percent of inpatients had an alcohol use disorder, 0.5% had alcohol withdrawal, and 8% required mechanical ventilation.
• Mechanical ventilation was significantly more common among inpatients with, versus without, an alcohol use disorder (odds ratio, [OR], 1.5), regardless of medical diagnosis. The association between mechanical ventilation and alcohol withdrawal was not reported.
• Longer duration of mechanical ventilation (≥96 hours) was not significantly more common among inpatients with alcohol use disorders. However, it was more likely among inpatients with (versus without) alcohol withdrawal (OR, 1.5).

Comments:

In this large study, alcohol use disorders were associated with increased use of mechanical ventilation, and alcohol withdrawal was linked with a longer duration of mechanical ventilation. Clinicians should carefully assess medical inpatients for alcohol use and monitor for withdrawal and change in respiratory status. However, because the initial timing of intubation (e.g., in the emergency department, the first hospital day) was not tracked, the study was unable to determine whether medical inpatients with alcohol use disorders and 1 of the 6 diagnoses should be initially triaged to higher levels of care.

Kevin L. Kraemer, MD, MSc

Reference:

De Wit M, Best AM, Gennings C, et al. Alcohol use disorders increase the risk for mechanical ventilation in medical patients. Alcohol Clin Exp Res. 2007;31(7):1224–1230.