The influence of alcohol abuse on agitation, delirium and sedative requirements of patients admitted to a general intensive care unit

Purpose: Patients with alcohol-related disease constitute an increasing proportion of those admitted to intensive careunit. There is currently limited evidence regarding the impact of alcohol use on levels of agitation, delirium and sedativerequirements in intensive care unit. This study aimed to determine whether intensive care unit-admitted alcohol-abusepatients have different sedative requirements, agitation and delirium levels compared to patients with no alcohol issues.Methods: This retrospective analysis of a prospectively acquired database (June 2012–May 2013) included 257 patients.Subjects were stratified into three risk categories: alcohol dependency (n ¼ 69), at risk (n ¼ 60) and low risk (n ¼ 128)according to Fast Alcohol Screening Test scores and World Health Organisation criteria for alcohol-related disease. Dataon agitation and delirium were collected using validated retrospective chart-screening methods and sedation data wereextracted and then log-transformed to fit the regression model.Results: Incidence of agitation (p ¼ 0.034) and delirium (p ¼ 0.041) was significantly higher amongst alcohol-dependentpatients compared to low-risk patients as was likelihood of adverse events (p ¼ 0.007). In contrast, at-risk patients wereat no higher risk of these outcomes compared to the low-risk group. Alcohol-dependent patients experienced suboptimalsedation levels more frequently and received a wider range of sedatives (p ¼ 0.019) but did not receive higher dailydoses of any sedatives.Conclusions: Our analysis demonstrates that when admitted to intensive care unit, it is those who abuse alcohol mostseverely, alcohol-dependent patients, rather than at-risk drinkers who have a significantly increased risk of agitation,delirium and suboptimal sedation. These patients may require closer assessment and monitoring for these outcomeswhilst admitted.