Admissions To Critical Care.

Abstract

Introduction: Alcohol related admissions to critical care are increasing.  However, there is uncertainty about the impact of excessive alcohol use on the intensive care stay and recovery from critical illness.

Aim: The aim of this study was to understand the impact of alcohol use disorders on the critically ill patient’s journey.

Settings & participants: The setting for this study was a 20 bed mixed ICU, in a large teaching hospital in Scotland.  On admission patients were allocated to one of three alcohol groups: low risk; harmful/hazardous or alcohol dependency.

Methods: This was a mixed methods study. An 18 month prospective observational cohort study was undertaken. In addition, 21 in depth, semi structured interviews were undertaken with patients with and without alcohol use disorders, three to seven months after discharge from critical care.

Results: 580 ICU patients were screened for the presence of alcohol use disorders during the study period. 34.4% of patients were admitted with a background of alcohol misuse. ICU stay was significantly different between the three study groups, with those in the alcohol dependency group having a longer stay (p=0.01). After adjustment for all lifestyle factors which were significantly different between the groups, alcohol dependence was associated with more than a twofold increased odds of ICU mortality (OR 2.28; 95% CI 1.2-4.69, p=0.01). Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience; impact and support for activities of daily living; social support and cohesion; and the impact of alcohol use disorders on recovery.

Conclusions: Alcohol related admissions account for a significant proportion of admissions to critical care and alcohol dependency is independently associated with ICU outcome. A more targeted rehabilitation pathway for all patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, needs to be generated.