Intensive & critical care nursing · 2025
Evaluation of alcohol withdrawal assessment in mechanically ventilated patients in a trauma/surgical intensive care unit.
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Smith Zachary, McKinney Amanda L, Bollig Reagan, McKnight Catherine L, Daley Brian J, Rowe A Shaun
Аннотация
OBJECTIVE: Alcohol withdrawal syndrome (AWS) is a common and potentially life-threatening complication in critically ill patients. AWS has been shown to increase mortality as well as several other morbidities in critically ill patients. The optimal method for monitoring AWS in mechanically ventilated patients is unclear. As the use of the Clinical Institute Withdrawal Assessment of Alcohol, Revised (CIWA-Ar) has not been validated in mechanically ventilated patients, the purpose of the study was to determine if the use of Richmond Agitation-Sedation Scale (RASS) or CIWA-Ar resulted in improved outcomes in mechanically ventilated critically ill patients with AWS.
METHODS: A retrospective, quasi-experimental study was conducted in a Trauma Surgical Intensive Care Unit. Mechanically ventilated patients admitted to the trauma service and receiving symptom-triggered benzodiazepine therapy for AWS were included. Before April 2020, regardless of mechanical ventilation status, AWS therapy was guided by CIWA-Ar. After April 2020, AWS therapy for mechanically ventilated patients was guided by RASS.
RESULTS: Forty-eight patients were included (RASS: n = 24, CIWA-Ar: n = 24). Patients in the RASS group had a shorter median ICU length of stay (6 days [2.5-12] vs. 9 days [5-22]; p = 0.0224) and shorter median time on mechanical ventilation (2.6 days [1.2-6.5] vs. 5.7 days [2.3-9.8]; p = 0.0253) as compared to the CIWA-Ar group. However, the RASS group had a longer median hospital length of stay (16 days [9.5-23] vs. 15 days [12-47]; p = 0.0328).
CONCLUSION: Using RASS to guide symptom-triggered benzodiazepine therapy for AWS in mechanically ventilated patients was associated with significantly shorter ICU length of stay and duration of mechanical ventilation compared to CIWA-Ar.
IMPLICATION FOR CLINICAL PRACTICE: Implementing a RASS guided monitoring algorithm in patients with AWS may lead to better assessment of ventilated patients at high risk of AWS. This may lead to shorter lengths of stay and duration of mechanical ventilation.
METHODS: A retrospective, quasi-experimental study was conducted in a Trauma Surgical Intensive Care Unit. Mechanically ventilated patients admitted to the trauma service and receiving symptom-triggered benzodiazepine therapy for AWS were included. Before April 2020, regardless of mechanical ventilation status, AWS therapy was guided by CIWA-Ar. After April 2020, AWS therapy for mechanically ventilated patients was guided by RASS.
RESULTS: Forty-eight patients were included (RASS: n = 24, CIWA-Ar: n = 24). Patients in the RASS group had a shorter median ICU length of stay (6 days [2.5-12] vs. 9 days [5-22]; p = 0.0224) and shorter median time on mechanical ventilation (2.6 days [1.2-6.5] vs. 5.7 days [2.3-9.8]; p = 0.0253) as compared to the CIWA-Ar group. However, the RASS group had a longer median hospital length of stay (16 days [9.5-23] vs. 15 days [12-47]; p = 0.0328).
CONCLUSION: Using RASS to guide symptom-triggered benzodiazepine therapy for AWS in mechanically ventilated patients was associated with significantly shorter ICU length of stay and duration of mechanical ventilation compared to CIWA-Ar.
IMPLICATION FOR CLINICAL PRACTICE: Implementing a RASS guided monitoring algorithm in patients with AWS may lead to better assessment of ventilated patients at high risk of AWS. This may lead to shorter lengths of stay and duration of mechanical ventilation.