Cliniciansʼ evaluation and management of mental health, substance abuse, and chronic pain conditions in the intensive care unit*

Broyles, Lauren M.; Colbert, Alison; Tate, Judith A.; Swigart, Valerie; Happ, Mary Beth

doi:10.1097/01.ccm.0000292010.11345.24

Cited by 27 publications

(23 citation statements)

References 61 publications

(50 reference statements)

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“…It is important for the anesthesiologists and surgeons to be aware of which drugs are used by the patient and the frequency of their preoperative use; however, the limited knowledge of a patient’s history of drug use due to impaired communication or concealment of drug abuse may lead to insufficient preoperative preparation 3 . Illicit drugs or administration techniques may result in life-threatening complications 4 (e.g., pseudoaneurysm at the injection site and limb ischemia) to further complicate the situation. Perioperative management may be complicated by medical or psychiatric co-morbidities; psychological states presenting as delirium, hallucination, or difficult behavior; drug effects related to intoxication, withdrawal, tolerance, or opioid-induced hyperalgesia 5 ; and the patient’s social disruption or attitudes toward treatment 6 .…”

Section: Introductionmentioning

confidence: 99%

Preoperative screening for illicit drug use in patients undergoing emergency surgery: A prospective observational study

Ren

et al. 2018

Sci Rep

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Knowledge of illicit drug users (IDUs) is important because of the comorbidity related to drug use. In this prospective, observational study, we screened 1007 patients undergoing emergency surgery and found that 75 of them (7.5%) were IDUs The results of preoperative screening showed that the rates of HIV and syphilis infection were significantly higher in IDUs (HIV (+) 2.6%, syphilis (+) 10.7%) than in non-IDUs (HIV (+) 0, syphilis (+) 0.5%). Intraoperative consumption of remifentanil (IDUs: 1.85 ± 1.30 vs. non-IDUs: 1.31 ± 0.86, p = 0.009), midazolam (IDUs: 4.82 ± 1.52 vs. non-IDUs: 4.15 ± 1.81, p = 0.002), and atracurium (IDUs: 31.5 ± 15.1 vs. non-IDUs: 25.5 ± 11.9, p = 0.006) and the proportion of patients requiring postoperative fentanyl (IDUs: 15 (20.0%) vs. non-IDUs: 95 (1.2%), p = 0.031) were significantly increased in IDUs compared to non-IDUs. Postoperative complications were observed in 22.7% (17/75) of patients who were IDUs, which was significantly increased when compared with non-IDUs (6.0%, 56/932, p < 0.001). The mortality rate within 30 days after surgery was similar between the two groups. These findings suggested that the IDUs were associated with increased rates of HIV and syphilis infection; greater consumption of intraoperative opioids, sedatives, and muscle relaxants; increased postoperative complications and a similar mortality rate within 30 days after surgery when compared with non-IDUs.

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Section: Introductionmentioning

confidence: 99%

Preoperative screening for illicit drug use in patients undergoing emergency surgery: A prospective observational study

Ren

et al. 2018

Sci Rep

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“…96 Unfortunately, identifying patients at risk may be challenging due to altered patient sensorium, patient and family reluctance to provide accurate information on use of alcohol and other drugs, and failure of physicians to inquire about the use of alcohol. 97 Although measurement of blood alcohol concentration is an easily obtainable test, no study to our knowledge has examined the relationship between blood alcohol concentration and the likelihood of developing alcohol withdrawal syndrome. An estimated 5% of patients with AUDs develop severe withdrawal or delirium tremens, which carries a mortality rate of 5% to 15%.…”

Section: Management Of Withdrawal Syndromesmentioning

confidence: 99%

Alcohol-Use Disorders in the Critically Ill Patient

Wit

Jones

Sessler

et al. 2010

Chest

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A lcohol-use disorders (AUDs) encompass a spectrum of disorders, including excessive use, abuse, dependence, and addiction. Abuse occurs when a patient experiences adverse socioeconomic or health consequences related to the use of the substance. 1 Dependence is present either when the patient experiences withdrawal symptoms on discontinuation of the substance or when larger amounts are necessary to achieve the desired effect. 1 Addiction is indicated by the patient experiencing a compulsive craving for a substance. 1 At any one time, a patient may have more than one of these disorders simultaneously present. The National Institutes of Health 2 have put forth guidelines that quantify excessive and unhealthy use of alcohol; a level of use above this threshold increases a patient's risk for health problems. 3 Men aged Յ 65 years who consume more than four standard drinks in a typical day or . 14 standard drinks in a typical week have excessive and unhealthy alcohol consumption. These volumes are halved for women of all ages and men aged .

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“…The inability of patients to communicate because of sedation, mechanical ventilation, and delirium is clearly a barrier. In addition, Broyles et al 11 found that clinicians either do not question enough about drug and alcohol intake or use selective questioning based on stereotyping of patients. The use of screening tools (Table 3) such as the CAGE questionnaire, the Alcohol Use Disorders Identifi cation Test (AUDIT), the AUDIT-C, the AUDIT-PC, and the Michigan Alcoholism Screening Test improves the identifi cation of an AUD during history taking.…”

Section: Identifying Icu Patients At Risk For Alcohol Withdrawalmentioning

confidence: 99%

“…Unfortunately, a patient's history of alcohol consumption is often poorly obtained, not detailed enough, or not obtained at all. [11][12][13][14] For example, in a retrospective review 12 of approximately 2000 trauma patients, only 7.3% of patients had an adequate history taken that would have highlighted an AUD. In the ICU, alcohol histories may be missed for several reasons.…”

Section: Identifying Icu Patients At Risk For Alcohol Withdrawalmentioning

confidence: 99%

Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management

Sutton-Smith

Jutel

2016

Critical Care Nurse

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Management of alcohol withdrawal in critically ill patients is a challenge. The alcohol consumption histories of intensive care patients are often incomplete, limiting identification of patients with alcohol use disorders. Abrupt cessation of alcohol places these patients at risk for alcohol withdrawal syndrome. Typically benzodiazepines are used as first-line therapy to manage alcohol withdrawal. However, if patients progress to more severe withdrawal or delirium tremens, extra adjunctive medications in addition to benzodiazepines may be required. Sedation and mechanical ventilation may also be necessary. Withdrawal assessment scales such as the Clinical Institute of Withdrawal Assessment are of limited use in these patients. Instead, general sedation-agitation scales and delirium detection tools have been used. The important facets of care are the rapid identification of at-risk patients through histories of alcohol consumption, management with combination therapies, and ongoing diligent assessment and evaluation. (Critical Care Nurse. 2016;36[1]:28–39)

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Cliniciansʼ evaluation and management of mental health, substance abuse, and chronic pain conditions in the intensive care unit*

Cited by 27 publications

References 61 publications

Preoperative screening for illicit drug use in patients undergoing emergency surgery: A prospective observational study

Preoperative screening for illicit drug use in patients undergoing emergency surgery: A prospective observational study

Alcohol-Use Disorders in the Critically Ill Patient

Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management

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