Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?

Autor: Shawn M. Cohen, Ben Murray, Kevin Stephenson, Katharine A. Bradley, Shewit P. Giovanni, Emily C. Williams, Sarah C. Katsandres, Catherine L. Hough, Tessa L. Steel, Hillary Sobeck
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Adult
Nervous system
medicine.medical_specialty
Future studies
lcsh:Social pathology. Social and public welfare. Criminology
Monitoring
Sedation
030508 substance abuse
Logistic regression
law.invention
lcsh:HV1-9960
03 medical and health sciences
Benzodiazepines
0302 clinical medicine
law
Chart review
Alcohol-induced disorders
medicine
Humans
030212 general & internal medicine
Letter to the Editor
lcsh:R5-920
Ethanol
business.industry
Public health
physiologic
General Medicine
Emergency department
Hypnotics and sedatives
medicine.disease
Intensive care unit
Drug monitoring
Substance Withdrawal Syndrome
Alcoholism
Intensive Care Units
Critical care
Alcohol withdrawal syndrome
Emergency medicine
Quality of health care
medicine.symptom
0305 other medical science
business
lcsh:Medicine (General)
Zdroj: Addiction Science & Clinical Practice, Vol 16, Iss 1, Pp 1-6 (2021)
Addiction Science & Clinical Practice
ISSN: 1940-0640
Popis: Background The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate. Objectives To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics. Methods The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression. Results After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black. Conclusions CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.
Databáze: OpenAIRE
Externí odkaz: