This feature examines the impact of pharmacologic interventions on the treatment of the critically ill patient — an area of health care that has become increasingly complex. Recent advances in drug therapy for adult ICU patients (including evolving and controversial data) will be reviewed and assessed in terms of clinical, humanistic, and economic outcomes. Direct questions or comments to Gil Fraser, PharmD, at fraseg@mmc.org.
Get full access to this article
View all access options for this article.
References
1.
LieberC.S.Medical disorders of alcoholism.N Engl J Med.1995; 333(16): 1058–65.
2.
SaitzR., O'MalleyS.S.Pharmacotherapies for alcohol abuse. Withdrawal and treatment.Med Clin North Am.1997; 81(4): 881–907.
3.
MooreR.D., BoneL.R., GellerG.Prevalence, detection, and treatment of alcoholism in hospitalized patients.JAMA.1989; 261(3): 403–7.
4.
SpiesC.D., RommelspacherH.Alcohol withdrawal in the surgical patient: Prevention and treatment.Anesth Anal.1999; 88(4): 946–54.
5.
JenkinsD.H.Substance abuse and withdrawal in the intensive care unit. Contemporary issues.Surg Clin North Am.2000; 80(3): 1033–53.
6.
SpiesC.D., NordmannA., BrummerG.Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract.Acta Anaesthesiol Scand.1996; 40(6): 649–56.
7.
ChangP.H., SteinbergM.B.Alcohol withdrawal.Med Clin North Am.2001; 85(5): 1191–212.
8.
FreedlandE.S., McMickenD.B.Alcohol-related seizures, Part 2: Clinical presentation and management.J Emerg Med.1993; 11(5): 605–18.
9.
WojnarM., BizonZ., WasilewskiD.The role of somatic disorders and physical injury in the development and course of alcohol withdrawal delirium.Alcohol Clin Exp Res.1999; 23(2): 209–13.
10.
SpiesC.D., DubiszN., NeumannT.Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of a prospective, randomized trial.Crit Care Med.1996; 24(3): 414–22.
11.
ErstadB.L., CotugnoC.L.Management of alcohol withdrawal.Am J Health Syst Pharm.1995; 52(7): 697–709.
12.
MayfieldD., McLeodG., HallP.The CAGE questionnaire: Validation of a new alcoholism screening instrument.Am J Psychiatry.1974; 131(10): 1121–3.
13.
BushB., ShawS., ClearyP.Screening for alcohol abuse using the CAGE questionnaire.Am J Med.1987; 82(2): 231–5.
14.
SegatoreM., AdamsD., LangeS.Managing alcohol withdrawal in the acutely ill hospitalized adult.J Neurosci Nurs.1999; 31(3): 129–41.
15.
SchumacherL., PruittJ.N., PhillipsM.Identifying patients “at risk” for alcohol withdrawal syndrome and a treatment protocol.J Neurosci Nurs.2000; 32(3): 158–63.
16.
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 4th ed.Washington, DC: American Psychiatric Association; 1994.
17.
SullivanJ.T., SykoraK., SchneidermanJ.Assessment of alcohol withdrawal: The revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar).Br J Addict.1989; 84(11): 1353–7.
18.
FoyA., MarchS., DrinkwaterV.Use of an objective clinical scale in the assessment and management of alcohol withdrawal in a large general hospital.Alcohol Clin Exp Res.1988; 12(3): 360–4.
19.
Anonymous.Management of the agitated intensive care unit patient.Crit Care Med.2002; 30(suppl 1): S97–S123.
20.
Mayo-SmithM.F.Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal.JAMA.1997; 278(2): 144–51.
21.
HolbrookA.M., CrowtherR., LotterA.Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal.CMAJ.1999; 160(5): 649–55.
22.
SolomonJ., RouckL.A., KoepkeH.H.Double-blind comparison of lorazepam and chlordiazepoxide in the treatment of the acute alcohol abstinence syndrome.Clin Ther.1983; 6(1): 52–8.
23.
KumarA., BleckT.P.Intravenous midazolam for the treatment of refractory status epilepticus.Crit Care Med.1992; 20(4): 483–8.
24.
SaitzR., Mayo-SmithM.F., RobertsM.S.Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial.JAMA.1994; 272(7): 519–23.
25.
DaeppenJ.B., GacheP., LandryU.Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: A randomized treatment trial.Arch Intern Med.2002; 162(10): 1117–21.
26.
JaegerT.M., LohrR.H., PankratzV.S.Symptom-triggered therapy for alcohol withdrawal syndrome in medical inpatients.Mayo Clin Proc.2001; 76(7): 695–701.
27.
SaitzR., FriedmanL.S., Mayo-SmithM.F.Alcohol withdrawal: A nationwide survey of inpatient treatment practices.J Gen Intern Med.1995; 10(9): 479–87.
28.
SpiesC.D., DubiszN., FunkW.Prophylaxis of alcohol withdrawal syndrome in alcohol-dependent patients admitted to the intensive care unit after tumour resection.Br J Anaesth.1995; 75: 734–9.
29.
CraftP.P., FoilM.B., CunninghamP.R.Intravenous ethanol for alcohol detoxification in trauma patients.South Med J.1994; 87(1): 47–54.
30.
HansbroughJ.F., Zapata-SirventR.L., CarrollW.J.Administration of intravenous alcohol for prevention of withdrawal in alcoholic burn patients.Am J Surg.1984; 148(2): 266–9.
31.
EggersV., TioJ., NeumannT.Blood alcohol concentration for monitoring ethanol treatment to prevent alcohol withdrawal in the intensive care unit.Intensive Care Med.2002; 28: 1475–82.
32.
WilkensL., RuschulteH., RuckoldtH.Standard calculation of ethanol elimination rate is not sufficient to provide ethanol substitution therapy in the postoperative course of alcohol-dependent patients.Intensive Care Med.1998; 24(5): 459–63.
33.
McCowanC., MarikP.Refractory delirium tremens treated with propofol: A case series.Crit Care Med.2000; 28(6): 1781–4.
34.
CoomesT.R., SmithS.W.Successful use of propofol in refractory delirium tremens.Ann Emerg Med.1997; 30(6): 825–8.
35.
CurrierD.S., BevacquaB.K.Acute tachyphylaxis to propofol sedation during ethanol withdrawal.J Clin Anesth.1997; 9(5): 420–3.
