New article provides guidance on managing critically ill patients at risk for alcohol withdrawal

Alcohol withdrawal adds challenges to caring for critically ill patients, and nurses must be diligent at each stage of care to minimize complications, according to an article in the February issue of Critical Care Nurse (CCN).

The article, "Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management," provides much-needed guidance to critical care nurses and other clinicians whose patients may have alcohol use disorder (AUD), including abuse and dependency conditions of varying severity.

Lead author Lynsey Sutton, RN, MNclin, is associate charge nurse manager of a level 3 intensive care unit, Capital and Coast District Health Board, Wellington Regional Hospital, Wellington, New Zealand. She is a guest teaching assistant in the postgraduate nursing program at Victoria University of Wellington, Wellington, New Zealand.

"The abrupt cessation of alcohol places patients with an AUD at risk for additional complications, and nurses are perfectly placed at the bedside to obtain histories of alcohol consumption from patients or the patients' families. This may help identify those at risk for withdrawal early," she said.

For the study, the researchers reviewed more than 100 articles related to alcohol use and critically ill patients that had been published in peer-reviewed journals.

Their work can help frontline nurses who are caring for critically ill patients at risk for alcohol withdrawal syndrome (AWS).

Managing alcohol withdrawal effectively begins with the identification of patients with an AUD as indicated by the patients' medical histories. Unfortunately, a patient's history of alcohol consumption is often poorly obtained, not detailed enough or not obtained at all.
The researchers recommend that a validated tool be developed to enable nurses to obtain a more comprehensive history of alcohol use, including past withdrawal or detoxification episodes.

If patients at risk are identified at the time of admission, nurses will be better able to detect signs and symptoms of alcohol withdrawal and initiate treatment early. This practice might halt the progression from mild to severe withdrawal and prevent delirium tremens.

The researchers also suggest development of a laboratory test or biomarker to highlight chronic alcohol use, especially when an alcohol history is unobtainable. Current blood tests focus on recent alcohol consumption, which may not help identify those at risk for withdrawal.

"The clinical manifestations of critical illness and alcohol withdrawal are often similar, and a worsening clinical condition in a patient with AWS should not always be assumed to be withdrawal related," Sutton said.

The article also discusses various therapies, tools and assessment scales nurses can use to evaluate and monitor response to treatment.

The researchers call for further studies related to nearly every aspect of alcohol withdrawal in critically ill patients to help validate tools and develop evidence-based practice guidelines.

Source:

American Association of Critical-Care Nurses

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