To evaluate management and outcome of patients admitted with Delerium tremens(DT) to Intensive Care Unit(ICU) compared to patients without DT.
Retrospective chart review of patients with DT's admitted to ICU in 2008 and comparison with non-DT admissions.
During the study period there were 1800 non-DT and 38 (2%) DT admissions to the ICU. In the DT group, 90% were males, 71% Hispanic and they were younger compared to the non-DT group (49 vs 57 year-old). The most common co-morbids found in the DT group were hypertension (55%), Hepatitis C (23%), chronic liver disease (21%) and psychiatric illness (26%). Urine toxicology was available in 34/38 admission, with 38% being positive for recreational drugs. APACHE IV score was significantly lower in the DT compared to the non-DT group (P 0.005). The length of stay (LOS) in the ICU as well as the LOS on mechanical ventilation(MV) was significantly higher in the DT compared with the non-DT group (P < 0.001). ICU complications included pneumonia (44 %), rhabdomyolysis (34%), GI bleeding (13%). All the DT patients received lorazepam (average 69 mg/day, range of 4–397 mg/24 hours), haloperidol in 55%, diphenhydramine in 36 % and propofol in 18%. There was a non-significant trend for patients in the DT group to require less MV and to have a lower mortality that of the non-DT group.
Our DT admission is lower than that reported nationwide and up to 38% of those patients had alcohol and substance use. Management is challenging due to the high requirement of sedatives. Despite a lower ICU mortality, these patients have significant complications and longer LOS on MV and in ICU.
Early recognition and management of DT and awareness of the association with substance use is of the outmost importance in an inner city hospital. This could help to decrease morbidity, LOS and use of ICU resources.
Swapna Muppuri, No Financial Disclosure Information; No Product/Research Disclosure Information