Abuse and Addiction in ICU

Study Overview
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Brief Summary
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Investigators are seeking to determine the impact of recent alcohol, smoking or psychotropic drug use prior to intensive care unit (ICU) admission on incidence of delirium and sedation requirements. Study design: A prospective observational study, in a medical ICU of a tertiary university hospital. Methods: For all new ICU admissions, a 1-page questionnaire including Alcohol Use Disorders Identification Test (AUDIT-C), smoking history and prior medication use was given to the patient or closest family members. Delirium was assessed by trained ICU nurses using Intensive Care Delirium Screening Checklist and Richmond Agitation-Sedation Scale.

Official Title
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Effect of Recent Alcohol, Smoking and Psychotropic Drug Use on Delirium in ICU

Conditions
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Substance Withdrawal Syndrome

Intervention / Treatment
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* Other: AUDIT-C
* Other: Smoking history
* Other: Prior psychotropic medication use


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who are older than 18 years of age New patients admitted to medical ICU for the 1st time during their stay in hospital Exclusion Criteria: Had history of stroke or other primary neurologic disease GCS ≤ 8 prior to ICU admission Transferred from other ICU (except for emergency ICU stay which is limited to less than 36 hours) Not registered within 24 hours after admission Refused to participate If comatous state persists Delirium assessment is not possible due to newly developed neurologic disease, such as cerebral infarction Medical ICU stay less than 24 hours Readmission to medical ICU

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| AUDIT-C > 4<br>Significant alcohol use within 1 year prior to ICU admission (AUDIT-C>4) | Other: AUDIT-C<br>* Patients or their proxy/closest family member(s) undergo a comprehensive questionnaire including AUDIT-C about his/her alcohol behavior during last year and will be categorized into two groups: Those with AUDIT-C>4 versus AUDIT-C of 4 or below.<br>* Other names: Alcohol Use Disorders Identification Test;|
| AUDIT-C <=4<br>No significant alcohol use within 1 year prior to ICU admission (AUDIT-C: equal or less than 4) | Other: AUDIT-C<br>* Patients or their proxy/closest family member(s) undergo a comprehensive questionnaire including AUDIT-C about his/her alcohol behavior during last year and will be categorized into two groups: Those with AUDIT-C>4 versus AUDIT-C of 4 or below.<br>* Other names: Alcohol Use Disorders Identification Test;|
| Smoking history positive last year<br>Who smoke cigarette within 1-year prior to ICU admission | Other: Smoking history<br>* Patients or their proxy/closest family member(s) undergo a comprehensive questionnaire including smoking history during last year and will be categorized into two groups: Current smoker versus ex- or never smoker (we also recorded smoking pack-years to distinguish heavy smokers)<br>|
| Smoking history negative last year<br>Who did not smoke cigarette within 1-year prior to ICU admission | Other: Smoking history<br>* Patients or their proxy/closest family member(s) undergo a comprehensive questionnaire including smoking history during last year and will be categorized into two groups: Current smoker versus ex- or never smoker (we also recorded smoking pack-years to distinguish heavy smokers)<br>|
| Prior psychotropic medication use - yes<br>Who used psychotropic medication within 1-year prior to ICU admission | Other: Prior psychotropic medication use<br>* Patients or their proxy/closest family member(s) undergo a comprehensive questionnaire including psychotropic medication use prior admission to ICU and will be categorized into two groups: Those who use psychotropic medication versus those who do not use psychotropic medication.<br>|
| Prior psychotropic medication use - no<br>Who did not use psychotropic medication within 1-year prior to ICU admission | Other: Prior psychotropic medication use<br>* Patients or their proxy/closest family member(s) undergo a comprehensive questionnaire including psychotropic medication use prior admission to ICU and will be categorized into two groups: Those who use psychotropic medication versus those who do not use psychotropic medication.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Delirium during ICU stay |  | From date of ICU admission until the date of ICU discharge, whichever came first, assessed up to 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ICU length of stay |  | From date of ICU admission until the date of first documented discharge from ICU or death, whichever came first, assessed up to 3 months | 
| Mortality | Death in MICU | From date of ICU admission until the date of death, assessed up to 3 months | 
| Maximal doses of dexmedetomidine |  | From date of ICU admission until the date of first documented discharge from ICU or death, whichever came first, assessed up to 3 months | 
| Cumulative dose of dexmedetomidine | Cumulative dose of dexmedetomidine during the patient's MICU stay | From date of ICU admission until the date of first documented discharge from ICU or death, whichever came first, assessed up to 3 months | 
| Cumulative dose of midazolam | Cumulative dose of midazolam during the patient's MICU stay | From date of ICU admission until the date of first documented discharge from ICU or death, whichever came first, assessed up to 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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intensive care unit, delirium, substance withdrawal