Rahul D Pawar1, Lakshman Balaji2, Anne V Grossestreuer2, Garrett Thompson2, Mathias J Holmberg3, Mahmoud S Issa4, Parth V Patel2, Ryan Kronen5, Katherine M Berg6, Ari Moskowitz7, Michael W Donnino8. 1. Division of Hospital Medicine, Department of Medicine, and Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.D.P.). 2. Center for Resuscitation Science and Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (L.B., A.V.G., G.T., P.V.P.). 3. Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, and Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Randers, Denmark (M.J.H.). 4. Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts (M.S.I.). 5. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.K.). 6. Center for Resuscitation Science and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.M.B.). 7. Center for Resuscitation Science and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Division of Critical Care Medicine, Montefiore Medical Center, Bronx, New York (A.M.). 8. Center for Resuscitation Science, Department of Emergency Medicine, and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (M.W.D.).
Abstract
BACKGROUND: Thiamine supplementation is recommended for patients with alcohol use disorder (AUD). The authors hypothesize that critically ill patients with AUD are commonly not given thiamine supplementation. OBJECTIVE: To describe thiamine supplementation incidence in patients with AUD and various critical illnesses (alcohol withdrawal, septic shock, traumatic brain injury [TBI], and diabetic ketoacidosis [DKA]) in the United States. DESIGN: Retrospective observational study. SETTING: Cerner Health Facts database. PATIENTS: Adult patients with a diagnosis of AUD who were admitted to the intensive care unit with alcohol withdrawal, septic shock, TBI, or DKA between 2010 and 2017. MEASUREMENTS: Incidence and predicted probability of thiamine supplementation in alcohol withdrawal and other critical illnesses. RESULTS: The study included 14 998 patients with AUD. Mean age was 52.2 years, 77% of participants were male, and in-hospital mortality was 9%. Overall, 7689 patients (51%) received thiamine supplementation. The incidence of thiamine supplementation was 59% for alcohol withdrawal, 26% for septic shock, 41% for TBI, and 24% for DKA. Most of those receiving thiamine (n = 3957 [52%]) received it within 12 hours of presentation in the emergency department. The predominant route of thiamine administration was enteral (n = 3119 [41%]). LIMITATION: Specific dosing and duration were not completely captured. CONCLUSION: Thiamine supplementation was not provided to almost half of all patients with AUD, raising a quality-of-care issue for this cohort. Supplementation was numerically less frequent in patients with septic shock, DKA, or TBI than in those with alcohol withdrawal. These data will be important for the design of quality improvement studies in critically ill patients with AUD. PRIMARY FUNDING SOURCE: National Institutes of Health.
BACKGROUND: Thiamine supplementation is recommended for patients with alcohol use disorder (AUD). The authors hypothesize that critically ill patients with AUD are commonly not given thiamine supplementation. OBJECTIVE: To describe thiamine supplementation incidence in patients with AUD and various critical illnesses (alcohol withdrawal, septic shock, traumatic brain injury [TBI], and diabetic ketoacidosis [DKA]) in the United States. DESIGN: Retrospective observational study. SETTING: Cerner Health Facts database. PATIENTS: Adult patients with a diagnosis of AUD who were admitted to the intensive care unit with alcohol withdrawal, septic shock, TBI, or DKA between 2010 and 2017. MEASUREMENTS: Incidence and predicted probability of thiamine supplementation in alcohol withdrawal and other critical illnesses. RESULTS: The study included 14 998 patients with AUD. Mean age was 52.2 years, 77% of participants were male, and in-hospital mortality was 9%. Overall, 7689 patients (51%) received thiamine supplementation. The incidence of thiamine supplementation was 59% for alcohol withdrawal, 26% for septic shock, 41% for TBI, and 24% for DKA. Most of those receiving thiamine (n = 3957 [52%]) received it within 12 hours of presentation in the emergency department. The predominant route of thiamine administration was enteral (n = 3119 [41%]). LIMITATION: Specific dosing and duration were not completely captured. CONCLUSION: Thiamine supplementation was not provided to almost half of all patients with AUD, raising a quality-of-care issue for this cohort. Supplementation was numerically less frequent in patients with septic shock, DKA, or TBI than in those with alcohol withdrawal. These data will be important for the design of quality improvement studies in critically ill patients with AUD. PRIMARY FUNDING SOURCE: National Institutes of Health.
Authors: Jonathan M Wai; Christopher Aloezos; Wenzhu B Mowrey; Sarah W Baron; Regina Cregin; Howard L Forman Journal: J Subst Abuse Treat Date: 2019-01-23
Authors: Bertha F Polegato; Amanda G Pereira; Paula S Azevedo; Nara A Costa; Leonardo A M Zornoff; Sergio A R Paiva; Marcos F Minicucci Journal: Nutr Clin Pract Date: 2019-01-15 Impact factor: 3.080
Authors: Michael W Donnino; Lars W Andersen; Maureen Chase; Katherine M Berg; Mark Tidswell; Tyler Giberson; Richard Wolfe; Ari Moskowitz; Howard Smithline; Long Ngo; Michael N Cocchi Journal: Crit Care Med Date: 2016-02 Impact factor: 7.598