Clark Brendan J, Jones Jacqueline, Reed K Diandra, Hodapp Rachel, Douglas Ivor S, Van Pelt David, Burnham Ellen L, Moss Marc
1 Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado.
2 University of Colorado College of Nursing, Denver, Colorado.
Ann Am Thorac Soc. 2017 Jul;14(7):1154-1161. doi: 10.1513/AnnalsATS.201611-854OC.
Alcohol misuse is common in patients admitted to the intensive care unit (ICU), but there is currently no evidence-based approach to address drinking in ICU survivors.
We sought to describe the experience of ICU survivors with alcohol misuse during their hospitalization and the 3 months after hospital discharge to inform an alcohol-specific intervention for this unique population.
We conducted a descriptive qualitative study of ICU survivors from medical ICUs in three separate hospitals with a positive screening result on the Alcohol Use Disorders Identification Test. Semistructured interviews were conducted 3 months after hospital discharge of patients. Patients were also allowed to nominate up to two friends or family members for enrollment to provide additional perspective on the patient's experience.
We enrolled 50 patients and 22 of their friends and/or family members. The average APACHE II score was 23, 80% of patients were male, and the average age was 50 years; 70% of patients and 77% of friends/family members completed the semistructured interview 3 months after hospital discharge. We identified three domains that could inform an alcohol-specific intervention, each with multiple themes: motivation with complications (anxiety and depression, critical illness as a catalyst, delirium and cognitive impairment); therapeutic alliance (autonomy, failure and opportunities to build a therapeutic alliance); and the return to the home milieu (lack of screening for depression and anxiety, social network support for drinking, social isolation, social network support for abstinence, lack of available and affordable treatment, and negative experiences with Alcoholics Anonymous).
An alcohol intervention for ICU survivors would account for the context in which patients are making a decision about their drinking and optimize the patient-provider interaction. Contrary to current paradigms that focus on addressing alcohol consumption only during a hospitalization, an intervention for ICU survivors should continue as patients transition from the hospital to home.
在重症监护病房（ICU）收治的患者中，酒精滥用情况较为常见，但目前尚无基于证据的方法来解决ICU幸存者的饮酒问题。
我们试图描述ICU幸存者在住院期间以及出院后3个月内酒精滥用的经历，以为针对这一特殊人群的酒精专项干预提供参考。
我们对来自三家不同医院内科ICU的ICU幸存者进行了一项描述性定性研究，这些幸存者在酒精使用障碍识别测试中的筛查结果为阳性。在患者出院3个月后进行半结构化访谈。患者还可提名最多两名朋友或家人参与，以提供关于患者经历的更多观点。
我们纳入了50名患者及其22名朋友和/或家人。急性生理与慢性健康状况评分系统（APACHE II）的平均得分为23分，80%的患者为男性，平均年龄为50岁；70%的患者以及77%的朋友/家人在出院3个月后完成了半结构化访谈。我们确定了三个可为酒精专项干预提供参考的领域，每个领域都有多个主题：伴有并发症的动机（焦虑和抑郁、危重病作为催化剂、谵妄和认知障碍）；治疗联盟（自主性、建立治疗联盟的失败与机遇）；以及回归家庭环境（缺乏对抑郁和焦虑的筛查、饮酒的社会网络支持、社会隔离、戒酒的社会网络支持、缺乏可用且负担得起的治疗，以及戒酒互助会的负面经历）。
针对ICU幸存者的酒精干预应考虑患者做出饮酒决定时的背景情况，并优化患者与提供者之间的互动。与目前仅关注住院期间饮酒问题的模式不同，针对ICU幸存者的干预应在患者从医院过渡到家庭的过程中持续进行。
