Drug withdrawal, cocaine and sedative use disorders increase the need for mechanical ventilation in medical patients

Aims: Alcohol use disorders increase the need for mechanical ventilation (MV) in critically ill medical, surgical and trauma patients. Studies examining other drug use disorders (DUD) in trauma patients have not demonstrated heightened rates of intensive care unit (ICU) complications. Patients with asthma and concurrent cocaine or heroin use disorders have an increased need for MV. The objective of this study is to determine if the presence of DUD and drug withdrawal syndromes are associated with increased need for MV in medical patients. Design: Analysis of a national database. Setting: The Nationwide Inpatient Sample, the largest all-payer in-patient database was utilized for the years 2002-2004. Participants: Adult patients with one of the six common diagnoses associated with medical ICU admission were included. Intervention: None. Measurements: Univariate analysis and multivariate logistic regression were performed to determine if DUD and drug withdrawal were associated independently with the use of MV. Findings: A total 1 218 875 patients fulfilled one of the six diagnoses; 22 827 (1.9%) had DUD, and 102 841 (8.4%) underwent MV. Independent of the medical diagnosis, DUD was associated with an increased risk for requiring MV by univariate analysis (relative risk = 1.50, P < 0.0001). By multivariate analyses, sedative and cocaine use disorders remained associated with increased need for MV. Independent of medical diagnosis and substance, drug withdrawal was associated with increased odds of MV by both univariate and multivariate analysis (odds ratio = 2.94, P < 0.0001). Conclusions: DUD are associated with increased need for MV in medical patients. This study demonstrates the importance of screening all medical patients for DUD.