Abstract：
Pneumonia (PNA) may complicate the Severe Alcohol Withdrawal Syndrome (SAWS), with ICU admission, mechanical ventilation (MV), prolonged length of stay (LOS), and adverse events.
To examine the onset, features and courses of PNA in patients with SAWS to aid management.
A 33 month contiguous review of SAWS and PNA was conducted at an urban public hospital.
There were 279 episodes of Alcohol Withdrawal Syndrome (AWS) among 255 patients. Males predominated (91%) with a mean age of 45.8 years (range 23-73), of whom 31% (87/279) developed SAWS with ICU management. Direct ICU admission occurred for 62 patients; 25 were transferred for delirium, seizures, escalating sedation, PNA or other complications. PNA was identified for 34 ICU direct admissions and 13 ward patients. Ten transfers to the ICU also developed PNA for an ICU total of 44/87 (51%), of whom 82% (36/44) required MV. Another 10 ICU patients without PNA received MV for high dose sedation or respiratory failure. Most ICU patients (72/87 (83%)), including all with MV, required IV infusion of sedation. MV prolonged LOS, but LOS for PNA with MV was similar to all MV. ICU transfers had longer LOS with greater use of MV than direct admits (p<0.05). PNA was identified before ICU admission or transfer for 73% (32/44 (p<0.05)), and usually before intubation. Most PNA was Community Acquired Pneumonia (CAP) with P. Pneumoniae frequently cultured.
PNA with SAWS is predominately CAP and occurs early. Focused ICU admission with respiratory support are priorities of initial management.
To examine the onset, features and courses of PNA in patients with SAWS to aid management.
A 33 month contiguous review of SAWS and PNA was conducted at an urban public hospital.
There were 279 episodes of Alcohol Withdrawal Syndrome (AWS) among 255 patients. Males predominated (91%) with a mean age of 45.8 years (range 23-73), of whom 31% (87/279) developed SAWS with ICU management. Direct ICU admission occurred for 62 patients; 25 were transferred for delirium, seizures, escalating sedation, PNA or other complications. PNA was identified for 34 ICU direct admissions and 13 ward patients. Ten transfers to the ICU also developed PNA for an ICU total of 44/87 (51%), of whom 82% (36/44) required MV. Another 10 ICU patients without PNA received MV for high dose sedation or respiratory failure. Most ICU patients (72/87 (83%)), including all with MV, required IV infusion of sedation. MV prolonged LOS, but LOS for PNA with MV was similar to all MV. ICU transfers had longer LOS with greater use of MV than direct admits (p<0.05). PNA was identified before ICU admission or transfer for 73% (32/44 (p<0.05)), and usually before intubation. Most PNA was Community Acquired Pneumonia (CAP) with P. Pneumoniae frequently cultured.
PNA with SAWS is predominately CAP and occurs early. Focused ICU admission with respiratory support are priorities of initial management.
摘要：
肺炎（PNA）可能会使严重酒精戒断综合征（SAWS）复杂化，入住ICU,机械通气(MV),延长住院时间(LOS)，和不良事件。
为了检查发病情况，SAWS患者PNA的特点和病程以辅助管理。
在城市公立医院对SAWS和PNA进行了为期33个月的连续审查。
255例患者中出现279例酒精戒断综合征（AWS）。男性占主导地位（91％），平均年龄为45.8岁（范围23-73岁），其中31%(87/279)在ICU管理下开发了SAWS。62例患者直接入住ICU；25例因谵妄而转移，癫痫发作,不断升级的镇静，PNA或其他并发症。确定了34例ICU直接入院和13例病房患者的PNA。向ICU的十次转移还开发了PNA，ICU总数为44/87（51％），其中82%(36/44)需要MV。另外10名没有PNA的ICU患者因高剂量镇静或呼吸衰竭而接受了MV。大多数ICU患者（72/87（83％）），包括所有带MV的，需要静脉输注镇静。MV延长LOS,但带MV的PNA的LOS与所有MV相似。ICU转移的LOS更长，MV的使用比直接入院更多（p<0.05）。在ICU入院或转院前发现PNA的比例为73%(32/44(p<0.05))，通常在插管前。大多数PNA是社区获得性肺炎（CAP），肺炎克雷伯菌频繁培养。
具有SAWS的PNA主要是CAP并且早期发生。有呼吸支持的重点ICU入院是初始管理的优先事项。
为了检查发病情况，SAWS患者PNA的特点和病程以辅助管理。
在城市公立医院对SAWS和PNA进行了为期33个月的连续审查。
255例患者中出现279例酒精戒断综合征（AWS）。男性占主导地位（91％），平均年龄为45.8岁（范围23-73岁），其中31%(87/279)在ICU管理下开发了SAWS。62例患者直接入住ICU；25例因谵妄而转移，癫痫发作,不断升级的镇静，PNA或其他并发症。确定了34例ICU直接入院和13例病房患者的PNA。向ICU的十次转移还开发了PNA，ICU总数为44/87（51％），其中82%(36/44)需要MV。另外10名没有PNA的ICU患者因高剂量镇静或呼吸衰竭而接受了MV。大多数ICU患者（72/87（83％）），包括所有带MV的，需要静脉输注镇静。MV延长LOS,但带MV的PNA的LOS与所有MV相似。ICU转移的LOS更长，MV的使用比直接入院更多（p<0.05）。在ICU入院或转院前发现PNA的比例为73%(32/44(p<0.05))，通常在插管前。大多数PNA是社区获得性肺炎（CAP），肺炎克雷伯菌频繁培养。
具有SAWS的PNA主要是CAP并且早期发生。有呼吸支持的重点ICU入院是初始管理的优先事项。
