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The Impact of Alcohol Abuse on Multiple Organ Dysfunction in the Surgical Patient

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Alcohol Use Disorders and the Lung

Part of the book series: Respiratory Medicine ((RM,volume 14))

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Abstract

Individuals with an alcohol-use disorder (AUD) admitted to trauma and/or surgical services in hospital show a two- to fourfold higher rate of postoperative complications, leading to longer hospital stays and increased mortality. Chronic alcohol consumption damages the central and peripheral nerve system and can cause a severe state of physiological withdrawal called the “alcohol withdrawal syndrome” that when manifested during their management in the intensive care unit (ICU) is associated with more adverse outcomes, both in the ICU and after hospital discharge. Often unrecognized, decreased beta-endorphin levels in these individuals may cause their pain to be more pronounced. In parallel, the risk for cardiac complications including arrhythmias and circulatory insufficiency in the postoperative period is increased up to fivefold in individuals with an AUD. Further, alcohol-induced hepatic insufficiency when present leads to higher levels of toxic substances, including ammonia and lactic acid, and promotes insulin resistance and decreased cellular glucose uptake. In addition, disturbances in haemostasis, including decreased platelet function and impaired hepatic synthesis of coagulation factors, are associated with (if not causative of) a twofold increased risk of postoperative bleeding complications. Finally, alterations in the neuroendocrine axis and in the immune system result in a three- to fivefold increased risk of nosocomial infections including pneumonia, wound infections and urinary tract infections. As a result of these myriad pathophysiological mechanisms, surgical patients with an AUD require increased attention to promote a good response to treatment and to minimize their risk of developing multiple organ failure.

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Abbreviations

ACE:

Angiotensin-converting enzyme

ADH:

Antidiuretic hormone

AUD:

Alcohol-use disorder

AUDIT:

Alcohol-use disorder identification test

AWS:

Alcohol withdrawal syndrome

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

CAD:

Coronary artery disease

CAGE:

Cut down, annoyance, guilty, eye opener

CAM-ICU:

Confusion Assessment Method for the ICU

CDT:

Carbohydrate-deficient transferrin

CHD:

Coronary heart disease

CIWA-Ar:

Clinical Institute Withdrawal Assessment for Alcohol-Revised scale

DDS:

Delirium Detection Score

DIA:

Daily alcohol intake

EtG:

Ethylglucuronide

EtOH:

Ethanol

ICDSC:

Intensive Care Delirium Screening Checklist

IFN:

Interferon

IL:

Interleukin

ITS:

Intensive care unit

GABA-A:

Gamma-aminobutyric acid type-A

GGT:

y-Glutamyl transpeptidase

MCV:

Mean corpuscular volume

NMDA:

N-Methyl-d-aspartate

PBMC:

Peripheral blood monocytes

PEA:

Pulseless electrical activity

PEth:

Phosphatidylethanol

RASS:

Richmond Agitation–Sedation Scale

TNF:

Tumour necrosis factor

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine Mitte and Campus Virchow Klinikum Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany

    Katharina Chalk M.D. & Claudia Spies M.D.

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  1. Katharina Chalk M.D.
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  2. Claudia Spies M.D.
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Correspondence to Claudia Spies M.D. .

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  1. Division of Pulmonary, Allergy and Critical Care Medicine, Emory University School of Medicine and the Atlanta VA Medical Center, Atlanta, Georgia, USA

    David M. Guidot

  2. Division of Pulmonary, Allergy and Critical Care Medicine, Emory University School of Medicine and the Atlanta VA Medical Center, Decatur, Georgia, USA

    Ashish J. Mehta

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Chalk, K., Spies, C. (2014). The Impact of Alcohol Abuse on Multiple Organ Dysfunction in the Surgical Patient. In: Guidot, D., Mehta, A. (eds) Alcohol Use Disorders and the Lung. Respiratory Medicine, vol 14. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4614-8833-0_14

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