Alcohol Withdrawal Patient Is Taken Off ICU Ventilator Prematurely

This case involves a 45-year-old female patient with a history of alcohol abuse who presented to the hospital with complaints of abdominal pain. She was admitted for management of alcohol withdrawal. During the course of her admission, the patient was admitted to the ICU. The patient eventually deteriorated and was found unresponsive with respiratory depression, however, she was taken off breathing assistance. A subsequent chest X-ray showed fluid in her lungs. Two days later, the patient suffered cardiopulmonary arrest.

Question(s) For Expert Witness

1. How often do you manage patients with alcohol withdrawal that are put on respiratory assistance in the ICU?

2. Would managing a patient with alcohol withdrawal in the ICU require precautions that are otherwise not required for other patients?

3. What qualifies a patient to be taken off respiratory assistance while in the ICU?

Expert Witness Response E-135423

I frequently manage patients with alcohol withdrawal in the ICU, many of whom have required some form of respiratory assistance (both noninvasive and invasive mechanical ventilation). Due to the medical strategies needed to appropriately manage withdrawal symptoms, patients with alcohol withdrawal require particular precautions. These include close monitoring of their ability to maintain airway latency and protection in the context of both alcohol withdrawal itself and side effects of alcohol withdrawal medications. Ideally, patients are managed in a way that avoids the need for invasive mechanical ventilation, though depending on the severity of withdrawal, this strategy may not be feasible. Typically, the ability to maintain adequate ventilation and oxygenation with an appropriate mental status and the ability to protect their airway qualifies a person to be removed from respiratory assistance in the ICU. However, specific considerations that apply to noninvasive ventilation that differ from invasive mechanical ventilation. Certain circumstances make noninvasive ventilation inappropriate even if they continue to require respiratory assistance.