A daily pint could protect intensive care patients from delirium

Giving patients in intensive care a pint of beer daily could get them home sooner. That’s the basis for a new clinical trial at university Hospital in Basel, Switzerland, where 118 patients will be given a daily serving of half-a-litre (just under a pint) of beer to see if it protects them against delirium.

Delirium affects up to 80 per cent of people admitted to intensive care units (iCus), often triggering terrifying

hallucinations, confusion, aggression and lack of concentration.

it’s caused by a range of factors, from reduced oxygen flow to the brain (due to, for example, severe respiratory infections such as Covid-19 or pneumonia), to pain from illness or injury.

normally when the brain senses stress or risk of injury, it releases a chemical called catecholamine as part of the fight-or-flight response. But in severe pain, such as that often experienced by patients in iCu, abnormally high levels of the chemical are produced — which ‘flood’ the brain and cause the symptoms of delirium.

Studies show patients who suffer delirium spend an average of 21 days in intensive care, compared with nine for other patients.

even when they’re discharged, their problems can persist: they’re more at risk of dementia, due to the permanent effects of delirium on the brain and have higher rates of post-traumatic stress disorder and depression.

Some conditions, such as high blood pressure or chronic lung disease (such as emphysema or bronchitis), can increase the chances of delirium. But even those with no apparent underlying risk factors can be affected.

Treatment for delirium typically involves improving pain control, reducing the amount of sedation patients receive (to make them more lucid) and, where possible, taking them off mechanical ventilators to reduce their sense of detachment from the real world.

Doctors setting up the new trial believe a daily tipple could prevent delirium in the first place, because of the calming effects that both a small amount of alcohol and the hops in beer can have.

‘Hops contain humulone [a chemical that gives them their bitter taste], which has been shown to have a calming effect and improve sleep quality,’ they said.

it’s well-known that heavy drinkers admitted to intensive care are more likely to suffer delirium because they experience alcohol withdrawal while in hospital. But the Swiss team is convinced the same withdrawal symptoms also affect sensible drinkers. So as well as the natural calming effect, beer is also thought to reduce any feelings of alcohol withdrawal.

in the trial, due to start next March for 12 months, iCu patients will be split into three groups: those given beer, another alcoholfree beer, and the rest no beer at all — daily for six days.

The aim of the trial is to see if beer reduces delirium and whether alcoholic beer has a greater effect than alcohol-free varieties. (The risks of giving very sick people alcohol are relatively low, as beer is not especially high in alcohol.)

Dr ron Daniels, an intensive care consultant at university Hospitals Birmingham nHS Foundation Trust, said the trial made sense because using small amounts of alcohol to ward off delirium was once fairly common practice in the nHS.

‘in some intensive care units, doctors used to give ethyl alcohol [pure alcohol] into the bloodstream to counter delirium. it fell out of favour because it was perceived as slightly distasteful.’