Friday, June 6, 2014

Steroids and Delirium in ICU

Delirium is common in mechanically ventilated patients in the ICU and associated with short- and long-term morbidity and mortality. The use of systemic corticosteroids is also common in the ICU. Outside the ICU setting, corticosteroids are a recognized risk factor for delirium, but their relationship with delirium in critically ill patients has not been fully evaluated. We hypothesized that systemic corticosteroid administration would be associated with a transition to delirium in mechanically ventilated patients with acute lung injury.
Design: Prospective cohort study.
Setting: Thirteen ICUs in four hospitals in Baltimore, MD.
Patients: Five hundred twenty mechanically ventilated adult patients with acute lung injury.

Delirium evaluation was performed by trained research staff using the validated Confusion Assessment Method for the ICU screening tool. A total of 330 of the 520 patients (64%) had at least two consecutive ICU days of observation in which delirium was assessable (e.g., patient was noncomatose), with a total of 2,286 days of observation and a median (interquartile range) of 15 (9, 28) observation days per patient. These 330 patients had 99 transitions into delirium from a prior nondelirious, noncomatose state. The probability of transitioning into delirium on any given day was 14%. Using multivariable Markov models with robust variance estimates, the following factors (adjusted odds ratio; 95% CI) were independently associated with transition to delirium:
older age (compared to < 40 years old, 40–60 yr [1.81; 1.26–2.62], and ≥ 60 yr [2.52; 1.65–3.87]) and
administration of any systemic corticosteroid in the prior 24 hours (1.52; 1.05–2.21).

After adjusting for other risk factors, systemic corticosteroid administration is significantly associated with transitioning to delirium from a nondelirious state. The risk of delirium should be considered when deciding about the use of systemic corticosteroids in critically ill patients with acute lung injury.

Schreiber, Matthew P. MD, MHS; Colantuoni, Elizabeth PhD; Bienvenu, Oscar J. MD, PhD; Neufeld, Karin J. MD, MPH; Chen, Kuan-Fu MD, PhD; Shanholtz, Carl MD; Mendez-Tellez, Pedro A. MD; Needham, Dale M. MD, PhD - Corticosteroids and Transition to Delirium in Patients With Acute Lung Injury - Critical Care Medicine: June 2014 - Volume 42 - Issue 6 - p 1480-1486

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