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Corticosteroids and transition to delirium in patients with acute lung injury.

Abstract：

OBJECTIVE: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. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS: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). CONCLUSIONS: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.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Schreiber MP,Colantuoni E,Bienvenu OJ,Neufeld KJ,Chen KF,Shanholtz C,Mendez-Tellez PA,Needham DM

doi

10.1097/CCM.0000000000000247

subject

Has Abstract

pub_date

2014-06-01 00:00:00

pages

1480-6

issue

eissn

0090-3493

issn

1530-0293

journal_volume

pub_type

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Corticosteroids and transition to delirium in patients with acute lung injury.