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Critical Care Medicine:
doi: 10.1097/CCM.0000000000000247
Clinical Investigations

Corticosteroids and Transition to Delirium in Patients With Acute Lung Injury*

Schreiber, Matthew P. MD, MHS1; Colantuoni, Elizabeth PhD2,3; Bienvenu, Oscar J. MD, PhD3,4; Neufeld, Karin J. MD, MPH3,4; Chen, Kuan-Fu MD, PhD5; Shanholtz, Carl MD6; Mendez-Tellez, Pedro A. MD3,7; Needham, Dale M. MD, PhD3,8,9

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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.

Copyright © 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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