title: 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.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Thirteen ICUs in four hospitals in Baltimore, MD.
  
  
  METHODS
  Five hundred twenty mechanically ventilated adult patients with acute lung injury.
  
  
  METHODS
  None.
  
  
  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.
authors.affiliation: 1Division of Pulmonary and Critical Care, University of Nevada School of Medicine, Las Vegas, NV. 2Department of Biostatistics, Johns Hopkins University, Baltimore, MD. 3Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD. 4Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD. 5Department of Emergency Medicine, Chang Gung University and Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan 6Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD. 7Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University, Baltimore, MD. 8Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD. 9Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Schreiber
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Bienvenu
authors.forename: Karin J
authors.initials: KJ
authors.lastname: Neufeld
authors.forename: Kuan-Fu
authors.initials: KF
authors.lastname: Chen
authors.forename: Carl
authors.initials: C
authors.lastname: Shanholtz
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Mendez-Tellez
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D018806:APACHE; D055371:Acute Lung Injury / Q000150:complications / Q000188:drug therapy*; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000367:Age Factors; D016638:Critical Illness / Q000628:therapy; D003693:Delirium / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones