【每日动态】糖皮质激素可诱发急性肺损伤患者的谵妄
这个帖子发布于 10 年零 148 天前，其中的信息可能已发生改变或有所发展。
Abstract
Objective. Delirium is common inmechanically ventilated patients in the ICU and associated with short- andlong-term morbidity and mortality. The use of systemic corticosteroids is alsocommon in the ICU. Outside the ICU setting, corticosteroids are a recognizedrisk factor for delirium, but their relationship with delirium in criticallyill patients has not been fully evaluated. We hypothesized that systemiccorticosteroid administration would be associated with a transition to deliriumin mechanically ventilated patients with acute lung injury.
Design. Prospective cohort study.
Setting. Thirteen ICUs in four hospitals inBaltimore, MD.
Patients. Five hundred twenty mechanicallyventilated adult patients with acute lung injury.
Interventions. None.
Measurements and Main Results. Deliriumevaluation was performed by trained research staff using the validatedConfusion Assessment Method for the ICU screening tool. A total of 330 of the520 patients (64%) had at least two consecutive ICU days of observation inwhich delirium was assessable (e.g., patient was noncomatose), with a total of2,286 days of observation and a median (interquartile range) of 15 (9, 28)observation days per patient. These 330 patients had 99 transitions intodelirium from a prior nondelirious, noncomatose state. The probability oftransitioning into delirium on any given day was 14%. Using multivariableMarkov models with robust variance estimates, the following factors (adjustedodds 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 ≥ 60yr [2.52; 1.65–3.87]) and administration of any systemic corticosteroid in theprior 24 hours (1.52; 1.05–2.21).
Conclusions. After adjusting for other riskfactors, systemic corticosteroid administration is significantly associatedwith transitioning to delirium from a nondelirious state. The risk of deliriumshould be considered when deciding about the use of systemic corticosteroids incritically ill patients with acute lung injury.
Objective. Delirium is common inmechanically ventilated patients in the ICU and associated with short- andlong-term morbidity and mortality. The use of systemic corticosteroids is alsocommon in the ICU. Outside the ICU setting, corticosteroids are a recognizedrisk factor for delirium, but their relationship with delirium in criticallyill patients has not been fully evaluated. We hypothesized that systemiccorticosteroid administration would be associated with a transition to deliriumin mechanically ventilated patients with acute lung injury.
Design. Prospective cohort study.
Setting. Thirteen ICUs in four hospitals inBaltimore, MD.
Patients. Five hundred twenty mechanicallyventilated adult patients with acute lung injury.
Interventions. None.
Measurements and Main Results. Deliriumevaluation was performed by trained research staff using the validatedConfusion Assessment Method for the ICU screening tool. A total of 330 of the520 patients (64%) had at least two consecutive ICU days of observation inwhich delirium was assessable (e.g., patient was noncomatose), with a total of2,286 days of observation and a median (interquartile range) of 15 (9, 28)observation days per patient. These 330 patients had 99 transitions intodelirium from a prior nondelirious, noncomatose state. The probability oftransitioning into delirium on any given day was 14%. Using multivariableMarkov models with robust variance estimates, the following factors (adjustedodds 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 ≥ 60yr [2.52; 1.65–3.87]) and administration of any systemic corticosteroid in theprior 24 hours (1.52; 1.05–2.21).
Conclusions. After adjusting for other riskfactors, systemic corticosteroid administration is significantly associatedwith transitioning to delirium from a nondelirious state. The risk of deliriumshould be considered when deciding about the use of systemic corticosteroids incritically ill patients with acute lung injury.
