Mckenzie, C. (2015) Corticosteroids in delirium: Yet another critical care conundrum? Critical Care Medicine, 43 (12), 2703-2704. (doi:10.1097/CCM.0000000000001436).
Abstract
In this issue of Critical Care Medicine, Wolters et al (1) report an important piece of work undertaken in a mixed medical and surgical ICU in The Netherlands. The authors conducted a prospective case control study in which they showed no association between the presence of corticosteroids and the transition to delirium. Daily mental status was classified as “coma”, “delirium,” or an “awake without delirium” state. Transitions between states were analyzed using a first-order Markov multinomial logistic regression model with 11 different covariables.
This is an important piece of work for the critical care multidisciplinary team. We are familiar with increase in mortality, morbidity, and long-term cognitive concerns that can be caused by critical care delirium (2, 3). There is also the less measured human cost of observing a dear relative or friend “going mad” acting aggressively to staff or appearing terrified out of their wits (4).
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