Steroids prescribed in the ICU linked to delirium

May 27, 2014

New Johns Hopkins research suggests that critically ill patients receiving steroids in a hospital's intensive care unit (ICU) are significantly more likely to develop delirium. Results of their research, they say, suggest minimizing the use of steroids could reduce delirium in the ICU.

While it usually goes away after a few days, studies show in the ICU has a long-term impact. It has been associated with worse functional recovery and cognitive impairments of a magnitude consistent with moderate traumatic brain injury or mild Alzheimer's disease.

Overall, up to 80 percent of ventilated patients develop delirium in the ICU, and researchers have been looking for risk factors.

In a report published in the June issue of the journal Critical Care Medicine, the investigators said that in more than one-third of the ICU days evaluated, mechanically with were given systemic corticosteroids at a range of doses during their ICU stay.

For the study, researchers looked at the medical records of 330 acute lung injury patients with a collective 2,286 days in an ICU at four Baltimore hospitals between October 2004 and October 2007. They found that patients were 52 percent more likely to newly develop delirium if they had been treated with steroids on the prior day. Older age was also associated with an increased risk of developing delirium. Delirium can be marked by poor memory and thinking, sometimes with disorientation, hallucinations and agitation.

"We need to be cautious in our use of steroids in and weigh the risks and benefits of using them," says study leader Dale M. Needham, M.D., Ph.D., an associate professor of medicine and of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. "Sometimes they are necessary, but we need to be thoughtful about minimizing the dose and duration of steroid use when possible."

Needham says there are a wide variety of reasons why an ICU patient would receive steroids. They may be ordered to respond to inflammation in the lung or elsewhere in the body. Steroids also were used frequently to treat septic shock in the ICU, but more recent studies have shown fewer benefits from steroids in this condition.

Other research being done by Needham and his group suggests that may also have an effect on patients' physical impairments after they leave the ICU.

Explore further: Team finds first biomarker linked to delirium duration

Related Stories

Team finds first biomarker linked to delirium duration

December 16, 2013
Researchers from the Regenstrief Institute and the Indiana University Center for Aging Research have identified the first biomarker that appears to be linked to the duration of delirium. This novel role for S100ß as a biomarker ...

Longer stay in hospital ICU has lasting impact on quality of life

April 2, 2014
Patients have substantial physical impairments even two years after being discharged from the hospital after a stay in an intensive care unit (ICU), new Johns Hopkins research suggests.

PTSD symptoms common after an ICU stay

May 19, 2014
Patients who have survived a stay in the intensive care unit (ICU) have a greatly increased risk of developing symptoms of post-traumatic stress disorder (PTSD), according to a new study presented at the 2014 American Thoracic ...

Statin use reduces delirium in critically ill patients

January 17, 2014
Continued use of statins may help prevent delirium in critically ill patients who received statins before hospital admission, according to a new study of 470 intensive care patients in the UK.

Long-term cognitive impairment too common after critical illness

October 2, 2013
Patients treated in intensive care units across the globe are entering their medical care with no evidence of cognitive impairment but oftentimes leaving with deficits similar to those seen in patients with traumatic brain ...

Simple measures to promote sleep can reduce delirium in intensive care patients

February 20, 2013
A hospital is not the best place to get a good night's sleep, especially in a noisy intensive care unit. It's a cause for concern because studies have shown that a lack of sleep can cause patients to experience delirium—an ...

Recommended for you

To reduce postoperative pain, consider sleep—and caffeine

August 18, 2017
Sleep is essential for good mental and physical health, and chronic insufficient sleep increases the risk for several chronic health problems.

Despite benefits, half of parents against later school start times

August 18, 2017
Leading pediatrics and sleep associations agree: Teens shouldn't start school so early.

Doctors exploring how to prescribe income security

August 18, 2017
Physicians at St. Michael's Hospital are studying how full-time income support workers hired by health-care clinics can help vulnerable patients or those living in poverty improve their finances and their health.

Schoolchildren who use e-cigarettes are more likely to try tobacco

August 17, 2017
Vaping - or the use of e-cigarettes - is widely accepted as a safer option for people who are already smoking.

Federal snack program does not yield expected impacts, researchers find

August 17, 2017
A well-intentioned government regulation designed to offer healthier options in school vending machines has failed to instill better snacking habits in a sample of schools in Appalachian Virginia, according to a study by ...

Study shows cigarette makers shifted stance on nicotine patches, gum

August 17, 2017
The use of nicotine patches, gum, lozenges, inhalers or nasal sprays—together called "nicotine replacement therapy," or NRT—came into play in 1984 as prescription medicine, which when combined with counseling, helped ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.