It is rather common to prescribe corticosteroids to patients who are receiving treatment in intensive care units (Schreiber et al., 2014). However, recent studies have found that the use of steroids by patients in ICUs (specifically, patients with acute lung injury or other lung problems) is connected to the increased risk of delirium (Schreiber et al., 2014; Fong, Tulebaev, and Inouye, 2009). It has also been shown that steroids ought to be considered an additional risk factor of delirium for elderly patients (Fong et al. 2009); it has been recorded that, combined with other drugs, it can directly cause confusion and hallucination (Moss, Kemp, & Brown, 2014).
Fong et al. (2009) state that:
- postoperative delirium is a common phenomenon among elderly patients. It affects 15-53% of patients aged more than 65; the frequency significantly increases among the elderly patients treated in ICUs, reaching 70-87%;
- corticosteroids, among some other medications, increase the risk of delirium;
- cortisol, a steroid hormone, combined with acute stress, is believed to hasten and/or maintain delirium;
- steroids can lead to a decrease in cognitive function (though it occurs not in all patients).
Skwarecki (2014), who summarizes the findings of Schreiber et al. (2014), asserts that:
- systemic corticosteroid usage has been shown to have a major correlation to the delirious state among patients who were undergoing mechanical ventilation;
- during the study, 330 patients who had acute lung injury; were receiving mechanical ventilation; were not comatose for no less than two consecutive days; and had not had a preexisting dementia, language, or cognitive impairments, were observed;
- among these patients, “41% of the time they had been given steroids on the previous day compared with 34% of days that did not transition to delirium”;
- on the whole, the systematic usage of corticosteroids was significantly related to the transition to the delirious state;
- older age (40-60 years, or over 60 years) was also shown to have a crucial relation to the development of delirium;
- therefore, it is of paramount importance to carefully consider all the risks and benefits of prescribing steroids to patients with acute lung injury treated in ICUs, especially to those of elderly age.
According to another study by Moss et al. (2014), it is evident that:
- steroid psychosis is not an uncommon occurrence among patients who are receiving glucocorticoids orally;
- the research literature does not suggest that there is a link between the delirious state and the combination of long-acting beta-agonists and inhaled glucocorticoids;
- however, an elderly patient (aged 89) with the chronic obstructive pulmonary disease hallucinated and suffered from confusion within a week after being administered the inhaled combination of budesonide (a glucocorticoid steroid) and formoterol;
- after the cancellation of the inhaled budesonide and formoterol combination, the patient’s hallucinations and confusion ceased.
These studies make it evident that the prescription of corticosteroids to patients who receive treatment in ICUs should be done carefully, with thorough consideration of both the positive and negative outcomes it might cause. The research by Schreiber et al. (2014), as well as the study by Fong et al. (2009), also show that the elderly age has a significant association with the risk of delirium; therefore, the prescription of steroids should be done with even more caution to the patients belonging to this age group.
References
Fong, T. G., Tulebaev, S. R., & Inouye, S. K. (2009). Delirium in elderly adults: Diagnosis, prevention and treatment. Nature Reviews Neurology, 5(4), 210-220. Web.
Moss, J. M., Kemp, D. W., & Brown, J. N. (2014). Combination of inhaled corticosteroid and bronchodilator-induced delirium in an elderly patient with lung disease. Journal of Pharmacy Practice, 27(1), 79-83. Web.
Schreiber, M. P., Colantuoni, E., Bienvenu, O. J., Neufeld, K. J., Chen, K.-F., Shanholtz, C.,…Needham, D. M. (2014). Corticosteroids and transition to delirium in patients with acute lung injury. Critical Care Medicine, 42(6), 1480-1486. Web.
Skwarecki, B. (2014). Steroid use in ICU may increase risk for delirium. Web.