Delirium is a common complication of critically ill patients and is often associated with metabolic disorders. One of the most frequent metabolic disorders in intensive care unit (ICU) patients is hyperglycaemia. The aim of this retrospective study of 196 adult ICU patients was to determine if there is an association between hyperactive delirium and blood glucose levels in ICU patients. Hyperactive delirium was diagnosed using the delirium detection score. Blood glucose levels were monitored by blood gas analysis every 4 h. Hyperactive delirium was detected in 55 (28%) patients. Delirious patients showed significantly higher blood glucose levels than non-delirious patients Higher overall complication rates, length of ventilation, ICU stay and mortality rates were seen in the delirium group. In a multivariate analysis, glucose level, alcohol abuse, APACHE II score, complication by hospital-acquired pneumonia and a diagnosis of polytrauma on-admission all significantly influenced the appearance of delirium.
RummansTAEvansJMKrahnLE: Delirium in elderly patients: Evaluation and management. Mayo Clin Proc1995; 70: 989–998.
2.
FrancisJMartinDKapoorWN: A prospective study of delirium in hospitalized elderly. JAMA1990; 263: 1097–1101.
3.
McNicollLPisaniMAZhangY: Delirium in the intensive care unit: Occurrence and clinical course in older patients. J Am Geriatr Soc2003; 51: 591–598.
4.
InouyeSK: The dilemma of delirium: Clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med1994; 97: 278–288.
5.
ElyEWGautamSMargolinR: The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med2001; 27: 1892–1900.
6.
ElyEWInouyeSKBernardGR: Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA2001; 286: 2703–2710.
7.
PandharipandePShintaniAPetersonJ: Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology2006; 104: 21–26.
8.
ButlerSOBtaicheIFAlanizC: Relationship between hyperglycemia and infection in critically ill patients. Pharmacotherapy2005; 25: 963–976.
9.
OtterHMartinJBasellK: Validity and reliability of the DDS for severity of delirium in the ICU. Neurocrit Care2005; 2: 150–158.
10.
TrzepaczPT: Update on the neuropathogenesis of delirium. Dement Geriatr Cogn Disord1999; 10: 330–334.
11.
HawleyRJNemeroffCBBissetteG: Neurochemical correlates of sympathetic activation during severe alcohol withdrawal. Alcohol Clin Exp Res1994; 18: 1312–1316.
12.
AdinoffBRuetherKKrebaumS: Increased salivary cortisol concentrations during chronic alcohol intoxication in a naturalistic clinical sample of men. Alcohol Clin Exp Res2003; 27: 1420–1427.
13.
RobertssonBBlennowKBraneG: Hyperactivity in the hypothalamic—pituitary—adrenal axis in demented patients with delirium. Int Clin Psychopharmacol2001; 16: 39–47.
14.
WackerPNunesPVCabritaH: Post-operative delirium is associated with poor cognitive outcome and dementia. Dement Geriatr Cogn Disord2006; 21: 221–227.
15.
JacksonJCGordonSMHartRP: The association between delirium and cognitive decline: A review of the empirical literature. Neuropsychol Rev2004; 14: 87–98.
16.
MilbrandtEBDeppenSHarrisonPL: Costs associated with delirium in mechanically ventilated patients. Crit Care Med2004; 32: 955–962.
17.
ElyEWShintaniATrumanB: Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA2004; 291: 1753–1762.
18.
ThomasonJWShintaniAPetersonJF: Intensive care unit delirium is an independent predictor of longer hospital stay: A prospective analysis of 261 non-ventilated patients. Crit Care2005; 9: R375–R381.
19.
ElyEWMargolinRFrancisJ: Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med2001; 29: 1370–1379.
20.
MeagherDJO'HanlonDO'MahonyE: Relationship between etiology and phenomenologic profile in delirium. J Geriatr Psychiatry Neurol1998; 11: 146–149.
21.
PunBTGordonSMPetersonJF: Large-scale implementation of sedation and delirium monitoring in the intensive care unit: A report from two medical centers. Crit Care Med2005; 33: 1199–1205.
22.
KrahneDHeymannASpiesC: How to monitor delirium in the ICU and why it is important. Clin Effectiveness Nurs2006; 10: 1016–1027.
23.
IngelsCDebaveyeYMilantsI: Strict blood glucose control with insulin during intensive care after cardiac surgery: Impact on 4-years survival, dependency on medical care, and quality-of-life. Eur Heart J2006; 27: 2716–2724.
24.
Van den BergheGWoutersPWeekersF: Intensive insulin therapy in the critically ill patients. N Engl J Med2001; 345: 1359–1367.
25.
GandhiGYNuttallGAAbelMD: Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc2005; 80: 862–866.
26.
YildizeliBOzyurtkanMOBatirelHF: Factors associated with postoperative delirium after thoracic surgery. Ann Thorac Surg2005; 79: 1004–1009.
27.
LangoucheLVan den BergheG: Glucose metabolism and insulin therapy. Crit Care Clin2006; 22: 119–129.
28.
Van den BergheGWilmerAHermansG: Intensive insulin therapy in the medical ICU. N Engl J Med2006; 354: 449–461.
29.
FinneySJZekveldCEliaA: Glucose control and mortality in critically ill patients. JAMA2003; 290: 2041–2047.
30.
KnausWADraperEAWagnerDP: APACHE II: A severity of disease classification system. Crit Care Med1985; 13: 818–829.
31.
GarnerJSJarvisWREmoriTG: CDC definitions for nosocomial infections, 1988. Am J Infect Control1988; 16: 128–140.
32.
American Thoracic Society: Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med2005; 171: 388–416.
33.
DellingerRPCarletJMMasurH: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med2004; 30: 536–555.
34.
AugoustidesJGFloydTFMcGarveyML: Major clinical outcomes in adults undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest: Quantification of organ-based perioperative outcome and detection of opportunities for perioperative intervention. J Cardiothorac Vasc Anesth2005; 19: 446–452.
35.
RobertsB: Screening for delirium in an adult intensive care unit. Intensive Crit Care Nurs2004; 20: 206–213.
36.
DuboisMJBergeronNDumontM: Delirium in an intensive care unit: A study of risk factors. Intensive Care Med2001; 27: 1297–1304.
37.
ElyEWTrumanBManziDJ: Consciousness monitoring in ventilated patients: Bispectral EEG monitors arousal not delirium. Intensive Care Med2004; 30: 1537–1543.
38.
OtterHSC: Response to the Letter to the Editor on ‘validity and reliability of the DDS for severity of delirium in the ICU’. Neurocrit Care2006; 4: 192–193.
39.
GirardTDJacksonJCElyEW: Comment on ‘validity and reliability of the DDS for severity of delirium in the ICU’. Neurocrit Care2006; 4: 190–191.
