Systemic inflammation and delirium in the periextubation period of mechanical ventilation : an observational prospective study of intensive care unit patients

Background: Delirium is a common problem in intensive care units (ICUs) and is associated with poor outcomes. The association between inflammation and delirium in the peri-extubation period of mechanical ventilation (MV) is poorly understood. Methods: We conducted a prospective, observational study of adult patients on MV for >48 hours in an ICU. At extubation (0 h) and 24 h later, the Confusion Assessment Method for the ICU (CAM-ICU) and the following serum biomarkers were assessed:C-reactive protein (CRP), procalcitonin, white blood cell (WBC) count, interleukin (IL)-6 and -8. Patients were classified into delirious (D; at least one positive CAM-ICU) and nondelirious (N; negative CAM-ICU at both times) groups. Results: Of the 28 enrolled patients, 12 were in group D, and 16 were in group N. Patient characteristics were not different except for the Acute Physiology and Chronic Health Evaluation II score and Sequential Organ Failure Assessment score at 0 h. At 24 h, procalcitonin and IL-6 levels were higher in group D. During the 24-h period,CRP, IL-6, and IL-8 levels decreased in group N, and WBC count increased in group D. Conclusions: The results indicate an association between prolonged inflammation and delirium in the peri-extubation period of MV.