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Aim: Knowledge of risk factors may provide strategies to reduce the high burden of delirium in intensive care unit (ICU) patients. We aimed to compare the risk of delirium after deep sedation with propofol versus midazolam in ICU patients. Methods: In this prospective cohort study, ICU patients who were in an unarousable state for ≥24 h due to continuous sedation with propofol and/or midazolam were included. Patients admitted ≤24 h, those with an acute neurological disorder and those receiving palliative sedation were excluded. ICU patients were assessed daily for delirium during the 7 days following an unarousable state due to continuous sedation. Results: Among 950 included patients, 605 (64%) subjects were delirious during the 7 days after awaking. The proportion of subsequent delirium was higher after midazolam sedation (152/207 [73%] patients) and after both propofol and midazolam sedation (257/377 [68%] patients), compared to propofol sedation only (196/366 [54%] patients). Midazolam sedation (adjusted cause‐specific hazard ratio [adj. cause‐specific HR] 1.32, 95% confidence interval [CI] 1.05‐1.66) and propofol and midazolam sedation (adj. cause‐specific HR 1.29, 95% CI 1.06‐1.56) were associated with a higher risk of subsequent delirium compared to propofol sedation only. Conclusion: This study among sedated ICU patients suggests that, compared to propofol sedation, midazolam sedation is associated with a higher risk of subsequent delirium. This risk seems more apparent in patients with high cumulative midazolam intravenous doses. Our findings underpin the recommendations of the Society of Critical Care Medicine Pain, Agitation/sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep (disruption) guidelines to use propofol over benzodiazepines for sedation in ICU patients. [ABSTRACT FROM AUTHOR]

Patients were evaluated for the presence of delirium twice daily using the CAM-ICU, however, for comparison of the delirium diagnosis, the CAM-ICU cannot serve as the gold standard. With interest we read the report on Natural Language Processing (NLP) diagnosed behavioral disturbance (NLP-Dx-Bd) in relation to delirium [[1]], but it left us also somewhat confused. [Extracted from the article]

Dear Editor, Intensive care unit (ICU) survivors are at risk of developing mental health problems, such as symptoms of posttraumatic stress disorder (PTSD), anxiety and depression [[1]-[3]]. This study investigated the association between systemic glucocorticoid use during ICU admission and the incidence of PTSD symptoms in a large population of ICU survivors. [Extracted from the article]