Steroid Dosing and Delirium after Lung Transplant Surgery

Abstract

Purpose Evaluate impact of a modified immunosuppressive regimen with decreased steroid dosing on incidence of delirium experienced by lung transplant patients. Methods We retrospectively reviewed the EMR for lung transplants between 6/14/2015 to 1/24/2017. The exposure variable was high (500-1000mg intraoperatively tapered to 2 mg/kg/day to 0.5mg/kg/day) versus low (500mg intraoperatively tapered to 1 mg/kg/day to 0.5mg/kg/day) steroid dosing. Covariates assessed included demographics, comorbidities, pre-transplant medications, and intraoperative variables. Number of days with Confusion Assessment Method (CAM) positive scores and total number of high (>=3) Richmond Agitation Sedation Scale (RASS) scores in POD1-7 were recorded. We performed stepwise variable selection and multivariate analysis using the Poisson model (for high RASS frequency) and negative binomial model (for CAM positive days). Results There were 74 lung transplants during the study period. 23 received high dose and the remainder received low dose steroids. There were no significant differences in patient characteristics aside from more patients with LAS Conclusion Delirium and agitation are common and multifactorial in lung transplant patients. A lower steroid dosing protocol appears to decrease frequency of postoperative delirium and agitation.