In this episode, I’ll discuss the case for continuing statins for patients admitted to the ICU.
Nonpharmacologic therapy remains the mainstay for the prevention of delirium in ICU patients.
Statins are among the many medications that have been studied for the treatment and prevention of ICU delirium, and they are of particular interest due to their many pleiotropic and anti-inflammatory effects which could theoretically play a role in the pathology of delirium.
While starting a new statin in ICU patients has not convincingly been shown to prevent delirium, a recent review article published in AJHP highlights the potential role of statin continuation in the prevention of ICU delirium.
The review highlights several studies that seem to suggest patients benefit from lower delirium rates if their prehospital statin is continued during an ICU stay.
A 2009 prospective observational study of patients undergoing cardiac surgery with cardiopulmonary bypass suggested that prehospital statin use had a neuroprotective effect, reducing the odds of delirium by 46%.
In a 2014 prospective cohort study of patients in the ICU with sepsis, the longer a patient’s prehospital statin was withheld in their ICU stay, the higher the risk of developing delirium.
And in another 2014 prospective cohort study of a mixed medical and surgical ICU population, the lack of prehospital statin use was associated with increased ventilatory support requirements.
The authors of the review also cite an analysis that states for every day that statin use is continued in the ICU, the odds of a patient being free of delirium and coma increase by 39%.
The authors conclude that compared to starting a new statin…
…the neuroprotective benefits seen in patients continuing use of statins [in the ICU] are much more convincing. More consideration should be given to continuing a patient’s home statin regimen in the ICU, especially if the patient is at increased risk for delirium.
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