Delirium in critically ill military patients following trauma: A cohort analysis.

Critically ill military trauma patients have been found to have a high incidence of psychological morbidity following their Intensive Care Unit (ICU) experience, including recall of significant auditory and visual hallucinations. It follows that this may be attributable to delirium, which has not been previously described in a young, previously fit population following trauma. The case-notes of 85 male patients (mean age 26 years), admitted to a single UK ICU following military trauma, were retrospectively assessed for delirium using DSM-IV criteria. Of the 993 ICU days assessed, 13.4% were delirium-positive, with just over half of patients (51.8%) experiencing at least one day of delirium. On delirium-positive days, 69.2% received a documented intervention, with the majority of interventions (66.4%) being pharmacological, commonly with a sedative or anti-psychotic. Presence of delirium was significantly associated with severity of injury, assessed by Injury Severity Score (OR 1.037, 95% CI 1.003-1.072, p = 0.031). Duration of ICU stay was significantly increased, from 4 to 8 days (p < 0.005), as was the duration of mechanical ventilation (for the 84.7% of patients who were ventilated) from 7 to 13 days (p < 0.005). Delirium is common in military trauma patients, despite their young age and premorbid fitness. A review of longer-term psychological outcomes should be considered.

The role of the liver in lipid metabolism during cold acclimation in non-hibernator rodents.

Cold exposure increases the demand for energy substrates. Cold acclimation of rats led to a 3-fold increase in fatty acid (FA) beta-oxidation (P<0.01) for ex vivo livers perfused at 37 degrees C. This increase was preserved following perfusion at 25 degrees C (P<0.001). In vitro measurement of absolute rates of hepatic beta-oxidation revealed no significant difference following cold acclimation, implying changes in fatty acid flux through beta-oxidation rather than increased oxidation capacity. Total FA uptake was increased one-third following perfusion at 25 degrees C (P<0.001) and cold acclimation (P<0.05) and cold acclimation led to diversion of tissue FA from storage to beta-oxidation (P<0.01). In separate experiments, in vivo hepatic lipogenesis rates for saponifiable lipids doubled (P<0.01) and cholesterol synthesis increased one-third (P<0.001). Taken together these data suggest the oxidation and synthesis of lipids occur simultaneously in hepatic tissue possibly to increase prevailing tissue FA concentrations and to generate heat through increased metabolic flux rates.