Intensive care unit hypoglycemia predicts depression during early recovery from acute lung injury*

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Abstract
To evaluate the association between intensive care unit blood glucose levels and depression after acute lung injury. Prospective cohort study. Twelve intensive care units in four hospitals in Baltimore, MD. Consecutive acute lung injury survivors (n = 104) monitored during 1717 intensive care unit patient-days and screened for depression at 3 months after acute lung injury. None. The prevalence of a positive screening test for depression (Hospital Anxiety and Depression subscale score ≥8) at follow-up was 28%. After adjustment for confounders, patients with a mean daily minimum intensive care unit glucose level 100 mg of midazolam-equivalent agent (relative risk 2.4, 95% confidence interval 1.1–3.8). Hypoglycemia in the intensive care unit is associated with an increased risk of positive screening for depression during early recovery from acute lung injury. Baseline depressive symptoms, morbid obesity, and intensive care unit benzodiazepine dose were also associated with postacute lung injury depressive symptoms. These findings warrant increased glucose monitoring for intensive care unit patients at risk for hypoglycemia and further research on how patient and intensive care unit management factors may contribute to postintensive care unit depression.