Cardiorespiratory Patterns in Severe Delirium Tremens

To define the hemodynamic and oxygen metabolism patterns associated with severe delirium tremens, we examined cardiorespiratory variables in five patients over the 24 hours before (control), at the time of (delirium tremens), and during the 24 hours after resolution of (postresolution) delirium tremens. In comparing the delirium tremens period with the control period, significant increases were found in mean +/- SD cardiac index (4.9 +/- 1.7 L/min X sq m vs 3.6 +/- 0.7 L/min X sq m), left cardiac work index (6.4 +/- 2.4 kg X m/sq m vs 5.0 +/- 1.7 kg X m/sq m), oxygen delivery (681 +/- 204 mL/min X sq m vs 546 +/- 176 mL/min X sq m), and oxygen consumption (204 +/- 38 mL/min X sq m vs 165 +/- 16 mL/min X sq m). Values for the control and postresolution periods were not significantly different. These results demonstrate that a hyperdynamic cardiorespiratory state is present during delirium tremens; this increased cardiac output may be a compensatory hemodynamic response to increased oxidative metabolism that requires additional therapeutic support.