Abstract
ObjectiveDelirium is common in intensive care patients and is associated with short- and long-term adverse outcomes. We investigated the long-term risk of cognitive impairment and post-traumatic stress disorder (PTSD) in intensive care patients with and without delirium.MethodsThis is a prospective cohort study in ICUs in two Australian university-affiliated hospitals. Patients were eligible if they were older than 18 years, mechanically ventilated for more than 24 h and did not meet exclusion criteria. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. Variables assessing cognitive function and PTSD symptoms were collected at ICU discharge, after 6 and 12 months: Mini-Mental State Examination, Telephone Interview for Cognitive Status, Impact of Events Scale-Revised and Informant Questionnaire for Cognitive Decline (caregiver).Results103 participants were included of which 36% developed delirium in ICU. Patients with delirium were sicker and had longer duration of mechanical ventilation and ICU length of stay. After 12 months, 41/60 (68.3%) evaluable patients were cognitively impaired, with 11.6% representing the presence of symptoms consistent with dementia. When evaluated by the patient’s caregiver, the patient’s cognitive function was found to be severely impaired in a larger proportion of patients (14/60, 23.3%). Delirium was associated with worse cognitive function at ICU discharge, but not with long-term cognitive function. IES-R scores, measuring PTSD symptoms, were significantly higher in patients who had delirium compared to patients without delirium. In regression analysis, delirium was independently associated with cognitive function at ICU discharge and PTSD symptoms at 12 months.ConclusionsIntensive care survivors have significant rates of long-term cognitive decline and PTSD symptoms. Delirium in ICU was independently associated with short-term but not long-term cognitive function, and with long-term PTSD symptoms.Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616001116415, 15/8/2016 retrospectively registered, https://www.anzctr.org.au
Highlights
With improvements in critical care and declining intensive care unit (ICU) mortality, the number of ICU survivors is increasing
Suggested otherwise in the past, delirium is not associated with short-term mortality in critically ill patients, except for an increase in 90-day mortality associated with the mixed delirium subtype [16,17,18]
Patients with delirium were sicker compared to patients without delirium (APACHE Acute physiological and chronic health evaluation II (II) 23 ± 8 vs 18 ± 7, p = .002), spent more hours on mechanical ventilation (144 [72–258] vs 62 [40–119], p < .001), had a longer ICU length of stay (199 h [165–479] vs 150 [101–265], p = .001) but similar 1-year mortality
Summary
With improvements in critical care and declining intensive care unit (ICU) mortality, the number of ICU survivors is increasing These survivors are frequently left with significant long-term complications [1]. Delirium is an acute organic brain dysfunction characterised by disturbances of attention and cognition with a fluctuating course as a direct consequence of an underlying medical condition [4]. It occurs in different healthcare settings [5], affecting between 15 and 20% of general hospital patients, and up to 80% of patients in an ICU [6, 7]. Defining the extent of the association between delirium and persistent cognitive impairments in critically ill patients has been identified as an important research priority due to the high prevalence of both conditions [19]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
