Delirium After Mechanical Ventilation in Intensive Care Units: The Cognitive and Psychosocial Assessment (CAPA) Study Protocol

Abstract

BackgroundIn the intensive care unit (ICU), critical illness delirium occurs in the context of multiple comorbidities, multi-organ failure, and invasive management techniques, such as mechanical ventilation, sedation, and lack of sleep. Delirium is characterized by an acute confusional state defined by fluctuating mental status, inattention, and either disorganized thinking or an altered level of consciousness. The long-term cognitive and psychosocial function of patients that experience delirium in the ICU is of crucial interest because preliminary data suggest a strong association between ICU-related delirium and long-term cognitive impairment.ObjectiveThe aim of this study is to explore the relationship between delirium in the ICU and adverse outcomes by following mechanically ventilated patients for one year following their discharge from the ICU and collecting data on their long-term cognition and psychosocial function.MethodsThis study will be conducted by enrolling patients in two tertiary ICUs in Australia. We aim to recruit 200 patients who have been mechanically ventilated for more than 24 hours. Data will be collected at the following three time points: (1) at discharge where they will be administered the Mini-Mental State Examination (MMSE); (2) at 6 months after discharge from the ICU discharge where the Impact of Events Scale Revised (IES-R) and the Telephone Inventory for Cognitive Status (TICS) tests will be administered; and (3) at 12 months after discharge from the ICU where the patients will be administered the TICS and IES-R tests, as well as the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). The IQCODE will be administered to their “person responsible” or the significant other of the patient.ResultsLong-term cognition and psychosocial function will be the primary outcome of this study. Mortality will also be investigated as a secondary outcome. Active enrollment will take place until the end of September 2016 and data collection will conclude at the end of September 2017. The analysis and results are expected to be available by March 2018.ConclusionDelirium during mechanical ventilation has been linked to longer ICU and hospital stays, higher financial burdens, increased risks of long-term cognitive impairment (ie, dementia), poor functional outcomes and quality of life, and decreased survival. However, delirium during mechanical ventilation in the ICU is not well understood. This study will advance our knowledge of the comprehensive, long-term effects of delirium on cognitive and psychosocial function.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616001116415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371216 (Archived by WebCite at http://www.webcitation.org/ 6nfDkGTcW)

Validity and reliability of the Persian version of the confusion assessment method for intensive care units

“…Delirium rate is considerably higher among ICU patients. The rate becomes even higher (close to 80%) among mechanicallyventilated patients (1,7,8).…”

Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium

“…This is a multicentre prospective cohort study between October 2012 and June 2016 in mixed ICUs of two large university-affiliated hospitals in Australia: the Canberra Hospital in the Australian Capital Territory and the Prince of Wales Hospital in Sydney, New South Wales. The full study protocol has been previously published [21].…”

Abnormal Sleep, Circadian Rhythm Disruption, and Delirium in the ICU: Are They Related?

“…Environmental characteristics specific to the ICU and related to sleep and circadian rhythm disruption ( 8 ) may worsen symptoms. Such factors include the lack of normal variability in light-dark cycle ( 9 ), noise ( 10 ), the use of mechanical ventilation ( 11 , 12 ), and need for continuous infusions of sedative drugs ( 13 ). The available literature suggests that there may be a close relationship between delirium, sleep, circadian rhythm, and critical illness, however, no causal pathway has been yet clearly described or the directionality of the relationship understood.…”