Delirium as a predictor of long-term cognitive impairment in survivors of critical illness

Abstract

Objective To test the hypothesis that duration of delirium in the intensive care unit (ICU) is an independent predictor of long-term cognitive impairment after critical illness requiring mechanical ventilation. Design Prospective cohort study. Setting Medical ICU in a large community hospital in the United States. Patients Mechanically ventilated medical ICU patients who were assessed daily for delirium while in the ICU and underwent comprehensive cognitive assessments 3 and 12 months after discharge. Measurements and Main Results Of 126 eligible patients, 99 survived ≥3 months post-critical illness; long-term cognitive outcomes were obtained for 77 (78%) patients. Median age was 61 years, 51% were admitted with sepsis/ARDS, and median duration of delirium was 2 days. At 3-and 12-month follow-up, 79% and 71% of survivors had cognitive impairment, respectively (with 62% and 36% being severely impaired). After adjusting for age, education, preexisting cognitive function, severity of illness, severe sepsis, and exposure to sedative medications in the ICU, increasing duration of delirium was an independent predictor of worse cognitive performance—determined by averaging age- and education-adjusted T-scores from nine tests measuring seven domains of cognition—at 3-month (p = 0.02) and 12-month follow-up (p = 0.03). Duration of mechanical ventilation, alternatively, was not associated with long-term cognitive impairment (p = 0.20 and 0.58). Conclusions In this study of mechanically ventilated medical ICU patients, duration of delirium was independently associated with long-term cognitive outcomes, representing a potentially modifiable predictor of this common public health problem.

Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

“…1 These errors can increase the risk of adverse drug events (ADEs) during hospitalization or following discharge. [2][3][4] Hospitals attempt to avert medication errors and ADEs by implementing medication reconciliation, the process by which a clinician compiles an accurate list of all medications that an individual is currently taking [5][6][7] and uses that list to provide correct medications anywhere within the health care system. 8 Hospital-based medication reconciliation is to be completed upon admission, transfer, and at discharge.…”

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

“…Delirium is associated with a prolonged stay in the intensive care unit (ICU) and hospital, increased morbidity and mortality rate, higher costs [2,3,5] and adverse long-term outcome [6,7]. There are several delirium assessment tools for ICU patients such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).…”

Post-intensive care cognitive impairment: questions in mind?

“…The mean age was 54 years or less in ten of the studies reviewed by Wolters et al [5]. Although the elderly were under-represented in this review (all studies enrolled older individuals), one study describes cognitive sequelae in 'older' (mean age 61) ICU survivors of 80 and 70 % at 3 and 12 months, respectively [12]. Normal aging may be accompanied by cognitive decline or dementia [13].…”

“…Features by which risk can be stratified have not been identified. Intensive care unit delirium, a clinical feature associated with post-ICU cognitive impairment [12], may be preventable with measures such as early mobility or pharmacological prophylaxis. Whether depression or post-traumatic stress disorder, commonly described psychiatric morbidities in the critically ill, predict cognitive outcome as well as whether psychiatric symptoms [24] are risk factors for development of cognitive impairments [25] is also not clear.…”