Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium
Abstract Objective Delirium 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. Methods This is a...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-08-01
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| Series: | Annals of Intensive Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13613-020-00723-2 |
| _version_ | 1818851450042712064 |
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| author | Daniella Bulic Michael Bennett Ekavi N. Georgousopoulou Yahya Shehabi Tai Pham Jeffrey C. L. Looi Frank M. P. van Haren |
| author_facet | Daniella Bulic Michael Bennett Ekavi N. Georgousopoulou Yahya Shehabi Tai Pham Jeffrey C. L. Looi Frank M. P. van Haren |
| author_sort | Daniella Bulic |
| collection | DOAJ |
| description | Abstract Objective Delirium 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. Methods This 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). Results 103 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. Conclusions Intensive 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 |
| first_indexed | 2024-12-19T07:05:13Z |
| format | Article |
| id | doaj.art-d3595042c1da407db3123557a44cbf01 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-19T07:05:13Z |
| publishDate | 2020-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-d3595042c1da407db3123557a44cbf012022-12-21T20:31:19ZengSpringerOpenAnnals of Intensive Care2110-58202020-08-0110111010.1186/s13613-020-00723-2Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without deliriumDaniella Bulic0Michael Bennett1Ekavi N. Georgousopoulou2Yahya Shehabi3Tai Pham4Jeffrey C. L. Looi5Frank M. P. van Haren6Faculty of Medicine, University of New South WalesPrince of Wales Clinical School of Medicine, Faculty of Medicine, University of New South WalesAustralian National University Medical SchoolPrince of Wales Clinical School of Medicine, Faculty of Medicine, University of New South WalesInterdepartmental Division of Critical Care Medicine, University of TorontoAcademic Unit of Psychiatry and Addiction Medicine, Australian National University Medical SchoolAustralian National University Medical SchoolAbstract Objective Delirium 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. Methods This 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). Results 103 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. Conclusions Intensive 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.auhttp://link.springer.com/article/10.1186/s13613-020-00723-2DeliriumIntensive carePost-traumatic stress disorderCognitionPsychosocial functionLong-term outcomes |
| spellingShingle | Daniella Bulic Michael Bennett Ekavi N. Georgousopoulou Yahya Shehabi Tai Pham Jeffrey C. L. Looi Frank M. P. van Haren Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium Annals of Intensive Care Delirium Intensive care Post-traumatic stress disorder Cognition Psychosocial function Long-term outcomes |
| title | Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium |
| title_full | Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium |
| title_fullStr | Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium |
| title_full_unstemmed | Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium |
| title_short | Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium |
| title_sort | cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium |
| topic | Delirium Intensive care Post-traumatic stress disorder Cognition Psychosocial function Long-term outcomes |
| url | http://link.springer.com/article/10.1186/s13613-020-00723-2 |
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