Delirium as a predictor of long-term cognitive impairment in survivors of critical illness.
OBJECTIVE
To test the hypothesis that duration of delirium in the intensive care unit is an independent predictor of long-term cognitive impairment after critical illness requiring mechanical ventilation.


METHODS
Prospective cohort study.


METHODS
Medical intensive care unit in a large community hospital in the United States.


METHODS
Mechanically ventilated medical intensive care unit patients who were assessed daily for delirium while in the intensive care unit and who underwent comprehensive cognitive assessments 3 and 12 mos after discharge.


RESULTS
Of 126 eligible patients, 99 survived>or=3 months after critical illness; long-term cognitive outcomes were obtained for 77 (78%) patients. Median age was 61 yrs, 51% were admitted with sepsis/acute respiratory distress syndrome, and median duration of delirium was 2 days. At 3-mo and 12-mo 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 intensive care unit, increasing duration of delirium was an independent predictor of worse cognitive performance-determined by averaging age-adjusted and education-adjusted T-scores from nine tests measuring seven domains of cognition-at 3-mo (p=.02) and 12-mo follow-up (p=.03). Duration of mechanical ventilation, alternatively, was not associated with long-term cognitive impairment (p=.20 and .58).


CONCLUSIONS
In this study of mechanically ventilated medical intensive care unit patients, duration of delirium (which is potentially modifiable) was independently associated with long-term cognitive impairment, a common public health problem among intensive care unit survivors.
Girard
Timothy D
TD
Division of Allergy, Pulmonary, and Critical Care Medicine, Center for Health Services Research, Department of Medicine, Vanderbilt University School of Medicine, and Department of Medicine, Saint Thomas Hospital, Nashville, TN, USA. timothy.girard@vanderbilt.edu
Jackson
James C
JC
Pandharipande
Pratik P
PP
Pun
Brenda T
BT
Thompson
Jennifer L
JL
Shintani
Ayumi K
AK
Gordon
Sharon M
SM
Canonico
Angelo E
AE
Dittus
Robert S
RS
Bernard
Gordon R
GR
Ely
E Wesley
EW
D000368:Aged; D003072:Cognition Disorders / Q000150:complications / Q000503:physiopathology*; D016638:Critical Illness / Q000453:epidemiology*; D003693:Delirium / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D013997:Time Factors
J Am Geriatr Soc. 1992 Jun;40(6):601-6
1587979
J Gerontol A Biol Sci Med Sci. 2000 Sep;55(9):M527-34
10995051
Intensive Care Med. 2006 Jun;32(6):923-6
16525845
JAMA. 1994 Jan 12;271(2):134-9
8264068
JAMA. 2004 Apr 14;291(14):1753-62
15082703
Am J Respir Crit Care Med. 1999 Jul;160(1):50-6
10390379
Lancet. 2008 Jan 12;371(9607):126-34
18191684
Ann Intern Med. 1990 Dec 15;113(12):941-8
2240918
Intensive Care Med. 2009 Jul;35(7):1276-80
19350214
J Am Geriatr Soc. 2005 Oct;53(10):1658-66
16181163
Arch Gen Psychiatry. 1982 May;39(5):593-7
7092490
Int Rev Psychiatry. 2009 Feb;21(1):30-42
19219711
N Engl J Med. 1999 Mar 4;340(9):669-76
10053175
Crit Care Med. 2003 Apr;31(4):1250-6
12682500
Intensive Care Med. 2003 Mar;29(3):368-77
12536269
Arch Neurol. 1999 Mar;56(3):303-8
10190820
Crit Care Med. 2010 Feb;38(2):419-27
19915454
JAMA. 2001 Dec 5;286(21):2703-10
11730446
Stat Med. 2001 May 15-30;20(9-10):1487-98
11343369
N Engl J Med. 2001 Feb 8;344(6):395-402
11172175
Crit Care Med. 2003 Apr;31(4):1226-34
12682497
J Trauma. 2008 Jul;65(1):34-41
18580517
Intensive Care Med. 2001 May;27(5):859-64
11430542
Psychol Med. 1994 Feb;24(1):145-53
8208879
Intensive Care Med. 2001 Dec;27(12):1892-900
11797025
Gen Hosp Psychiatry. 2001 Mar-Apr;23(2):90-6
11313077
J Am Geriatr Soc. 2004 Sep;52(9):1456-62
15341546
Am J Respir Crit Care Med. 2009 Dec 1;180(11):1092-7
19745202
Crit Care Med. 1985 Oct;13(10):818-29
3928249
Neurology. 2001 Oct 9;57(7):1216-22
11591838
JAMA. 1992 Feb 19;267(7):949-53
1370853
Crit Care Med. 2009 Mar;37(3):825-32
19237884
Neuropsychol Rev. 2004 Jun;14(2):87-98
15264710
JAMA. 2000 Dec 6;284(21):2762-70
11105183
Age Ageing. 1999 Oct;28(6):551-6
10604507
Ann Intern Med. 1993 Sep 15;119(6):474-81
8357112
J Am Geriatr Soc. 2001 May;49(5):516-22
11380742
JAMA. 2009 Feb 4;301(5):489-99
19188334
Crit Care Med. 2001 Jul;29(7):1370-9
11445689
Arch Neurol. 2006 Apr;63(4):533-6
16606765
Am J Psychiatry. 1993 Jul;150(7):1015-9
8317569
Neurology. 2009 May 5;72(18):1570-5
19414723
Pharmacoeconomics. 1999 Oct;16(4):409-16
10623368
Crit Care. 2007;11(1):R28
17316452
Psychosom Med. 2006 May-Jun;68(3):369-75
16738066
Crit Care Med. 2004 Nov;32(11):2254-9
15640638
Am J Respir Crit Care Med. 2005 Feb 15;171(4):340-7
15542793
Stat Med. 2006 Jan 15;25(1):127-41
16217841
J Crit Care. 2006 Jun;21(2):125-32
16769455
JAMA. 2003 Jun 11;289(22):2983-91
12799407
JAMA. 2007 Dec 12;298(22):2644-53
18073360
Support Care Cancer. 2006 Nov;14(11):1111-8
16538498
Psychol Med. 1991 Aug;21(3):785-90
1946866
J Clin Psychiatry. 1987 Aug;48(8):314-8
3611032
Arch Intern Med. 2007 Aug 13-27;167(15):1629-34
17698685
Anaesthesia. 2005 Sep;60(9):847-53
16115244
Am J Respir Crit Care Med. 2002 Nov 15;166(10):1338-44
12421743
N Engl J Med. 2003 Feb 20;348(8):683-93
12594312
Hepatology. 2002 Feb;35(2):440-6
11826421
J Thorac Cardiovasc Surg. 2000 Oct;120(4):632-9
11003741
Intensive Care Med. 2007 Jan;33(1):66-73
17102966
Chest. 2006 Sep;130(3):869-78
16963688
Int Psychogeriatr. 2004 Sep;16(3):275-93
15559753
N Engl J Med. 2002 Apr 4;346(14):1061-6
11932474
Anaesthesia. 2008 Sep;63(9):941-7
18547292
Dement Geriatr Cogn Disord. 2008;26(1):1-8
18562793