title: 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 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.
authors.affiliation: 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
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Girard
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
authors.forename: Pratik P
authors.initials: PP
authors.lastname: Pandharipande
authors.forename: Brenda T
authors.initials: BT
authors.lastname: Pun
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Thompson
authors.forename: Ayumi K
authors.initials: AK
authors.lastname: Shintani
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Gordon
authors.forename: Angelo E
authors.initials: AE
authors.lastname: Canonico
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Bernard
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
mesh_terms: 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
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