Brain dysfunction in patients with chronic critical illness.
Critically ill patients frequently experience acute brain dysfunction in the form of coma or delirium, both of which are common during acute and chronic critical illness (CCI). These manifestations of brain dysfunction are associated with numerous adverse outcomes during acute critical  illness, including prolonged hospitalization, increased healthcare costs, and increased mortality. The prognosis of CCI patients with coma or delirium has not yet been thoroughly studied, but preliminary studies suggest this population is at high risk for detrimental outcomes associated with  acute brain dysfunction. Additionally, a high percentage of patients who survive acute or CCI suffer from long-term brain dysfunction, which manifests primarily as memory deficits and executive dysfunction and is predicted by brain dysfunction in the ICU. Interventions directed at reducing  the burden of brain dysfunction during critical illness have shown promise in studies of patients with acute critical illness, but these therapies have yet to be studied during CCI. Thus, multicenter randomized trials are needed to determine which interventions are most effective for such  patients. Until these data are available, management strategies that have been proven beneficial during acute critical illness-such as reduction of sedative exposure, especially to benzodiazepines, and early use of physical and occupational therapy-should be employed during the  treatment of patients with CCI.
Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8300, USA. timothy.girard@vanderbilt.edu
Timothy D
TD
Girard
D014150:Antipsychotic Agents / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000628:therapy; D002908:Chronic Disease; D003128:Coma / Q000453:epidemiology; D015897:Comorbidity; D016638:Critical Illness / Q000453:epidemiology*; D003693:Delirium / Q000453:epidemiology; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008140:Lorazepam / Q000008:administration & dosage
D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D006220:Haloperidol; D008140:Lorazepam