title: Risk factors for long-term brain dysfunction after chronic critical illness.
abstract: BACKGROUND
  Factors associated with long-term brain dysfunction (LTBD) in survivors of chronic critical illness (CCI) have not been explored but may be important for clinical practice and planning by patients, families, and providers.
  
  
  OBJECTIVE
  To identify risk factors for LTBD after treatment for CCI and to explore the association between acute delirium and coma during hospital treatment and LTBD.
  
  
  METHODS
  A prospective cohort study of adults admitted to a respiratory care unit for treatment of CCI.
  
  
  RESULTS
  Using the Confusion Assessment Method for ICU and the Richmond Agitation and Sedation Scale, we evaluated patients for delirium and coma during their hospital treatment for CCI. We collected data on other potential risk factors for LTBD by prospectively reviewing the patients' medical records and interviewing surrogates. We contacted survivors by telephone at 6 months after discharge to assess brain function using the telephone Confusion Assessment Method. Among 385 patients treated for CCI, 213 (56.1%) were dead at 6 months, and 108 of 167 (64.7%) of survivors were impaired. We used multinomial logistic regression in which the outcomes were (1) death, (2) brain dysfunction, and (3) survival without LTBD. Older patients, patients with higher Acute Physiology Score, and those with multiple complications during treatment for CCI were more likely to have LTBD. Acute brain dysfunction during hospital treatment was also associated with an increased risk of LTBD (odds ratio, 2.14; 95% confidence interval, 1.02-4.52).
  
  
  CONCLUSIONS
  LTBD after treatment for CCI is associated with brain dysfunction during such treatment as well as with older age and higher severity of illness of the patients.
authors: Department of Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY 10467, USA. ahope@montefiore.org
authors: Aluko A
authors: AA
authors: Hope
authors: R Sean
authors: RS
authors: Morrison
authors: Qingling
authors: Q
authors: Du
authors: Sylvan
authors: S
authors: Wallenstein
authors: Judith E
authors: JE
authors: Nelson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000503:physiopathology*; D003072:Cognition Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D003128:Coma / Q000453:epidemiology*; D016638:Critical Illness / Q000453:epidemiology* / Q000628:therapy; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012121:Respiration, Artificial; D012124:Respiratory Care Units; D012307:Risk Factors; D014140:Tracheotomy
references: Am J Respir Crit Care Med. 2010 Jul 15;182(2):183-91
references: 20299535
references: Am J Respir Crit Care Med. 2010 Aug 15;182(4):446-54
references: 20448093
references: Crit Care Med. 2013 Jan;41(1):263-306
references: 23269131
references: Crit Care Med. 2009 Jan;37(1):177-83
references: 19050611
references: J Trauma. 2011 Oct;71(4):860-6
references: 21537211
references: Crit Care Med. 2010 Feb;38(2):419-27
references: 19915454
references: JAMA. 2001 Dec 5;286(21):2703-10
references: 11730446
references: Anesthesiology. 2006 Jan;104(1):21-6
references: 16394685
references: Crit Care Med. 2010 Jul;38(7):1513-20
references: 20473145
references: Respir Care. 1985 May;30(5):339-47
references: 10315661
references: Crit Care Med. 2012 Jan;40(1):73-8
references: 21926610
references: Gerontologist. 1970 Spring;10(1):20-30
references: 5420677
references: JAMA. 2009 Feb 4;301(5):489-99
references: 19188334
references: Crit Care Med. 2012 Feb;40(2):502-9
references: 21946660
references: Arch Phys Med Rehabil. 1996 Nov;77(11):1101-8
references: 8931518
references: J Gen Intern Med. 1998 Sep;13(9):621-3
references: 9754518
references: Intensive Care Med. 2004 Mar;30(3):444-9
references: 14685663
references: Arch Intern Med. 2006 Oct 9;166(18):1993-9
references: 17030833
references: Intensive Care Med. 2013 Mar;39(3):376-86
references: 23328935
references: JAMA. 2004 Apr 14;291(14):1753-62
references: 15082703
references: J Chronic Dis. 1987;40(5):373-83
references: 3558716
references: Am J Respir Crit Care Med. 2009 Dec 1;180(11):1092-7
references: 19745202
references: Crit Care Med. 1985 Oct;13(10):818-29
references: 3928249
references: Crit Care Med. 2009 Nov;37(11):2888-94; quiz 2904
references: 19770733
references: Curr Opin Crit Care. 2006 Oct;12(5):405-11
references: 16943717
references: JAMA. 2003 Jun 11;289(22):2983-91
references: 12799407
references: JAMA. 2007 Dec 12;298(22):2644-53
references: 18073360
references: Arch Intern Med. 2007 Dec 10;167(22):2509-15
references: 18071175
references: Crit Care Med. 2010 Feb;38(2):428-37
references: 20095068
references: Ann Intern Med. 2010 Aug 3;153(3):167-75
references: 20679561
references: Crit Care. 2005 Aug;9(4):R375-81
references: 16137350
references: Chest. 2006 Sep;130(3):869-78
references: 16963688
references: N Engl J Med. 2002 Apr 4;346(14):1061-6
references: 11932474