title: Delirium in the ICU and subsequent long-term disability among survivors of mechanical ventilation.
abstract: OBJECTIVE
  Survivors of critical illness are frequently left with long-lasting disability. The association between delirium and disability in critically ill patients has not been described. We hypothesized that the duration of delirium in the ICU would be associated with subsequent disability and worse physical health status following a critical illness.
  
  
  METHODS
  Prospective cohort study nested within a randomized controlled trial of a paired sedation and ventilator weaning strategy.
  
  
  METHODS
  A single-center tertiary-care hospital.
  
  
  METHODS
  One hundred twenty-six survivors of a critical illness.
  
  
  RESULTS
  Confusion Assessment Method for the ICU, Katz activities of daily living, Functional Activities Questionnaire (measuring instrumental activities of daily living), Medical Outcomes Study 36-item Short Form General Health Survey Physical Components Score, and Awareness Questionnaire were used. Associations between delirium duration and outcomes were determined via proportional odds logistic regression with generalized estimating equations (for Katz activities of daily living and Functional Activities Questionnaire scores) or via generalized least squares regression (for Medical Outcomes Study 36-item Short Form General Health Survey Physical Components Score and Awareness Questionnaire scores). Excluding patients who died prior to follow-up but including those who withdrew or were lost to follow-up, we assessed 80 of 99 patients (81%) at 3 months and 63 of 87 patients (72%) at 12 months. After adjusting for covariates, delirium duration was associated with worse activities of daily living scores (p = 0.002) over the course of the 12-month study period but was not associated with worse instrumental activities of daily living scores (p = 0.15) or worse Medical Outcomes Study 36-item Short Form General Health Survey Physical Components Score (p = 0.58). Duration of delirium was also associated with lower Awareness Questionnaire Motor/Sensory Factors scores (p 0.02).
  
  
  CONCLUSIONS
  In the setting of critical illness, longer delirium duration is independently associated with increased odds of disability in activities of daily living and worse motor-sensory function in the following year. These data point to a need for further study into the determinants of functional outcomes in ICU survivors.
authors.affiliation: 1Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 2Center for Health Services Research, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 3Center for Quality of Aging, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 4Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN. 5Department of Psychiatry, Vanderbilt Medical Center, Nashville, TN. 6Clinical Research Center of Excellence, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN. 7Division of Critical Care, Department of Anesthesiology, Vanderbilt School of Medicine, Nashville, TN. 8Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN. 9Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN. 10Institute for Medicine and Public Heath, Vanderbilt University School of Medicine, Nashville, TN. 11Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Brummel
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
authors.forename: Pratik P
authors.initials: PP
authors.lastname: Pandharipande
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Thompson
authors.forename: Ayumi K
authors.initials: AK
authors.lastname: Shintani
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Bernard
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Girard
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003693:Delirium / Q000150:complications*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D011795:Surveys and Questionnaires; D017741:Survivors; D013997:Time Factors