title: Delirium After Mechanical Ventilation in Intensive Care Units: The Cognitive and Psychosocial Assessment (CAPA) Study Protocol.
abstract: BACKGROUND
  In the intensive care unit (ICU), critical illness delirium occurs in the context of multiple comorbidities, multi-organ failure, and invasive management techniques, such as mechanical ventilation, sedation, and lack of sleep. Delirium is characterized by an acute confusional state defined by fluctuating mental status, inattention, and either disorganized thinking or an altered level of consciousness. The long-term cognitive and psychosocial function of patients that experience delirium in the ICU is of crucial interest because preliminary data suggest a strong association between ICU-related delirium and long-term cognitive impairment.
  
  
  OBJECTIVE
  The aim of this study is to explore the relationship between delirium in the ICU and adverse outcomes by following mechanically ventilated patients for one year following their discharge from the ICU and collecting data on their long-term cognition and psychosocial function.
  
  
  METHODS
  This study will be conducted by enrolling patients in two tertiary ICUs in Australia. We aim to recruit 200 patients who have been mechanically ventilated for more than 24 hours. Data will be collected at the following three time points: (1) at discharge where they will be administered the Mini-Mental State Examination (MMSE); (2) at 6 months after discharge from the ICU discharge where the Impact of Events Scale Revised (IES-R) and the Telephone Inventory for Cognitive Status (TICS) tests will be administered; and (3) at 12 months after discharge from the ICU where the patients will be administered the TICS and IES-R tests, as well as the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). The IQCODE will be administered to their "person responsible" or the significant other of the patient.
  
  
  RESULTS
  Long-term cognition and psychosocial function will be the primary outcome of this study. Mortality will also be investigated as a secondary outcome. Active enrollment will take place until the end of September 2016 and data collection will conclude at the end of September 2017. The analysis and results are expected to be available by March 2018.
  
  
  CONCLUSIONS
  Delirium during mechanical ventilation has been linked to longer ICU and hospital stays, higher financial burdens, increased risks of long-term cognitive impairment (ie, dementia), poor functional outcomes and quality of life, and decreased survival. However, delirium during mechanical ventilation in the ICU is not well understood. This study will advance our knowledge of the comprehensive, long-term effects of delirium on cognitive and psychosocial function.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616001116415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371216 (Archived by WebCite at http://www.webcitation.org/ 6nfDkGTcW).
authors.affiliation: University of New South Wales, Faculty of Medicine, University of New South Wales, Randwick, Australia.
authors.forename: Daniella
authors.identifier: http://orcid.org/0000-0001-5022-7244
authors.initials: D
authors.lastname: Bulic
authors.affiliation: University of New South Wales, Faculty of Medicine, University of New South Wales, Randwick, Australia.|Prince of Wales Hospital, Anaesthetic Department, Prince of Wales Hospital, Randwick, Australia.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0003-0298-1300
authors.initials: M
authors.lastname: Bennett
authors.affiliation: Canberra Hospital, Intensive Care Research Department, Canberra Hospital, Garran, Australia.
authors.forename: Helen
authors.identifier: http://orcid.org/0000-0002-9005-8956
authors.initials: H
authors.lastname: Rodgers
authors.affiliation: Canberra Hospital, Intensive Care Research Department, Canberra Hospital, Garran, Australia.
authors.forename: Mary
authors.identifier: http://orcid.org/0000-0003-4880-2208
authors.initials: M
authors.lastname: Nourse
authors.affiliation: Prince of Wales Hospital, Anaesthetic Department, Prince of Wales Hospital, Randwick, Australia.
authors.forename: Patrick
authors.identifier: http://orcid.org/0000-0001-6558-9694
authors.initials: P
authors.lastname: Rubie
authors.affiliation: Academic Unit of Psychiatry and Addiction Medicine, Medical School, Australian National University, Canberra, Australia.|Faculty of Medicine, Melbourne Neuropsychiatry Centre, Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Jeffrey Cl
authors.identifier: http://orcid.org/0000-0003-3351-6911
authors.initials: JC
authors.lastname: Looi
authors.affiliation: Canberra Hospital, Intensive Care Research Department, Canberra Hospital, Garran, Australia.|Medical School, College of Medicine, Biology & Environment, Australian National University, Canberra, Australia.
authors.forename: Frank
authors.identifier: http://orcid.org/0000-0001-8037-4229
authors.initials: F
authors.lastname: Van Haren
keywords: cognition; delirium; intensive care; mechanical ventilation; psychosocial outcomes