1469CHEST ments. [7][8][9] Immobility, depression, and cognitive and neuromuscular impairments have been postulated as risk factors for long-term PF impairment in survivors of critical illness. 10 Post-ICU PF impairments are a major burden for patients, their families, and the health-care system because of high rates of institutionalization, frequent repeat hospitalizations, and other increased health-care services use. 10 There has been enhanced interest in studying the etiology, pathophysiology, prevention, and treatment of PF impairment of ICU survivors, 11 punctuated by the publication of three systematic reviews (SRs) in this fi eld. 12-14 Two of these reviews focused on describing the frequency, clinical features, and short-term outcomes (mortality, duration of mechanical ventilation, and length of hospitalization) related to the occurrence of neuromuscular abnormalities related M ore than 4 million ICU admissions occur annually in the United States. 1 ICU beds account for 10% of all hospital beds and result in at least 20% of hospital operating costs amounting to $90 billion annually. 2 Since our population is progressively aging, and most ICU patients are . 65 years of age, ICU care is expected to keep expanding in the next 2 decades. 3,4 This increase in the numbers of critically ill patients, along with improvement in ICU mortality, is creating a growing number of ICU survivors. 5 ICU survivors suffer from a variety of serious sequelae following their ICU stay, including late mortality, ongoing morbidity, neurocognitive defects, impaired mental health, poor functional capabilities, decreased quality of life, and decreased return to work and usual activities. 6 Up to 69% of ICU survivors have clinically important long-term physical function (PF) impair-

Background Elderly patients with cognitive impairment are at increased risk of developing delirium, especially in the intensive care unit. Objective To evaluate the efficacy of a computer-based clinical decision support system that recommends consulting a geriatrician and discontinuing use of urinary catheters, physical restraints, and unnecessary anticholinergic drugs in reducing the incidence of delirium. Methods Data for a subgroup of patients enrolled in a large clinical trial who were transferred to the intensive care units of a tertiary-care, urban public hospital in Indianapolis were analyzed. Data were collected on frequency of orders for consultation with a geriatrician; discontinuation of urinary catheterization, physical restraints, or anticholinergic drugs; and the incidence of delirium. Results The sample consisted of 60 adults with cognitive impairment. Mean age was 74.6 years; 45% were African American, and 52% were women. No differences were detected between the intervention and the control groups in orders for consultation with a geriatrician (33% vs 40%; P = .79) or for discontinuation of urinary catheters (72% vs 76%; P = .99), physical restraints (12% vs 0%; P=.47), or anticholinergic drugs (67% vs 36%; P=.37). The 2 groups did not differ in the incidence of delirium (27% vs 29%; P = .85). Conclusion Use of a computer-based clinical decision support system may not be effective in changing prescribing patterns or in decreasing the incidence of delirium.

BackgroundCurrently, there are no valid and reliable biomarkers to identify delirious patients predisposed to longer delirium duration. We investigated the hypothesis that elevated S100 calcium binding protein B (S100β) levels will be associated with longer delirium duration in critically ill patients.MethodsA prospective observational cohort study was performed in the medical, surgical, and progressive intensive care units (ICUs) of a tertiary care, university affiliated, and urban hospital. Sixty-three delirious patients were selected for the analysis, with two samples of S100β collected on days 1 and 8 of enrollment. The main outcome measure was delirium duration. Using the cutoff of <0.1 ng/mL and ≥0.1 ng/mL as normal and abnormal levels of S100β, respectively, on day 1 and day 8, four exposure groups were created: Group A, normal S100β levels on day 1 and day 8; Group B, normal S100β level on day 1 and abnormal S100β level on day 8; Group C, abnormal S100β level on day 1 and normal on day 8; and Group D, abnormal S100β levels on both day 1 and day 8.ResultsPatients with abnormal levels of S100β showed a trend towards higher delirium duration (P=0.076); Group B (standard deviation) (7.0 [3.2] days), Group C (5.5 [6.3] days), and Group D (5.3 [6.0] days), compared to patients in Group A (3.5 [5.4] days).ConclusionThis preliminary investigation identified a potentially novel role for S100β as a biomarker for delirium duration in critically ill patients. This finding may have important implications for refining future delirium management strategies in ICU patients.

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