Long-term cognitive impairment and delirium in intensive care: A prospective cohort study

Mitchell, Marion; Shum, David; Mihala, Gabor; Murfield, Jenny; Aitken, Leanne M.

doi:10.1016/j.aucc.2017.07.002

Cited by 58 publications

(59 citation statements)

References 42 publications

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“…Another explanation for the high functional levels at the 3‐month follow‐up could be selection bias. The patients in this study are comparable to those in other follow‐up studies . We did find that patients participating in the follow‐up has a lower SAPS II score and a higher BMI than those not visited, but we did not find any other substantial differences.…”

Section: Discussionsupporting

confidence: 82%

Physical function and actigraphy in intensive care survivors—A prospective 3‐month follow‐up cohort study

Estrup

Kjer

Vilhelmsen

et al. 2019

Acta Anaesthesiol Scand

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Funding informationDepartmental funding only.Background: Impaired physical function after intensive care unit (ICU) stay is common. We aimed to study the association between activity levels in the ward after discharge from ICU and physical function at 3-month follow-up.Methods: Prospective cohort study of adult patients admitted to the ICU for more than 24 hours. Patients wore an accelerometer for up to 7 days at the ward. At discharge from ICU and at 3-month follow-up, patients were tested with the Chelsea Critical Care Physical Assessment Tool (CPAx). Results:We screened 66 consecutive, eligible patients; 41 completed actigraphy and 19 patients were visited at 3 months. The median CPAx increased from 31 (IQR 23-41) at discharge from ICU to 47 (IQR 44-49) at follow-up (P < 0.0001). Mean daily activity for the first week was correlated with CPAx at ICU discharge (R 2 = 0.14, P = 0.017; all 41 patients). For the 19 visited patients, we found no significant correlation for activity levels with CPAx at ICU discharge (R 2 = 0.12, P = 0.14) nor at visit (R 2 = 0.2, P = 0.058). Conclusion:We found improved physical function for most patients 3 months after ICU treatment. Activity levels for 1 week after ICU discharge at the ward were not associated with better physical function at 3-month follow-up.

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Section: Discussionsupporting

confidence: 82%

Physical function and actigraphy in intensive care survivors—A prospective 3‐month follow‐up cohort study

Estrup

Kjer

Vilhelmsen

et al. 2019

Acta Anaesthesiol Scand

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“…Of the 9 studies that assessed the role of delirium in cognitive impairment, 6 reported a significant association. [15][16][17]26,29,35 Evidence linking other potentially preventable ICU factors with longterm cognitive impairment is much weaker or even more inconsistent. Because delirium is a significant and independent risk factor for developing cognitive impairment, putting an effort to prevent delirium in the ICU may be an important prevention strategy.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, mechanical ventilation and duration of mechanical ventilation were not significantly associated with cognitive impairment after critical illness in many studies, [2][3][4]11,13,20,26,[32][33][34] but still 2 studies found positive associations. 18,30 One of them emphasized the influence of long duration of mechanical ventilation (>23 days), 18 yet 2 other studies did not find such correlation.…”

Section: Discussionmentioning

confidence: 99%

“…17 Delirium in the ICU was positively associated with impaired information processing speed and executive functioning 6 months after discharge in adult ICU survivors who were ventilated for more than 12 hours during their ICU hospitalization. 26 However, not all studies have found an association between delirium and subsequent cognitive impairment. Davydow et al 13 did not find a significant association between delirium and worse cognitive performance in 120 nontraumatic ICU patients who completed a Modified Telephone Interview for Cognitive Status 12 months after discharge.…”

Section: Delirium and Duration Of Deliriummentioning

confidence: 99%

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Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment After Critical Illness: A Systematic Review

Sakusic

O’Horo

Dziadzko

et al. 2018

Mayo Clinic Proceedings

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Long-term cognitive impairment is common in survivors of critical illness. Little is known about the etiology of this serious complication. We sought to summarize current scientific knowledge about potentially modifiable risk factors during intensive care unit (ICU) treatment that may play a substantial role in the development of long-term cognitive impairment. All searches were run on October 1, 2017. The search strategy included Ovid MEDLINE, Ovid Embase, Ovid CDR, Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effect, Scopus, and Web of Science, and included MeSH headings and keywords related to intensive care, critical care, and cognitive disorders. Searches were restricted to adult subjects. Inclusion required follow-up cognitive evaluation at least 2 months after ICU discharge. Studies assessing patients with cardiac arrest, traumatic brain injury, and cardiac surgery history were excluded. The search strategy resulted in 3180 studies. Of these, 28 studies (.88%) met our inclusion criteria and were analyzed. Delirium and duration of delirium were associated with long-term cognitive impairment after ICU admission in 6 of 9 studies in which this factor was analyzed. Weaker and more inconsistent associations have been reported with hypoglycemia, hyperglycemia, fluctuations in serum glucose levels, and in-hospital acute stress symptoms. Instead, most of the studies did not find significant associations between long-term cognitive impairment and mechanical ventilation; use of sedatives, vasopressors, or analgesic medications; enteral feeding; hypoxia; extracorporeal membrane oxygenation; systolic blood pressure; pulse rate; or length of ICU stay. Prolonged delirium may be a risk factor for long-term cognitive impairment after critical illness, though this association has not been entirely consistent across studies. Other potentially preventable factors have not been shown to have strong or consistent associations with long-term cognitive dysfunction in survivors of critical illness.

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“…Zusätzlich ist aus Studien über zerebrale Funktionsstörungen im Rahmen des Intensivaufenthalts bekannt, dass die kognitive Funktion dieser Patienten auch noch Monate später beeinträchtigt ist. Dies wurde kürzlich in einer prospektiven Kohortenstudie an Intensivpatienten (nicht ausschließlich Patienten mit Sepsis) nachgewiesen [2].…”

Section: Kommentarunclassified

Sepsis-assoziierte Enzephalopathie – können wir besser werden?

2018

JC AINS

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Long-term cognitive impairment and delirium in intensive care: A prospective cohort study

Abstract: ICU delirium was positively associated with impaired information processing speed and executive functioning at six-months post-discharge for this cohort. Testing for cognitive impairment with RBANS and TMT should be considered due to its greater sensitivity in comparison to the MMSE.

Cited by 58 publications

References 42 publications

Physical function and actigraphy in intensive care survivors—A prospective 3‐month follow‐up cohort study

Physical function and actigraphy in intensive care survivors—A prospective 3‐month follow‐up cohort study

Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment After Critical Illness: A Systematic Review

Sepsis-assoziierte Enzephalopathie – können wir besser werden?

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