Newly identified precipitating factors in mechanical ventilation-induced brain damage: implications for treating ICU delirium

González-López, Adrián; Albaiceta, Guillermo M.; Talbot, Konrad

doi:10.1586/14737175.2014.915743

Cited by 8 publications

(12 citation statements)

References 57 publications

(25 reference statements)

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“…We determined that delirium was present in 51% of mechanically ventilated patients, in agreement with multiple studies conducted in other settings [ 1 , 2 , 4 , 12 ]. This incidence maybe low taking into account the high APACHE score reported in our study.…”

Section: Discussionsupporting

confidence: 89%

“…At bivariate analysis, notable predictors of delirium were a positive history of mental illness, having multiorgan dysfunction, neurosurgery for traumatic brain injuries, fevers, acidosis, hypercapnia, anemia, sedation, and endotracheal tube use. Many of these have been documented as predictors of delirium in other studies [ 2 , 4 , 5 , 7 , 15 – 17 ].…”

Section: Discussionmentioning

confidence: 90%

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Incidence and Risk Factors for Delirium among Mechanically Ventilated Patients in an African Intensive Care Setting: An Observational Multicenter Study

Kwizera

Nakibuuka

Ssemogerere

et al. 2015

Critical Care Research and Practice

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Aim. Delirium is common among mechanically ventilated patients in the intensive care unit (ICU). There are little data regarding delirium among mechanically ventilated patients in Africa. We sought to determine the burden of delirium and associated factors in Uganda. Methods. We conducted a multicenter prospective study among mechanically ventilated patients in Uganda. Eligible patients were screened daily for delirium using the confusional assessment method (CAM-ICU). Comparisons were made using t-test, chi-squares, and Fisher's exact test. Predictors were assessed using logistic regression. The level of statistical significance was set at P < 0.05. Results. Of 160 patients, 81 (51%) had delirium. Median time to onset of delirium was 3.7 days. At bivariate analysis, history of mental illness, sedation, multiorgan dysfunction, neurosurgery, tachypnea, low mean arterial pressure, oliguria, fevers, metabolic acidosis, respiratory acidosis, anaemia, physical restraints, marital status, and endotracheal tube use were significant predictors. At multivariable analysis, having a history of mental illness, sedation, respiratory acidosis, higher PEEP, endotracheal tubes, and anaemia predicted delirium. Conclusion. The prevalence of delirium in a young African population is lower than expected considering the high mortality. A history of mental illness, anaemia, sedation, endotracheal tube use, and respiratory acidosis were factors associated with delirium.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 90%

Incidence and Risk Factors for Delirium among Mechanically Ventilated Patients in an African Intensive Care Setting: An Observational Multicenter Study

Kwizera

Nakibuuka

Ssemogerere

et al. 2015

Critical Care Research and Practice

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“…Mechanical overloading is widely accepted as an environmental factor leading to tissue damage because of uncontrolled cell apoptosis (González-López, Albaiceta, & Talbot, 2014;Hattori, 2003;Hong et al, 2015;Puschina, Varaksin, & Obukhov, 2016).…”

Section: Discussionmentioning

confidence: 99%

Cleavage of caspase‐12 at Asp94, mediated by endoplasmic reticulum stress (ERS), contributes to stretch‐induced apoptosis of myoblasts

Song

Zhang

Wang

et al. 2018

Journal Cellular Physiology

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Mechanical overloading can lead to skeletal muscle damage instead of remodeling. This is attributed to the excessive apoptosis of myoblasts, mechanism of which remains to be elucidated. The present study aimed to investigate the involvement of endoplasmic reticulum stress (ERS) and caspase-12 in mediating the stretch-induced apoptosis of myoblasts. Myoblast apoptosis was evaluated by Hoechst staining, DNA fragmentation assay, Annexin V binding, and propidium iodide staining, as well as caspase-3 and poly-ADP-ribose polymerase 1 cleavage. First, our results showed that apoptosis was elevated in a time-dependent manner when myoblasts were subjected to cyclic mechanical stretch (CMS) for 12, 24, and 36 hr. Concomitantly, CMS triggered the ERS and caspase-12 cleavage; ERS inhibitor GSK 2606414 suppressed the CMS-induced cleavage of caspase-12 and myoblast apoptosis. Silencing caspase-12 attenuated the apoptosis of myoblasts under CMS. Furthermore, CMS-induced myoblast apoptosis was partially recovered by overexpressing wild-type caspase-12 in caspase-12-silenced myoblasts. In contrast, overexpressing mutant caspase-12 (D94N), which cannot be cleaved into the active caspase-12 fragments, failed to accomplish the same effect. Finally, C2C12 overexpressing truncated caspase-12 segment (TC-casp12-D94), which starts from Asp94 and ends at Asn419, underwent apoptosis under both static and stretched conditions. Interestingly, C2C12 myoblasts seemed to be resistant to stretch-induced apoptosis upon low-serum-induced differentiation. In conclusion, our study provided evidence that caspase-12 cleavage at Asp94, induced by ERS under mechanical stimuli, is the key molecule in initiating the stretch-triggered apoptosis of myoblasts.

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“…This incidence is in agreement with the other studies from various other centers across the world. 4,[9][10][11] Importantly, 50% of them were having hypoactive delirium, which could have been easily missed unless specifically screened for. Under recognition and under documentation of presence of delirium is a common pitfall in many ICUs.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, presence of delirium increases the duration of mechanical ventilation. 4,9,10 Thus, attempting for early extubation with daily awakening and breathing trials is vital.…”

Section: Discussionmentioning

confidence: 99%

Assessment of incidence and risk factors for intensive care acquired delirium in mechanically ventilated patients in surgical intensive care unit – National Hospital of Sri Lanka

Lochanie

Ranawaka

2018

Sri Lankan J Anaesthesiol

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Background: Delirium is a common, preventable complication of intensive care unit treatment. It is often under-diagnosed and is an independent predictor of mortality and morbidity. Delirium screening is not a routine practice currently at surgical ICU-NHSL. Methodology: Patients requiring mechanical ventilation for more than 24 hours at surgical ICU-NHSL were screened for delirium using CAM-ICU score. The potential risk factors contributing to delirium were also studied. Data was analysed using SPSS 17. Results: Delirium was present in 66.6% patients. Importantly, the commonest subtype was hypoactive delirium (50%) while hyperactive and mixed delirium accounted for 30% and 20% respectively. Significantly higher proportion of patients who developed delirium were males (p= 0.02). There was no association between patients' age and development of delirium. Patients with delirium had a significantly higher incidence of acute liver impairment (p=0.03), acute malnutrition (p=0.05) and impaired glycaemic control (p= 0.05). There was a statistically significant association between presence of invasive lines (p=0.004), use of propofol (p= 0.006) and use of opioids (0.03) and development of delirium. Conclusion: The study revealed high incidence of delirium in patients who are mechanically ventilated for more than 24 hours. Majority of them were having hypoactive delirium. The need for early identification using routine delirium screening tools and assessment of risk factors contributing to delirium is highlighted.

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Newly identified precipitating factors in mechanical ventilation-induced brain damage: implications for treating ICU delirium

Cited by 8 publications

References 57 publications

Incidence and Risk Factors for Delirium among Mechanically Ventilated Patients in an African Intensive Care Setting: An Observational Multicenter Study

Incidence and Risk Factors for Delirium among Mechanically Ventilated Patients in an African Intensive Care Setting: An Observational Multicenter Study

Cleavage of caspase‐12 at Asp94, mediated by endoplasmic reticulum stress (ERS), contributes to stretch‐induced apoptosis of myoblasts

Assessment of incidence and risk factors for intensive care acquired delirium in mechanically ventilated patients in surgical intensive care unit – National Hospital of Sri Lanka

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