Delirium as a Predictor of Long-Term Cognitive Impairment in Survivors of Critical Illness

By Timothy D. Girard, James C. Jackson, Pratik Pandharipande, B. Pun, Jennifer L. Thompson, Ayumi K. Shintani, Sharon M. Gordon, A. Canonico, Robert S. Dittus, Gordon R. Bernard and 1 more. Critical Care Medicine, 2010

1,105 citations recorded by the source corpus.

Objective:To test the hypothesis that duration of delirium in the intensive care unit is an independent predictor of long-term cognitive impairment after critical illness requiring mechanical ventilation. Design:Prospective cohort study. Setting:Medical intensive care unit in a large community hospital in the United States. Patients:Mechanically ventilated medical intensive care unit patients who were assessed daily for delirium while in the intensive care unit and who underwent comprehensive cognitive assessments 3 and 12 mos after discharge. Measurements and Main Results:Of 126 eligible patients, 99 survived ≥3 months after critical illness; long-term cognitive outcomes were obtained for 77 (78%) patients. Median age was 61 yrs, 51% were admitted with sepsis/acute respiratory distress syndrome, and median duration of delirium was 2 days. At 3-mo and 12-mo follow-up, 79% and 71% of survivors had cognitive impairment, respectively (with 62% and 36% being severely impaired). After adjusting for age, education, preexisting cognitive function, severity of illness, severe sepsis, and exposure to sedative medications in the intensive care unit, increasing duration of delirium was an independent predictor of worse cognitive performance—determined by averaging age-adjusted and education-adjusted T-scores from nine tests measuring seven domains of cognition—at 3-mo (p = .02) and 12-mo follow-up (p = .03). Duration of mechanical ventilation, alternatively, was not associated with long-term cognitive impairment (p = .20 and .58). Conclusions:In this study of mechanically ventilated medical intensive care unit patients, duration of delirium (which is potentially modifiable) was independently associated with long-term cognitive impairment, a common public health problem among intensive care unit survivors. (Crit Care Med 2010; 38:1513–1520

Subfields: Critical Care and Intensive Care Medicine, Epidemiology, Geriatrics and Gerontology

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In Critical Care and Intensive Care Medicine

Citations in the corpus

Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments (2021, neutral): “impairments, especially among older adults [72,73].”
Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit (2013, background): “Page 66 of 181 associated with significantly greater cognitive impairment in these patients at 3 and 12 months (328).”
Long-term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis (2010, positive): “Delirium has been associated with increased cognitive decline among patients with Alzheimer disease(9,32) as well as with increased rates of long-term cognitive impairment in mechanically ventilated patients.(33) Basic biological research to understand these mechanisms is clearly warranted.”
Sedation and analgesia in the mechanically ventilated patient. (2012, background): “hospitalization, delirium also predicts mortality, decreased quality of life, and poor cognitive outcomes in the long-term setting (127, 129, 130).”
Long-term complications of critical care (2011, background): “The duration of ICU delirium also has been associated with cognitive impairment at 1 yr (110); however, significant impairment has been observed even in patients who were apparently never delirious, suggesting additional mechanisms independent of delirium (114).”