The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: the VISIONS cohort magnetic resonance imaging study*.
The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: the VISIONS cohort magnetic resonance imaging study*.
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DOI：
10.1097/ccm.0b013e318250acc0
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发表时间：
2012-07
影响因子：
8.8
通讯作者：
VISIONS Investigation, VISualizing Icu SurvivOrs Neuroradiological Sequelae
中科院分区：
文献类型：
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作者：
Gunther ML;Morandi A;Krauskopf E;Pandharipande P;Girard TD;Jackson JC;Thompson J;Shintani AK;Geevarghese S;Miller RR 3rd;Canonico A;Merkle K;Cannistraci CJ;Rogers BP;Gatenby JC;Heckers S;Gore JC;Hopkins RO;Ely EW;VISIONS Investigation, VISualizing Icu SurvivOrs Neuroradiological Sequelae
谵妄持续时间是重症监护室（ICU）幸存者长期认知功能障碍（LTCI）的预测指标。假设谵妄和LTCI之间的关系可能存在神经解剖学基础，我们对谵妄持续时间、脑容量和LTCI之间的关系进行了探索性研究。内科和外科ICU呼吸衰竭或休克幸存者的前瞻性队列研究。使用定量高分辨率3特斯拉脑磁共振成像来计算出院时和3个月随访时的脑体积。使用ICU的混乱评估方法评估谵妄;在3个月和12个月随访时测试认知结果。线性回归用于检查谵妄持续时间和脑容量之间的关联，以及脑容量和认知结果之间的关联。共有47例患者完成了MRI方案。谵妄持续时间较长的患者表现出更大的脑萎缩，通过出院时[0.76，95%置信区间（CI）（0.10，1.41）; p=0.03]和3个月随访时[0.62（0.02，1.21），p=0.05]的更大脑室-脑比（VBR）测量。谵妄持续时间越长，上级额叶和海马放电时的体积越小[分别为−2.11 cm 3（−3.89，−0.32）; p=0.03]和−0.58 cm 3（−0.85，−0.31），p<0.001]，这两个区域分别负责执行功能和记忆。3个月时较大的脑萎缩（较高的VBR）与12个月时较差的认知表现相关[较低的RBANS成套测验评分-11.17（-21.12，-1.22），p=0.04]。3个月时，较小的上级额叶、丘脑和小脑体积与12个月时较差的执行功能和视觉注意力相关。这些初步数据表明，谵妄持续时间较长与出院后3个月内脑体积较小相关，而脑体积较小与LTCI相关长达12个月。然而，我们不能排除先前存在的较小的大脑体积解释这些发现。
Delirium duration is predictive of long-term cognitive impairment (LTCI) in Intensive Care Unit (ICU) survivors. Hypothesizing that a neuroanatomical basis may exist for the relationship between delirium and LTCI, we conducted this exploratory investigation of the associations between delirium duration, brain volumes and LTCI. A prospective cohort of medical and surgical ICU survivors with respiratory failure or shock. Quantitative high resolution 3-Tesla brain magnetic resonance imaging was used to calculate brain volumes at discharge and three-month follow-up. Delirium was evaluated using the Confusion Assessment Method for the ICU; cognitive outcomes were tested at three- and twelve-month follow-up. Linear regression was used to examine associations between delirium duration and brain volumes, and between brain volumes and cognitive outcomes. A total of 47 patients completed the MRI protocol. Patients with longer duration of delirium displayed greater brain atrophy as measured by a larger ventricle-to-brain ratio (VBR) at hospital discharge [0.76, 95% confidence intervals (CI) (0.10, 1.41); p=0.03] and at 3-month follow-up [0.62 (0.02, 1.21), p=0.05]. Longer duration of delirium was associated with smaller superior frontal lobe [−2.11 cm3 (−3.89, −0.32); p=0.03] and hippocampal volumes at discharge [−0.58 cm3 (−0.85, −0.31), p<0.001] – regions responsible for executive functioning and memory, respectively. Greater brain atrophy (higher VBR) at three months was associated with worse cognitive performances at twelve months [lower RBANS battery score −11.17 (−21.12, −1.22), p=0.04]. Smaller superior frontal lobes, thalamus, and cerebellar volumes at three months were associated with worse executive functioning and visual attention at twelve months. These preliminary data show that longer duration of delirium is associated with smaller brain volumes up to three months after discharge, and that smaller brain volumes are associated with LTCI up to 12 months. We cannot, however, rule out that smaller preexisting brain volumes explain these findings.