ICU delirium burden predicts functional neurologic outcomes.
ICU delirium burden predicts functional neurologic outcomes.
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DOI：
10.1371/journal.pone.0259840
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Westover MB
中科院分区：
文献类型：
--
作者：
Paixao L;Sun H;Hogan J;Hartnack K;Westmeijer M;Neelagiri A;Zhou DW;McClain LM;Kimchi EY;Purdon PL;Akeju O;Westover MB
我们调查了机械通气患者从ICU开始到整个住院期间的精神障碍负担对危重疾病后长达2.5年的功能神经预后的影响。对2013年10月至2016年5月连续178名机械通气的成人内外科ICU患者进行前瞻性队列研究。总之，患者每天使用ICU混淆评估方法(CAM-ICU)对2941天的精神错乱进行评估。住院精神障碍负担(DB)被量化为出现精神错乱的住院天数除以总的危险天数。在出院后3个月、6个月和12个月记录最长2.5年的生存状况和格拉斯哥预后评分的神经学结果。在178名患者中，19名(10.7%)因持续昏迷而被排除在结果分析之外。在其余159例中，123例(77.4%)出现了妄想。糖尿病独立地与ICU入院后2.5年死亡率增加4倍(调整风险比[AHR]，4.77；95%CI，2.10-10.83；P<；.001)，以及出院时较差的神经预后(调整后优势比[AOR]，0.02；0.01-0.09；P<；.001)，3(AOR，0.11；0.04-0.31；P<；.001)，6(AOR，0.10；0.04-0.29；P<；.001)和12个月(AOR，0.19；0.07-0.52；P=.001)。单独在ICU中的DB与死亡率无关(HR，1.79；0.93-3.44；P=.082)，并且预测神经系统结果的能力不如整个住院DB。同样，除了ICU精神错乱天数与出院时的神经预后相关(OR，0.90；0.81-0.99，P=.038)外，ICU中的精神错乱天数和整个住院天数与死亡率(HR，1.00；0.93-1.08；P=.917和HR，0.98；0.94-1.03，P=.535)也不相关。整个住院期间的精神错乱负担独立地预测危重疾病后2.5年内的长期神经结果和死亡，并且比单独在ICU的精神错乱负担和精神错乱天数更具预测性。
We investigated the effect of delirium burden in mechanically ventilated patients, beginning in the ICU and continuing throughout hospitalization, on functional neurologic outcomes up to 2.5 years following critical illness. Prospective cohort study of enrolling 178 consecutive mechanically ventilated adult medical and surgical ICU patients between October 2013 and May 2016. Altogether, patients were assessed daily for delirium 2941days using the Confusion Assessment Method for the ICU (CAM-ICU). Hospitalization delirium burden (DB) was quantified as number of hospital days with delirium divided by total days at risk. Survival status up to 2.5 years and neurologic outcomes using the Glasgow Outcome Scale were recorded at discharge 3, 6, and 12 months post-discharge. Of 178 patients, 19 (10.7%) were excluded from outcome analyses due to persistent coma. Among the remaining 159, 123 (77.4%) experienced delirium. DB was independently associated with >4-fold increased mortality at 2.5 years following ICU admission (adjusted hazard ratio [aHR], 4.77; 95% CI, 2.10–10.83; P < .001), and worse neurologic outcome at discharge (adjusted odds ratio [aOR], 0.02; 0.01–0.09; P < .001), 3 (aOR, 0.11; 0.04–0.31; P < .001), 6 (aOR, 0.10; 0.04–0.29; P < .001), and 12 months (aOR, 0.19; 0.07–0.52; P = .001). DB in the ICU alone was not associated with mortality (HR, 1.79; 0.93–3.44; P = .082) and predicted neurologic outcome less strongly than entire hospital stay DB. Similarly, the number of delirium days in the ICU and for whole hospitalization were not associated with mortality (HR, 1.00; 0.93–1.08; P = .917 and HR, 0.98; 0.94–1.03, P = .535) nor with neurological outcomes, except for the association between ICU delirium days and neurological outcome at discharge (OR, 0.90; 0.81–0.99, P = .038). Delirium burden throughout hospitalization independently predicts long term neurologic outcomes and death up to 2.5 years after critical illness, and is more predictive than delirium burden in the ICU alone and number of delirium days.
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影响因子：
8.8
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
通讯作者：
VISIONS Investigation, VISualizing Icu SurvivOrs Neuroradiological Sequelae
影响因子：
3.9
作者：
Cunningham C
通讯作者：
Cunningham C
del妄作为重症疾病幸存者长期认知障碍的预测指标。
影响因子：
8.8
作者：
Girard TD;Jackson JC;Pandharipande PP;Pun BT;Thompson JL;Shintani AK;Gordon SM;Canonico AE;Dittus RS;Bernard GR;Ely EW
通讯作者：
Ely EW
DOI：
10.1186/cc13084
发表时间：
2013-10-29
期刊：
Critical care (London, England)
影响因子：
--
作者：
Abelha FJ;Luís C;Veiga D;Parente D;Fernandes V;Santos P;Botelho M;Santos A;Santos C
通讯作者：
Santos C
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA