Delirium as a predictor of long-term cognitive impairment in survivors of critical illness.
Delirium as a predictor of long-term cognitive impairment in survivors of critical illness.
复制标题
del妄作为重症疾病幸存者长期认知障碍的预测指标。
DOI：
10.1097/ccm.0b013e3181e47be1
复制
发表时间：
2010-07
影响因子：
8.8
通讯作者：
Ely EW
中科院分区：
文献类型：
--
作者：
Girard TD;Jackson JC;Pandharipande PP;Pun BT;Thompson JL;Shintani AK;Gordon SM;Canonico AE;Dittus RS;Bernard GR;Ely EW
为了验证重症监护病房(ICU)中的精神错乱持续时间是需要机械通气的危重疾病后长期认知损害的独立预测因素的假设。前瞻性队列研究。美国一家大型社区医院的内科ICU。在ICU期间每天对机械通气的内科ICU患者进行精神障碍评估，并在出院后3个月和12个月进行全面的认知评估。在符合条件的患者中，99人在危重疾病后3个月存活于≥；77人(78%)获得了长期认知结果。中位年龄61岁，51%有脓毒症/ARDS入院，精神障碍持续时间中位数为2天。在3个月和12个月的随访中，79%和71%的幸存者分别有认知障碍(其中62%和36%严重受损)。在3个月(p=0.02)和12个月的随访(p=0.03)中，在调整了年龄、教育程度、既往认知功能、疾病严重程度、严重脓毒症和接触镇静药物后，在3个月(p=0.02)和12个月(p=0.03)的9项测试中，根据平均年龄和教育调整后的T分数，精神错乱的持续时间是认知能力较差的独立预测因素。另外，机械通气时间与长期认知损害无关(p=0.20和0.58)。在这项对机械呼吸内科ICU患者的研究中，精神错乱的持续时间与长期认知结果独立相关，代表了这一常见公共卫生问题的潜在可修改预测因子。
To test the hypothesis that duration of delirium in the intensive care unit (ICU) is an independent predictor of long-term cognitive impairment after critical illness requiring mechanical ventilation. Prospective cohort study. Medical ICU in a large community hospital in the United States. Mechanically ventilated medical ICU patients who were assessed daily for delirium while in the ICU and underwent comprehensive cognitive assessments 3 and 12 months after discharge. Of 126 eligible patients, 99 survived ≥3 months post-critical illness; long-term cognitive outcomes were obtained for 77 (78%) patients. Median age was 61 years, 51% were admitted with sepsis/ARDS, and median duration of delirium was 2 days. At 3-and 12-month 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 ICU, increasing duration of delirium was an independent predictor of worse cognitive performance—determined by averaging age- and education-adjusted T-scores from nine tests measuring seven domains of cognition—at 3-month (p = 0.02) and 12-month follow-up (p = 0.03). Duration of mechanical ventilation, alternatively, was not associated with long-term cognitive impairment (p = 0.20 and 0.58). In this study of mechanically ventilated medical ICU patients, duration of delirium was independently associated with long-term cognitive outcomes, representing a potentially modifiable predictor of this common public health problem.