Delirium During ICU Stay Could Cause Long-Lasting Brain Problems: Study

Results from new research suggest that patients requiring hospital stays in an intensive care unit (ICU) who experience delirium during the stay are more likely to suffer long-lasting cognitive impairment.

According to a study published online by the New England Journal of Medicine on October 3, researchers found that nearly three-quarters of delirious ICU patients suffered prolonged and disabling forms of cognitive impairment.

Researchers from the Tennessee Valley Healthcare System and the Department of Veterans Affairs evaluated 821 patients who were admitted to the ICU. Researchers tested patients who became delirious during their stay, with neurological tests three and 12 months after discharge.

Patients involved in the study were initially admitted to medical or surgical intensive care units (ICUs) after suffering from lung infections or stomach problems, but later suffered delirium during their stay. Nearly 75% of the ICU patients developed delirium during their stay according to the findings.

None of the patients were admitted for problems relating to the brain, such as stroke. Only 6% were initially admitted to the hospital with delirium symptoms.

Three months after discharge 40% of patients still had cognitive impairments equivalent to patients with traumatic brain injury (TBI). Nearly 26% of patients had memory or thinking impairment which was similar to patients suffering from mild Alzheimer’s disease. Researchers that found age played no factor in the increase or decrease of symptoms or prolonged experience of cognitive impairment.

After a year, 34% of patients still experienced brain function impairment similar to experiencing moderate TBI. Nearly one-quarter of patients also experienced a mild form of impairment similar to mild Alzheimer’s one year later.

Doctors found more days spent delirious during the hospital stay were associated with more severe forms of cognitive impairment at both three months and a year. However, the use of sedatives or analgesics was associated with increased risk of cognitive impairment at either follow-up.

Symptoms continued to persist for more than a year after the hospital stay, even after recovery from the initial medical problems.

Risks of Hospital Delirium

Patients who are delirious, severely confused or unable to focus are more likely to experience problems with thinking and memory. Patients who spent more time in that state continued to experience brain problems longer after being discharged.

Researchers say delirium is a sign that reveals a patient may be more severely ill than originally anticipated. As such, doctors should pay closer attention to the care and recovery of patients who have experienced delirium during their stay to attempt to mitigate the long-term problems.

Doctors point to increased efforts to reduce the number of days a patient remains delirious, increased pain management efforts, reduced sedatives and increased efforts to mobilize delirious patients as potential interventions.

Researchers warn that the problem will not be eliminated but may be reduced if efforts are redoubled. Researchers said it is important for patients to be aware of these issues when being admitted to the hospital.