Farshid R Bashar1, Amir Vahedian-Azimi2, Mohammadreza Hajiesmaeili3, Mahmood Salesi4, Behrooz Farzanegan5, Seyedpouzhia Shojaei3, Reza Goharani3, Seyed J Madani6, Kivan G Moghaddam7, Sevak Hatamian8, Hosseinali J Moghaddam9, Seyed M M Mosavinasab2, Elamin M Elamin10, Andrew C Miller11. 1. Anesthesia and Critical Care Department, Hamedan University of Medical Sciences, Hamedan, Iran. 2. Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran. 3. Anesthesiology Research Center, Anesthesia and Critical Care Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 4. Research Center for Prevention of Oral and Dental Disease, Baqiyatallah University of Medical Sciences, Tehran, Iran. 5. Tracheal Diseases Research Center, Anesthesia and Critical Care Department, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 6. Trauma Research Center, Medicine Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran. 7. Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: kgohari@tums.ac.ir. 8. Anesthesia and Critical Care Department, Alborz University of Medical Sciences, Karaj, Iran. 9. Anesthesiology Research Center, Anesthesia Care Department, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 10. Department of Medicine, Division of Pulmonary, Critical Care Medicine and Sleep, University of South Florida, Tampa, FL, USA; Department of Medicine, Division of Pulmonary, Critical Care Medicine and Sleep, James A. Haley Veteran Hospital, Tampa, FL, USA. Electronic address: eelamin@health.usf.edu. 11. Department of Emergency Medicine, J.W. Ruby Memorial Hospital, West Virginia University, Morgantown, WV, USA; Department of Emergency Medicine, Vident Medical Center, East Carolina University, Greenville, NC, USA. Electronic address: ACMiller2@hsc.wvu.edu.
Abstract
PURPOSE: We investigated the impact of delirium on illness severity, psychological state, and memory in acute respiratory distress syndrome patients with very long ICU stay. MATERIALS AND METHODS: Prospective cohort study in the medical-surgical ICUs of 2 teaching hospitals. Very long ICU stay (>75days) and prolonged delirium (≥40days) thresholds were determined by ROC analysis. Subjects were ≥18years, full-code, and provided informed consent. Illness severity was assessed using Acute Physiology and Chronic Health Evaluation IV, Simplified Acute Physiology Score-3, and Sequential Organ Failure Assessment scores. Psychological impact was assessed using the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, and the 14-question Post-Traumatic Stress Syndrome (PTSS-14). Memory was assessed using the ICU Memory Tool survey. RESULTS: 181 subjects were included. Illness severity did not correlate with delirium duration. On logistic regression, only PTSS-14<49 correlated with delirium (p=0.001; 95% CI 1.011, 1.041). 49% remembered their ICU stay clearly. 47% had delusional memories, 50% reported intrusive memories, and 44% reported unexplained feelings of panic or apprehension. CONCLUSION: Delirium was associated with memory impairment and PTSS-14 scores suggestive of PTSD, but not illness severity.
PURPOSE: We investigated the impact of delirium on illness severity, psychological state, and memory in acute respiratory distress syndromepatients with very long ICU stay. MATERIALS AND METHODS: Prospective cohort study in the medical-surgical ICUs of 2 teaching hospitals. Very long ICU stay (>75days) and prolonged delirium (≥40days) thresholds were determined by ROC analysis. Subjects were ≥18years, full-code, and provided informed consent. Illness severity was assessed using Acute Physiology and Chronic Health Evaluation IV, Simplified Acute Physiology Score-3, and Sequential Organ Failure Assessment scores. Psychological impact was assessed using the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, and the 14-question Post-Traumatic Stress Syndrome (PTSS-14). Memory was assessed using the ICU Memory Tool survey. RESULTS: 181 subjects were included. Illness severity did not correlate with delirium duration. On logistic regression, only PTSS-14<49 correlated with delirium (p=0.001; 95% CI 1.011, 1.041). 49% remembered their ICU stay clearly. 47% had delusional memories, 50% reported intrusive memories, and 44% reported unexplained feelings of panic or apprehension. CONCLUSION:Delirium was associated with memory impairment and PTSS-14 scores suggestive of PTSD, but not illness severity.
Authors: Karissa Weidman; Elyse LaFond; Katherine L Hoffman; Parag Goyal; Christopher N Parkhurst; Heather Derry-Vick; Edward Schenck; Lindsay Lief Journal: Ann Am Thorac Soc Date: 2022-07