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Brain dysfunction: another burden for the chronically critically ill.

Judith E Nelson1, Nidhi Tandon, Alice F Mercado

  • 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA. judith.nelson@mountsinai.org

Archives of Internal Medicine
|October 13, 2006
PubMed
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Chronic critical illness frequently causes prolonged brain dysfunction, including coma and delirium. Many survivors experience severe cognitive impairments and dependency, impacting long-term outcomes.

Area of Science:

  • Critical Care Medicine
  • Neuroscience
  • Pulmonology

Background:

  • Chronic critical illness is characterized by prolonged respiratory failure and other systemic derangements.
  • Brain dysfunction in this population is understudied but crucial for medical decision-making.
  • Previous research has not focused on the neurological sequelae of chronic critical illness.

Purpose of the Study:

  • To investigate the prevalence and duration of brain dysfunction in chronically critically ill adults.
  • To assess cognitive and functional outcomes in survivors at 3 and 6 months post-discharge.

Main Methods:

  • Prospective cohort study of 203 adults in a respiratory care unit (RCU) after tracheotomy for failure to wean.
  • Utilized the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Richmond Agitation-Sedation Scale (RASS) to measure coma and delirium.

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  • Assessed survivors at 3 and 6 months using a telephone-based Confusion Assessment Method.

    • Main Results:

    • 30% of patients remained comatose throughout their RCU stay; approximately 50% of non-comatose patients experienced delirium.
    • Patients averaged 17.9 days with coma or delirium during their RCU stay.
    • At 6 months, 68.2% of survivors were too impaired for cognitive assessment, and 62.4% were dependent in daily activities.

    Conclusions:

    • Severe, prolonged, and often permanent brain dysfunction is a significant feature of chronic critical illness.
    • These neurological deficits contribute substantially to the burden on patients and their families.
    • Findings highlight the need for improved management strategies and support for this patient population.