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ICU Delirium Linked to Post-Discharge Cognitive Decline

Cheryl Clark, for HealthLeaders Media, October 3, 2013

So often when patients are critically ill, he says, hospital teams say "'let's keep them sedated and not wake them up and interact with them, or let them interact with the environment,'" he says.

"After an illness, the lung, heart and kidneys tend to recover, but the brain probably has the least reserve, and illness may have longer lasting implications," he says, adding "perhaps we need to exercise the brain as well."

The researchers also found an association between a loss of a patient's ability to make decisions at three months, but not at the study's end point of 12 months. Also, use of other drugs like propofol, dexmedetomidine, and opiates did not appear to impact cognitive function.

The clinical trial, which was funded by the National Institutes of Health and others, enrolled 821 patients who had been admitted to either Vanderbilt or Saint Thomas Hospital in Nashville ICUs, and were followed for one year through May of 2010. All the patients were hospitalized for treatment of respiratory failure or shock.

Pandharipande says it's important that physicians who treat patients after their discharge "recognize that this is an entity that does exist, so when patients come to us saying they are having problems with memory or executive function (the ability to organize and make decisions), that they can't plan things or manage their finances, we don't blow them off and say, 'don't worry, you'll get better.' Because we don't know they're going to get better."

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