Toxic Hospital Practices May Fuel Readmissions
In Thursday's New England Journal of Medicine, Krumholz's theory got a boost from researchers at Vanderbilt University. Praktik Pandharipande, MD, and colleagues conducted a multi-center clinical trial of patients treated for respiratory failure or shock in intensive care units.
They found that delirium developed in 74% after their hospital stay. At three months after discharge, 40% had cognition scores 1.5 standard deviations below the mean scores for their age and educational levels, and similar to patients with a traumatic brain injury.
The big variable was the duration of delirium that the patients endured in the ICU, a not-infrequent occurrence in patients with long ICU episodes.
The longer the delirium persisted, Pandharipande says, the more likely the patient would suffer cognitive impairment, manifested by an inability to plan, or think, or organize, which clinicians refer to as "executive function." The effect was seen as long as one year after discharge.
Better Transitions Are Possible
The good news is that Pandharipande and Krumholz think that delirium is preventable to some extent. Instead of overusing sedatives, patients can be kept awake to keep them oriented and engaged with their surroundings so they aren't confused to the point of psychosis. Caregivers can use lighter sedatives. They haven't proven it yet, but it makes sense.
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