Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2020

Open Access 01-12-2020 | Care | Research

Association between delirium in the intensive care unit and subsequent neuropsychiatric disorders

Authors: Kyla N. Brown, Andrea Soo, Peter Faris, Scott B. Patten, Kirsten M. Fiest, Henry T. Stelfox

Published in: Critical Care | Issue 1/2020

Login to get access

Abstract

Background

Patients in the intensive care unit (ICU) are known to be at increased risk of developing delirium, but the risk of subsequent neuropsychiatric disorders is unclear. We therefore sought to examine the association between the presence of delirium in the ICU and incident neuropsychiatric disorders (including depressive, anxiety, trauma-and-stressor-related, and neurocognitive disorders) post-ICU stay among adult medical-surgical ICU patients.

Methods

Retrospective cohort study utilizing clinical and administrative data from both inpatient and outpatient healthcare visits to identify the ICU cohort and diagnostic information 5 years prior to and 1 year post-ICU stay. Patients ≥ 18 years of age admitted to one of 14 medical-surgical ICUs across Alberta, Canada, January 1, 2014–June 30, 2016, and survived to hospital discharge were included. The main outcome of interest was a new diagnosis of any neuropsychiatric disorder 1 year post-ICU stay. The exposure variable was delirium during the ICU stay identified through any positive delirium screen by the Intensive Care Unit Delirium Screening Checklist (ICDSC) during the ICU stay.

Results

Of 16,005 unique patients with at least one ICU admission, 4033 patients were included in the study of which 1792 (44%) experienced delirium during their ICU stay. The overall cumulative incidence of any neuropsychiatric disorder during the subsequent year was 19.7% for ICU patients. After adjusting for hospital characteristics using log-binomial regression, patients with delirium during the ICU stay had a risk ratio (RR) of 1.14 (95% confidence interval [CI] 0.98–1.33) of developing any neuropsychiatric disorder within 1 year post-ICU compared to those who did not experience delirium. Delirium was significantly associated with neurocognitive disorders (RR 1.59, 95% CI 1.08–2.35), but not depressive disorders (RR 1.16, 95% CI 0.92–1.45), anxiety (RR 1.16, 95% CI 0.92–1.47), and trauma-and-stressor-related (RR 0.82, 95% CI 0.53–1.28) disorders.

Conclusions

The diagnosis of new onset of neurocognitive disorders is associated with ICU-acquired delirium. In this study, significant associations were not observed for depressive, anxiety, and trauma-and-stressor-related disorders.
Appendix
Available only for authorised users
Literature
1.
Cavallazzi R, Saad M, Marik P. Delirium in the ICU: an overview. Ann Intensive Care. 2012;2(1):1–11.
2.
3.
Girard T, Jackson J, Pandaripande P, Pun B, Thompson J, Shintani A, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38(7):1513–20.PubMedPubMedCentral
4.
van den Boogaard M, Kox M, Quinn K, van Achterberg T, van der Hoeven J, Schoonhoven L, et al. Biomarkers associated with delirium in critically ill patients and their relation with long-term subjective cognitive dysfunction; indications for different pathways governing delirium in inflamed and non-inflamed patients. Crit Care. 2011;15(R297):1–9.
5.
Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Elseviers M, Bossaert L. Long term outcome after delirium in the intensive care unit. J Clin Nurs. 2009;18(23):3349–57.PubMed
6.
Shintani A, Girard T, Arbogast PG, Moons K, Ely E. Immortal time bias in critical care research: application of time-varying Cox regression for observational cohort studies. Crit Care Med. 2009;37(11):2939–45.PubMedPubMedCentral
7.
Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291(14):1753–62.PubMed
8.
Saczynski JS, Marcantonio ER, Quach L, Tamara GF, Gross A, Inouye SK, et al. Cognitive trajectories after postoperative delirium. N Engl J Med. 2012;367(1):30–9.PubMedPubMedCentral
9.
Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369(14):1306–16.PubMedPubMedCentral
10.
Wolters AE, Peelen LM, Welling MC, Kok L, de Lange DW, Cremer OL, et al. Long-term mental health problems after delirium in the ICU. Crit Care Med. 2016;44(10):1808–13.PubMed
11.
Witlox J, Eurelings L, de Jonghe J, Kalisvaart K, Eikelenboom P, van Gool W. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and demenetia: a meta-analysis. JAMA. 2010;304(4):443–51.PubMed
12.
O'Sullivan R, Inouye SK, Meagher D. Delirium and depression: inter-relationship and overlap in elderly people. Lancet Psychiatry. 2014;1(4):303–11.PubMedPubMedCentral
13.
14.
Sherin J, Nemeroff C. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues Clin Neurosci. 2011;13(3):263–78.PubMedPubMedCentral
15.
Granja C, Lopes A, Moreira S, Dias C, Costa-Pereira A, Carneiro A, et al. Patients’ recollections of experiences in the intensive care unit may affect their quality of life. Crit Care. 2005;9(1):R96–R109.PubMedPubMedCentral
16.
Asimakopoulou E, Madianos M. The prevalence of major depression-PTSD comorbidity among ICU survivors in five general hospitals of Athens: a cross-sectional study. Issues Ment Health Nurs. 2014;35(12):954–63.PubMed
17.
Davydow D, Gifford J, Desai S, Bienvenu O, Needham D. Depression in general intensive care unit survivors: a systematic review. Intensive Care Med. 2009;35(5):796–809.PubMed
18.
Davydow D, Hough C, Zatzick D, Katon W. Psychiatric symptoms and acute care service utilization over the course of the year following medical-surgical ICU admission: a longitudinal investigation. Crit Care Med. 2014;42(12):2473–81.PubMedPubMedCentral
19.
Apker J, Mallak LA, Gibson SC. Communicating in the “gray zone”: perceptions about emergency physician-hospitalist handoffs and patient safety. Acad Emerg Med. 2007;14(10):884–94.PubMed
20.
Griffiths J, Gager M, Waldmann C. Follow-up after intensive care. BJA Education. 2004;4(6):202–5.
21.
Riesenberg LA, Leitzsch J, Massucci JL, Jaeger J, Rosenfeld JC. Residents’ and attending physicians’ handoffs: a systematic review of the literature. Acad Med. 2009;84(12):1775–87.PubMed
22.
von Elm E, Altman DG, Egger M, Pocock S, Gøtzsche P, Vandenbroucke J, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–7.
23.
Statistics Canada. Alberta [Province] and Canada [Country] (table). Census Profile. 2016 Census statistics Canada catalogue no 98-316-X2016001. Ottawa 2017.
24.
Chiasson TC, Manns BJ, Stelfox HT. An economic evaluation of venous thrombolism prophylaxis strategies in critically ill trauma patients at risk of bleeding. PLoS Med. 2009;6(6):e1000098.PubMedPubMedCentral
25.
Stelfox HT, Soo A, Niven DJ, Fiest KM, Wunsch H, Rowan KM, et al. Assessment of the safety of discharging select patients directly home from the intensive care unit: a multicenter population-based cohort study. JAMA Intern Med. 2018;178(10):1390–9.PubMedPubMedCentral
26.
Brundin-Mather R, Soo A, Zuege DJ, Niven DJ, Fiest KM, Doig CJ, et al. Secondary EMR data for quality improvement and research: a comparison of manual and electronic data collection from an integrated critical care electronic medical record system. J Crit Care. 2018;47:295–301.PubMed
27.
28.
Fiest KM, Krewulak KD, Ely EW, Davidson JE, Ismail Z, Sept BG, et al. Partnering with family members to detect delirium in critically ill patients. Crit Care Med. 2020;48(7):954–61.PubMed
29.
Bergeron N, Dubois M, Dumont M, Dial S, Skrobik Y. Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(1):859–64.PubMed
30.
Abraham CM, Obremskey WT, Song Y, Jackson JC, Ely EW, Archer KR. Hospital delirium and psychological distress at 1 year and health-related quality of life after moderate-to-severe traumatic injury without intracranial hemorrhage. Arch Phys Med Rehabil. 2014;95(12):2382–9.PubMed
31.
Chlan L, Savik K. Patterns of anxiety in critically ill patients receiving mechanical ventilatory support. Nurs Res. 2011;60(3):S50–S7.PubMedPubMedCentral
32.
Guerra C, Linde-Zwirble WT, Wunsch H. Risk factors for dementia after critical illness in elderly Medicare beneficiaries. Crit Care. 2012;16(6):R233.PubMedPubMedCentral
33.
Jackson JC, Pandaripande P, Giard T, Brummel N, THompson J, Hughes C, et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet Respir Med. 2014;2(5):369–79.PubMedPubMedCentral
34.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association; 2013.
35.
Fiest KM, Jette N, Quan H, Germaine-Smith CS, Metcalfe A, Patten SB, et al. Systematic review and assessment of validated case definitions for depression in administrative data. BMC Psychiatry. 2014;14(289):1–11.
36.
Marrie RA, Walker JR, Graff LA, Lix LM, Bolton JM, Nugent Z, et al. Performance of administrative case definitions for depression and anxiety in inflammatory bowel disease. J Psychosom Res. 2016;89(1):107–13.
37.
Kim H, Chung S, Joo YH, Lee JS. The major risk factors for delirium in a clinical setting. Neuropsychiatr Dis Treat. 2016;12(1):1787–93.PubMedPubMedCentral
38.
39.
Fong TG, Tulebaez SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009;5(4):210–20.PubMedPubMedCentral
40.
Momennasab M, Ghahramani T, Yektatalab S, Zand F. Physical and mental health of patients immediately after discharge from intensive care unit and 24 hours later. Trauma Mon. 2016;21(1):e29231.PubMedPubMedCentral
41.
Paparrigopoulos T, Melissaki A, Tzavellas E, Karaiskos D, Ilias I, Kokras N. Increased co-morbidity of depression and post-traumatic stress disorder symptoms and common risk factors in intensive care unit survivors: a two-year follow-up study. Int J Psychiatry Clin Pract. 2014;18(1):25–31.PubMed
42.
Patten SB, Williams JV, Lavorato DH, Fiest KM, Bulloch AG, Wang J. The prevalence of major depression is not changing. Can J Psychiatr. 2015;60(1):31–4.
43.
Robins LN, Helzer JE, Weissman MM, Orvaschel H, Gruenberg E, Burke JDJ, et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry. 1984;41(1):949–58.PubMed
44.
Kessler RC, Petukhova M, Sampson NC, Zalslavsky AM, Wittchen H-U. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21(3):169–84.PubMedPubMedCentral
45.
Chahraoui K, Laurent A, Bioy A, Quenot J-P. Psychological experience of patients 3 months after a stay in the intensive care unit: a descriptive and qualitative study. J Crit Care. 2015;30(3):599–605.PubMed
46.
Rattray JE, Johnston M, Wildsmith JAW. Predictors of emotional outcomes of intensive care. Anaesthesia. 2005;60(11):1085–92.PubMed
47.
Battle C, James K, Temblett P. Depression following critical illness: analysis of incidence and risk factors. J Intensive Care Soc. 2015;16(2):105–8.PubMed
48.
49.
Modrykamien AM. The ICU follow-up clinic: a new paradigm for intensivists. Respir Care. 2012;57(5):764–72.PubMed
50.
Prinijha S, Field K, Rowan K. What patients think about ICU follow-up services: a qualitative study. Crit Care. 2009;13(R46):1–10.
51.
Garand L, Lingler JH, Conner KO, Dew MA. Diagnostic labels, stigma, and participation in research related to dementia and mild cognitive impairment. Res Gerontol Nurs. 2009;2(2):112–21.PubMedPubMedCentral
52.
Gulliver A, Griffiths K, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry. 2010;10(113):1–9.
Metadata
Title
Association between delirium in the intensive care unit and subsequent neuropsychiatric disorders
Authors
Kyla N. Brown
Andrea Soo
Peter Faris
Scott B. Patten
Kirsten M. Fiest
Henry T. Stelfox
Publication date
01-12-2020
Publisher
BioMed Central
Keywords
Care
Anxiety
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03193-x

Other articles of this Issue 1/2020

Critical Care 1/2020 Go to the issue

Research Letter

IL6-R blocking with tocilizumab in critically ill patients with hemophagocytic syndrome

Research

Performance of the cuff leak test in adults in predicting post-extubation airway complications: a systematic review and meta-analysis

Research

Facilitating ventilator weaning through rib fixation combined with video-assisted thoracoscopic surgery in severe blunt chest injury with acute respiratory failure

Research

Copeptin as a marker of outcome after cardiac arrest: a sub-study of the TTM trial

Review

Prevention of thrombotic risk in hospitalized patients with COVID-19 and hemostasis monitoring

Research Letter

Early awake prone position combined with high-flow nasal oxygen therapy in severe COVID-19: a case series