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European Journal of Medical Research
Published in: European Journal of Medical Research 1/2023

Open Access 01-12-2023 | Post-Intensive Care Syndrome | Research

Functional independence, frailty and perceived quality of life in patients who developed delirium during ICU stay: a prospective cohort study

Authors: Beatriz Lobo-Valbuena, Rosario Molina, Raúl Castañeda-Vozmediano, Leire Lopez de la Oliva Calvo, Ana Abella, María-Mercedes Garcia-Arias, Irene Salinas Gabiña, Federico Gordo

Published in: European Journal of Medical Research | Issue 1/2023

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Abstract

Background

Survivors of critical illness are frequently left with a long-lasting disability. We hypothesised that patients who developed delirium during ICU stay, compared with patients who did not, would have worse health-related quality of life following a critical illness.

Methods

Prospective longitudinal observational and analytical study assessing functional independence, frailty and perceived quality of life measured with the Barthel Index, the Clinical Frailty Scale, and the SF-36, comparing patients who developed delirium during ICU stay and patients who did not. The questionnaires were used at different times during the follow-up (upon ICU admission, at ICU discharge, at hospital discharge and 2 years after hospital discharge).

Results

In a cohort of 1462 patients, we matched 93 patients who developed delirium (delirium group) with 93 patients who did not develop delirium (no-delirium group). Of 156 completed questionnaires (84.7%), we observed that (a) in each of the two groups of patients, the scores related to functional independence (Barthel Index) and frailty (Clinical Frailty Scale) tended to improve over time (p < 0.001), being consistently less favourable in the delirium group compared to the no-delirium group (p < 0.001); (b) the patients who developed delirium also presented lower scores on the SF-36 scale, these differences being statistically significant, and therefore evidencing a worse quality of life, with impact on both the psychological and social spheres (p < 0.001).

Conclusions

Patients who developed delirium had significantly lower scores 2 years after hospital discharge on the three used questionnaires, displaying a clear negative impact on the physical, psychological, and social dimensions. The study's results reinforce the need to support and strengthen the care of ICU survivors.
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Literature
1.
Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703–10.PubMedCrossRef
2.
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.PubMedCrossRef
3.
Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825–73.PubMedCrossRef
4.
Zaal IJ, Devlin JW, Peelen LM, Slooter AJ. A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2015;43(1):40–7.PubMedCrossRef
5.
Krewulak KD, Stelfox HT, Ely EW, Fiest KM. Risk factors and outcomes among delirium subtypes in adult ICUs: a systematic review. J Crit Care. 2020;56:257–64.PubMedCrossRef
6.
Lat I, McMillian W, Taylor S, Janzen JM, Papadopoulos S, Korth L, et al. The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Crit Care Med. 2009;37(6):1898–905.PubMedCrossRef
7.
Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, Stiles RA, et al. Costs associated with delirium in mechanically ventilated patients. Crit Care Med. 2004;32(4):955–62.PubMedCrossRef
8.
Salluh JI, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015;350: h2538.PubMedCrossRefPubMedCentral
9.
Estrup S, Kjer CKW, Vilhelmsen F, Poulsen LM, Gøgenur I, Mathiesen O. Cognitive function 3 and 12 months after ICU discharge-a prospective cohort study. Crit Care Med. 2018;46(12):e1121–7.PubMedCrossRef
10.
Girard TD, Jackson JC, Pandharipande PP, Pun BT, Thompson JL, Shintani AK, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38(7):1513–20.PubMedCrossRefPubMedCentral
11.
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.PubMedCrossRefPubMedCentral
12.
Brummel NE, Jackson JC, Pandharipande PP, Thompson JL, Shintani AK, Dittus RS, et al. Delirium in the ICU and subsequent long-term disability among survivors of mechanical ventilation. Crit Care Med. 2014;42(2):369–77.PubMedCrossRefPubMedCentral
13.
Wolters AE, van Dijk D, Pasma W, Cremer OL, Looije MF, de Lange DW, et al. Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study. Crit Care. 2014;18(3):R125.PubMedCrossRefPubMedCentral
14.
Shankar-Hari M, Wunsch H, Rowan K, Singer M, Rubenfeld GD, Angus DC. Reflections on critical care’s past, present, and future. Crit Care Med. 2021;49(11):1855–65.PubMedCrossRef
15.
Davidson JE, Harvey MA, Bemis-Dougherty A, Smith JM, Hopkins RO. Implementation of the pain, agitation, and delirium clinical practice guidelines and promoting patient mobility to prevent post-intensive care syndrome. Crit Care Med. 2013;41(9 Suppl 1):S136–45.PubMedCrossRef
16.
Mehlhorn J, Freytag A, Schmidt K, Brunkhorst FM, Graf J, Troitzsch U, et al. Rehabilitation interventions for postintensive care syndrome: a systematic review. Crit Care Med. 2014;42(5):1263–71.PubMedCrossRef
17.
Herling SF, Greve IE, Vasilevskis EE, Egerod I, Bekker Mortensen C, Møller AM, et al. Interventions for preventing intensive care unit delirium in adults. Cochrane Database Syst Rev. 2018;11(11):009783.
18.
Van Der Schaaf M, Bakhshi-Raiez F, Van Der Steen M, Dongelmans DA, De Keizer NF. Recommendations for intensive care follow-up clinics; report from a survey and conference of Dutch intensive cares. Minerva Anestesiol. 2015;81(2):135–44.PubMed
19.
Baron R, Binder A, Biniek R, Braune S, Buerkle H, Dall P, et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine Revision 2015 (DAS-Guideline 2015) short version. Ger Med Sci. 2015;13:19.
20.
Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306.PubMedCrossRef
21.
Trogrlić Z, van der Jagt M, Bakker J, Balas MC, Ely EW, van der Voort PH, et al. A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes. Crit Care. 2015;19(1):157.PubMedCrossRefPubMedCentral
22.
Bernat Adell MD, Galarza Barrachina L, Bisbal Andrés E, Cebrián Graullera G, Pagés Aznar G, Morán Marmaneu M, et al. Factors affecting sleep quality in intensive care units. Med Intensiva (Engl Ed). 2021;45(8):470–6.PubMedCrossRef
23.
Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, et al. 2005. SAPS 3 From evaluation of the patient to evaluation of the intensive care unit. Part 2 Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med. 31(10): 1345–55
24.
Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the richmond agitation-sedation scale (RASS). JAMA. 2003;289(22):2983–91.PubMedCrossRef
25.
Chanques G, Ely EW, Garnier O, Perrigault F, Eloi A, Carr J, et al. The 2014 updated version of the confusion assessment method for the intensive care unit compared to the 5th version of the diagnostic and statistical manual of mental disorders and other current methods used by intensivists. Ann Intensive Care. 2018;8(1):33.PubMedCrossRefPubMedCentral
26.
Smith HA, Boyd J, Fuchs DC, Melvin K, Berry P, Shintani A, et al. Diagnosing delirium in critically ill children: validity and reliability of the pediatric confusion assessment method for the intensive care unit. Crit Care Med. 2011;39(1):150–7.PubMedCrossRefPubMedCentral
27.
Smith HA, Gangopadhyay M, Goben CM, Jacobowski NL, Chestnut MH, Savage S, et al. The preschool confusion assessment method for the ICU: valid and reliable delirium monitoring for critically ill infants and children. Crit Care Med. 2016;44(3):592–600.PubMedCrossRefPubMedCentral
28.
Mahoney FI, Barthel DW. Functional evaluation: the barthel index. Md State Med J. 1965;14:61–5.PubMed
29.
Muscedere J, Waters B, Varambally A, Bagshaw SM, Boyd JG, Maslove D, et al. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med. 2017;43(8):1105–22.PubMedCrossRefPubMedCentral
30.
Pugh RJ, Ellison A, Pye K, Subbe CP, Thorpe CM, Lone NI, et al. Feasibility and reliability of frailty assessment in the critically ill: a systematic review. Crit Care. 2018;22(1):49.PubMedCrossRefPubMedCentral
31.
Pulok MH, Theou O, van der Valk AM, Rockwood K. The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine. Age Ageing. 2020;49(6):1071–9.PubMedCrossRefPubMedCentral
32.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.PubMedCrossRefPubMedCentral
33.
34.
Alonso J, Prieto L, Antó JM. The Spanish version of the SF-36 health survey (the SF-36 health questionnaire): an instrument for measuring clinical results. Med Clin (Barc). 1995;104(20):771–6.PubMed
35.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36) I Conceptual framework and item selection. Med Care. 1992;30(6):473–83.PubMedCrossRef
36.
Pardo A, Ruiz M, San Martin R. Análisis de datos en ciencias sociales y de la salud. Síntesis, editor. Madrid2009.
37.
Furr R. Interpreting effect sizes in contrast analysis. Underst Stat. 2004;3(1):1–25.CrossRef
38.
Vargha A, Delaney HD. A critique and improvement of the CL common language effect size statistics of mcgraw and wong. J Educ Behav Stat. 2000;25(2):101–32.
39.
Lobo-Valbuena B, Gordo F, Abella A, Garcia-Manzanedo S, Garcia-Arias MM, Torrejón I, et al. Risk factors associated with the development of delirium in general ICU patients. A Prospective Observ Study PLoS One. 2021;16(9): e0255522.CrossRef
40.
van den Boogaard M, Schoonhoven L, Evers AW, van der Hoeven JG, van Achterberg T, Pickkers P. Delirium in critically ill patients: impact on long-term health-related quality of life and cognitive functioning. Crit Care Med. 2012;40(1):112–8.PubMedCrossRef
41.
Flaatten H, Kvåle R. Survival and quality of life 12 years after ICU a comparison with the general Norwegian population. Intensive Care Med. 2001;27(6):1005–11.PubMedCrossRef
42.
Goldberg TE, Chen C, Wang Y, Jung E, Swanson A, Ing C, et al. Association of delirium with long-term cognitive decline: a meta-analysis. JAMA Neurol. 2020;77(11):1373–81.PubMedCrossRef
43.
Li HC, Wei YC, Hsu RB, Chi NH, Wang SS, Chen YS, et al. Surviving and thriving 1 year after cardiac surgery: frailty and delirium matter. Ann Thorac Surg. 2021;111(5):1578–84.PubMedCrossRef
44.
Gracie TJ, Caufield-Noll C, Wang NY, Sieber FE. The association of preoperative frailty and postoperative delirium: a meta-analysis. Anesth Analg. 2021;133(2):314–23.PubMedCrossRefPubMedCentral
45.
Mazzola P, Tassistro E, Di Santo S, Rossi E, Andreano A, Valsecchi MG, et al. The relationship between frailty and delirium: insights from the 2017 delirium day study. Age Ageing. 2021;50(5):1593–9.PubMedCrossRef
46.
Sanchez D, Brennan K, Al Sayfe M, Shunker SA, Bogdanoski T, Hedges S, et al. Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study. Crit Care. 2020;24(1):609.PubMedCrossRefPubMedCentral
47.
Kin K, Yasuhara T, Tomita Y, Umakoshi M, Morimoto J, Date I. SF-36 scores predict postoperative delirium after surgery for cervical spondylotic myelopathy. J Neurosurg Spine. 2019;30:1–6.CrossRef
48.
Rylander C. Historic review of long-term outcomes research. Curr Opin Crit Care. 2019;25(5):523–9.PubMedCrossRef
49.
50.
Desmond DP, Maddux JF, Johnson TH, Confer BA. Obtaining follow-up interviews for treatment evaluation. J Subst Abuse Treat. 1995;12(2):95–102.PubMedCrossRef
51.
Robinson KA, Dinglas VD, Sukrithan V, Yalamanchilli R, Mendez-Tellez PA, Dennison-Himmelfarb C, et al. Updated systematic review identifies substantial number of retention strategies: using more strategies retains more study participants. J Clin Epidemiol. 2015;68(12):1481–7.PubMedCrossRefPubMedCentral
52.
Teague S, Youssef GJ, Macdonald JA, Sciberras E, Shatte A, Fuller-Tyszkiewicz M, et al. Retention strategies in longitudinal cohort studies: a systematic review and meta-analysis. BMC Med Res Methodol. 2018;18(1):151.PubMedCrossRefPubMedCentral
53.
Hayhurst CJ, Marra A, Han JH, Patel MB, Brummel NE, Thompson JL, et al. Association of hypoactive and hyperactive delirium with cognitive function after critical illness. Crit Care Med. 2020;48(6):e480–8.PubMedCrossRefPubMedCentral
54.
Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson LV. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 1999;160(1):50–6.PubMedCrossRef
55.
Hughes CG, Patel MB, Jackson JC, Girard TD, Geevarghese SK, Norman BC, et al. Surgery and anesthesia exposure is not a risk factor for cognitive impairment after major noncardiac surgery and critical illness. Ann Surg. 2017;265(6):1126–33.PubMedCrossRef
56.
Randolph C, Tierney MC, Mohr E, Chase TN. The repeatable battery for the assessment of neuropsychological status (RBANS): preliminary clinical validity. J Clin Exp Neuropsychol. 1998;20(3):310–9.PubMedCrossRef
57.
Giménez-Esparza Vich C, Alcántara Carmona S, García SM. Delirium in COVID-19 Practical aspects of a frequent association. Med Intensiva. 2022;46(6):336–40.PubMedCrossRefPubMedCentral
58.
Lobo-Valbuena B, Molina R, Gordo F. Post-intensive care syndrome. ICU Manage Practice. 2020;20(4):271–4.
59.
60.
Rai S, Anthony L, Needham DM, Georgousopoulou EN, Sudheer B, Brown R, et al. Barriers to rehabilitation after critical illness: a survey of multidisciplinary healthcare professionals caring for ICU survivors in an acute care hospital. Aust Crit Care. 2020;33(3):264–71.PubMedCrossRef
Metadata
Title
Functional independence, frailty and perceived quality of life in patients who developed delirium during ICU stay: a prospective cohort study
Authors
Beatriz Lobo-Valbuena
Rosario Molina
Raúl Castañeda-Vozmediano
Leire Lopez de la Oliva Calvo
Ana Abella
María-Mercedes Garcia-Arias
Irene Salinas Gabiña
Federico Gordo
Publication date
01-12-2023
Publisher
BioMed Central
Published in
European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI
https://doi.org/10.1186/s40001-023-01530-8

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