Sedation, analgesia & delirium · Consequences of delirium
Long-term cognitive impairment after critical illness
| Design | Prospective multicentre cohort study |
|---|---|
| Treatment | Longer duration of delirium during hospital stay |
| Control | Shorter or no delirium |
| Population | 821 patients in medical and surgical intensive care units, 6% cognitively impaired at baseline |
| Follow-up | 12 months |
| Primary endpoint | Global cognition and executive function at 3 and 12 months |
| Result | Delirium developed in 74% during the hospital stay. At 3 months, 40% had global cognition scores 1.5 standard deviations below population means — comparable to moderate traumatic brain injury. Longer delirium duration was associated with worse global cognition and executive function at both 3 and 12 months. |
| Secondary endpoints | Executive function, association with sedative exposure |
Patients in medical and surgical ICUs are at high risk for long-term cognitive impairment. A longer duration of delirium in the hospital was associated with worse global cognition and executive function scores at 3 and 12 months.
The trial authors, in the published abstract
The study that made ICU delirium a serious concern rather than a nursing inconvenience, by following patients home and testing them. It also created the expectation that treating delirium would help — which MIND-USA and AID-ICU then disappointed. Association is not causation, and prevention through lighter sedation remains the only strategy with support.
Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness. N Engl J Med 2013 Oct 3;369(14):1306-16.