Brain Problems Can Endure Long After Leaving the ICU

Earlier this year, our blog “Intensive Care Drives Somes Patients Crazy, Literally” discussed how experiencing a state of delirium during a stay in a hospital’s intensive care unit (ICU) can lead to long-term cognitive problems.

From an anecdotal standpoint, the medical professionals who staff ICUs have been aware of this reality for a long time. Our story referred to a study conducted at Johns Hopkins that found that 1 in 4 patients had post-traumatic stress symptoms two years after going home.

Now, a new study from the New England Journal of Medicine appears to confirm that a disturbing number of ICU patients often develop thinking and memory problems that might not go away for a long time, if ever.

As reported on Reuters.com researchers found that ICU patients who had endured delirium-a cognitive state of serious confusion and inability to focus-were more likely to have thinking and memory problems after their release from the hospital and after their initial physical issues were resolved.

“The longer you are delirious, the more likely you are to have long-term cognitive impairment that looks like Alzheimer’s disease or traumatic brain injury,” Dr. Wes Ely, one of the researchers, told Reuters.

Although caregivers were aware of the mental fuzziness characteristic of ICU residents, most assumed that they would improve once patients were no longer delirious and were discharged. Now, they’re realizing that being delirious could be a sign that a patient is more severely ill. Delirium is associated with inflammation and the death of brain cells.

Reuters recalled a study from last year that found that almost half of heart surgery patients developed delirium and that their minds often remained dulled for a year. The new study is notable because it included patients with a wide range of illnesses and ages; what they had in common is that they were very sick.

The study group was 821 people who ended up in the ICU because of respiratory failure or shock. Originally, they were hospitalized for infections or lung or stomach problems. None was hospitalized for brain-related issues such as strokes.

Nearly 3 in 4 of the patients became delirious during their ICU stay, typically for a few days at a time. Three months after leaving the hospital, 4 in 10 had thinking problems comparable to someone with moderate traumatic brain injury; 1 in 4 had cognitive scores as low as someone with mild Alzheimer’s disease.

And time did not necessarily heal these wounds-after a year, 1 in 3 were still functioning on the same level as someone with moderate traumatic brain injury.

The longer patients had been delirious in the ICU, the worse their thinking problems tended to be months after discharge. The researchers could not definitively associate the mental dysfunction with any particular medication, such opioids or sedatives, which are notorious for compromising cognitive ability. And the younger patients had risks similar to the group as a whole, even when they had no pre-existing disease.

Administering pain meds but fewer sedatives, and getting patients mobile as soon as possible might lessen the duration of delirium. “You can’t eliminate the problem, but maybe you can reduce it,” Ely told Reuters.

As we blogged in April, the Society of Critical Care Medicine has identified post-intensive care syndrome, or PICS. If you have a friend or loved one in ICU, make sure the staff knows you’re familiar with PICS, and ask what they know about the syndrome.

Find out how much sedation the patient is being given, and ask if it’s the lowest dose possible.

And when it’s time for discharge, ask transition care team members how to recognize and address the effects of delirium. Make sure they have a plan for treating its long-lasting effects.

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