Single assessment of delirium severity during postacute intensive care of chronically critically ill patients and its associated factors: post hoc analysis of a prospective cohort study in Germany

Objectives To assess the delirium severity (DS), its risk factors and association with adverse patient outcomes in chronically critically ill (CCI) patients.Design A prospective cohort study.Setting A tertiary care hospital with postacute intensive care units (ICUs) in Germany.Participants N=267 CCI...

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Main Authors: Gloria-Beatrice Wintermann, Kerstin Weidner, Bernhard Strauss, Jenny Rosendahl
Format: Article
Language:English
Published: BMJ Publishing Group 2020-10-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/10/10/e035733.full
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spelling doaj-a2018ced82ed4f73b5c87d004063a3962021-05-06T09:32:14ZengBMJ Publishing GroupBMJ Open2044-60552020-10-01101010.1136/bmjopen-2019-035733Single assessment of delirium severity during postacute intensive care of chronically critically ill patients and its associated factors: post hoc analysis of a prospective cohort study in GermanyGloria-Beatrice Wintermann0Kerstin Weidner1Bernhard Strauss2Jenny Rosendahl3Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Sachsen, GermanyDepartment of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Sachsen, GermanyInstitute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Thüringen, GermanyInstitute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Thüringen, GermanyObjectives To assess the delirium severity (DS), its risk factors and association with adverse patient outcomes in chronically critically ill (CCI) patients.Design A prospective cohort study.Setting A tertiary care hospital with postacute intensive care units (ICUs) in Germany.Participants N=267 CCI patients with critical illness polyneuropathy and/or critical illness myopathy, aged 18–75 years, who had undergone elective tracheotomy for weaning failure.Interventions None.Measures Primary outcomes: DS was assessed using the Confusion Assessment Method for the Intensive Care Unit-7 delirium severity score, within 4 weeks (t1) after the transfer to a tertiary care hospital. In post hoc analyses, univariate linear regressions were employed, examining the relationship of DS with clinical, sociodemographic and psychological variables. Secondary outcomes: additionally, correlations of DS with fatigue (using the Multidimensional Fatigue Inventory-20), quality of life (using the Euro-Quality of Life) and institutionalisation/mortality at 3 (t2) and 6 (t3) months follow-up were computed.Results Of the N=267 patients analysed, 9.4% showed severe or most severe delirium symptoms. 4.1% had a full-syndromal delirium. DS was significantly associated with the severity of illness (p=0.016, 95% CI −0.1 to −0.3), number of medical comorbidities (p<0.001, 95% CI .1 to .3) and sepsis (p<0.001, 95% CI .3 to 1.0). Patients with a higher DS at postacute ICU (t1), showed a higher mental fatigue at t2 (p=0.008, 95% CI .13 to .37) and an increased risk for institutionalisation/mortality (p=0.043, 95% CI 1.1 to 28.9/p=0.015, 95% CI 1.5 to 43.2).Conclusions Illness severity is positively associated with DS during postacute care in CCI patients. An adequate management of delirium is essential in order to mitigate functional and cognitive long-term sequelae following ICU.Trial registration number DRKS00003386.https://bmjopen.bmj.com/content/10/10/e035733.full
collection DOAJ
language English
format Article
sources DOAJ
author Gloria-Beatrice Wintermann
Kerstin Weidner
Bernhard Strauss
Jenny Rosendahl
spellingShingle Gloria-Beatrice Wintermann
Kerstin Weidner
Bernhard Strauss
Jenny Rosendahl
Single assessment of delirium severity during postacute intensive care of chronically critically ill patients and its associated factors: post hoc analysis of a prospective cohort study in Germany
BMJ Open
author_facet Gloria-Beatrice Wintermann
Kerstin Weidner
Bernhard Strauss
Jenny Rosendahl
author_sort Gloria-Beatrice Wintermann
title Single assessment of delirium severity during postacute intensive care of chronically critically ill patients and its associated factors: post hoc analysis of a prospective cohort study in Germany
title_short Single assessment of delirium severity during postacute intensive care of chronically critically ill patients and its associated factors: post hoc analysis of a prospective cohort study in Germany
title_full Single assessment of delirium severity during postacute intensive care of chronically critically ill patients and its associated factors: post hoc analysis of a prospective cohort study in Germany
title_fullStr Single assessment of delirium severity during postacute intensive care of chronically critically ill patients and its associated factors: post hoc analysis of a prospective cohort study in Germany
title_full_unstemmed Single assessment of delirium severity during postacute intensive care of chronically critically ill patients and its associated factors: post hoc analysis of a prospective cohort study in Germany
title_sort single assessment of delirium severity during postacute intensive care of chronically critically ill patients and its associated factors: post hoc analysis of a prospective cohort study in germany
publisher BMJ Publishing Group
series BMJ Open
issn 2044-6055
publishDate 2020-10-01
description Objectives To assess the delirium severity (DS), its risk factors and association with adverse patient outcomes in chronically critically ill (CCI) patients.Design A prospective cohort study.Setting A tertiary care hospital with postacute intensive care units (ICUs) in Germany.Participants N=267 CCI patients with critical illness polyneuropathy and/or critical illness myopathy, aged 18–75 years, who had undergone elective tracheotomy for weaning failure.Interventions None.Measures Primary outcomes: DS was assessed using the Confusion Assessment Method for the Intensive Care Unit-7 delirium severity score, within 4 weeks (t1) after the transfer to a tertiary care hospital. In post hoc analyses, univariate linear regressions were employed, examining the relationship of DS with clinical, sociodemographic and psychological variables. Secondary outcomes: additionally, correlations of DS with fatigue (using the Multidimensional Fatigue Inventory-20), quality of life (using the Euro-Quality of Life) and institutionalisation/mortality at 3 (t2) and 6 (t3) months follow-up were computed.Results Of the N=267 patients analysed, 9.4% showed severe or most severe delirium symptoms. 4.1% had a full-syndromal delirium. DS was significantly associated with the severity of illness (p=0.016, 95% CI −0.1 to −0.3), number of medical comorbidities (p<0.001, 95% CI .1 to .3) and sepsis (p<0.001, 95% CI .3 to 1.0). Patients with a higher DS at postacute ICU (t1), showed a higher mental fatigue at t2 (p=0.008, 95% CI .13 to .37) and an increased risk for institutionalisation/mortality (p=0.043, 95% CI 1.1 to 28.9/p=0.015, 95% CI 1.5 to 43.2).Conclusions Illness severity is positively associated with DS during postacute care in CCI patients. An adequate management of delirium is essential in order to mitigate functional and cognitive long-term sequelae following ICU.Trial registration number DRKS00003386.
url https://bmjopen.bmj.com/content/10/10/e035733.full
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