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Intensive-Care Units Pose Long-Term Brain Risk, Study Finds

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Intensive-Care Units Pose Long-Term Brain Risk, Study Finds

Critically ill patients who survive a stay in an intensive-care unit, where they are often heavily sedated and ventilated, can find themselves mentally impaired long after release. A new study says the problem is far more common and lasting than previously believed.

Nearly 80% of patients with prolonged ICU stays showed cognitive problems a year or more later, and more than half exhibited effects similar to Alzheimer's disease and traumatic brain injury, according to a report Wednesday in the New England Journal of Medicine.

The researchers, at Vanderbilt University in Nashville, Tenn., and the Tennessee Valley Veterans Affairs Geriatric Research Education and Clinical Center, said the findings highlight the need to modify ICU practices that put patients at risk of cognitive problems, and to offer rehabilitation programs to restore concentration, thinking and memory function after patients leave the hospital.

Intensive-care units traditionally keep patients heavily sedated, immobilized and on mechanical ventilation to keep them free of pain, anxiety and agitation as they heal or undergo invasive procedures. But prolonged sedation can trigger or exacerbate delirium, a temporary state of acute brain injury that can also be caused by conditions such as septic shock, an infection that spreads through the body and is a common reason for being admitted to an ICU.

Delirium, long linked to higher rates of death, is also associated with long-term mental impairment in ICU survivors, the study found. E. Wesley Ely, senior author of the study and founder of Vanderbilt's ICU Delirium and Cognitive Impairment Study Group, said some ICU-related brain injury could be prevented if the duration of delirium in the ICU is shortened. A new protocol Vanderbilt and others are following includes weaning patients from sedatives carefully, waking them regularly to see if they can breathe on their own sooner, and getting them out of bed and moving as soon as possible.

 

The study included 821 patients with respiratory failure or septic shock who had a median ICU stay of 5 days. Their ages ranged from 18 to 99. Only 6% had pre-existing cognitive impairment, and 75% developed delirium during their hospital stay. Assessed for cognitive function at one year after discharge, 34% still had scores similar to moderate traumatic brain injury, and 24% had scores similar to patients with mild Alzheimer's disease. In total, nearly 80% scored lower than predicted by age and education.

 

"Whether you are young or old and even if you are previously healthy, if you go into an ICU with significant breathing problems, are on a breathing machine or in shock, you may not be coming out with an intact brain," said Dr. Ely. And after discharge, he adds, "so many people are living in their own private hell of mental fog and no one around them knows about it, tells them it is going to happen, or tries to prevent or treat it."

 

References and further information

This article was originally produced by the Wall Street Journal.

 

To view the rest of the article visit the Wall Street Journal website  http://online.wsj.com/article/SB10001424052702303492504579111361055134336.html

 

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