Mental health-related quality of life is related to delirium in intensive care patients

Longitudinal trajectories of health-related quality of life among critical care survivors: A latent class growth approach

OBJECTIVES

This study explored the trajectories of health-related quality of life (HRQOL) and the factors influencing these trajectories.

RESEARCH METHODOLOGY/DESIGN

Prospective observational cohort study.

SETTING

19 intensive care units (ICUs) in South Korea.

MAIN OUTCOME MEASURES

We used the Medical Outcomes Study Short Form version 2 (SF-36v2) to assess HRQOL at 3, 6, 12, and 24 months post-discharge. Additionally, we evaluated intensive care experience, post-intensive care syndrome, and demographic and clinical characteristics to identify factors. HRQOL trajectory groups were identified via latent class growth modeling, with determining factors analyzed using multinomial logistic regression.

RESULTS

The analysis identified three distinct groups for the physical component summary (PCS) and mental component summary (MCS) of the SF-36v2. For the PCS, the groups were labeled "Resilient Stable," "Moderate Recovered," and "Slow Recovering." For the MCS, the classifications were "Resilient Stable," "Low Recovered," and "Persistent Low." The determinants of the PCS Moderate Recovered and Slow Recovering Groups included older age, female gender, less educated, increased comorbidities, discharge to extended care facilities, and post-intensive care syndrome. Conversely, the MCS Low Recovered and Persistent Low Groups were determined by the intensive care experience and post-intensive care syndrome.

CONCLUSION

Our study identified specific vulnerable groups for PCS and MCS and their determinants in terms of HRQOL recovery among ICU survivors.

IMPLICATIONS FOR CLINICAL PRACTICE

There is a need for a preemptive approach for survivors with determinants that place them in vulnerable groups for poorer HRQOL as well as systematic monitoring of post-intensive care syndrome in various healthcare settings.

Clear Minds: Unravelling Delirium in Older Adults

With an explosive population growth of older adults, the incidence rates of neuropsychiatric syndromes, particularly delirium, are increasing in the community and hospital settings. Delirium is an acute disturbance in cognition and attention that may signify a serious medical, life-threatening condition and may mimic psychiatric-mental health issues. Although its prevalence rate is lower in the community, delirium affects up to 87% of hospitalized older adults and can cost up to $152 billion each year. Despite its common occurrence, delirium is often undetected in 50% to 60% across all care settings, delaying treatment and resulting in poor patient outcomes, such as increased mortality, prolonged hospital stays, cognitive and functional impairment, decreased quality of life, and institutionalization. The current article addresses strategies to recognize delirium and presents evidence-based approaches and future considerations for delirium management. [Journal of Psychosocial Nursing and Mental Health Services, 62(11), 11-18.].

Two months outcomes following delirium in the pediatric intensive care unit

The lasting consequences of delirium in children are not well characterized. This study aimed to compare the two-month outcomes in pediatric intensive care unit (PICU) survivors according to the presence of delirium. Post-hoc analysis of a single-center prospective study of mechanically ventilated (invasive ventilation or non-invasive ventilation) children followed at the CHU Sainte-Justine PICU follow-up clinic two months after PICU discharge, between October 2018 and August 2022. Delirium was defined as one or more Cornell Assessment of Pediatric Delirium (CAPD) scores ≥ 9. Primary outcome was survivors' quality of life and secondary outcomes were sleep and posttraumatic stress and anxiety and depression in parents. Multivariable linear and logistic regression models assessed the independent associations between delirium and outcomes while adjusting for age, sex, comorbidity, diagnosis, severity of illness, PICU length of stay, and invasive mechanical ventilation. Of the 179 children included over a 47 month-period, 117 (65.4%) had delirium. Children with delirium were more commonly intubated (91.5% vs. 30.7%, p < 0.001) and had higher PELOD-2 scores (10 vs. 4, p < 0.001). On multivariable analysis, delirium was associated with a decreased quality of life at 2.3 months post discharge (p = 0.03). The severity of the delirium episode (higher scores of CAPD) was associated with a higher likelihood of sleep disturbances (OR 1.13, p = 0.01) and parental anxiety (OR 1.16, p = 0.01), in addition to lower quality of life (p = 0.03).Conclusions: Two months following their PICU stay, children with delirium had a lower quality of life, suggesting a lasting effect of delirium on children and their families.

Long-term outcomes with haloperidol versus placebo in acutely admitted adult ICU patients with delirium

PURPOSE

We assessed long-term outcomes in acutely admitted adult patients with delirium treated in intensive care unit (ICU) with haloperidol versus placebo.

METHODS

We conducted pre-planned analyses of 1-year outcomes in the Agents Intervening against Delirium in the ICU (AID-ICU) trial, including mortality and health-related quality of life (HRQoL) assessed by Euroqol (EQ) 5-dimension 5-level questionnaire (EQ-5D-5L) index values and EQ visual analogue scale (EQ VAS) (deceased patients were assigned the numeric value zero). Outcomes were analysed using logistic and linear regressions with bootstrapping and G-computation, all with adjustment for the stratification variables (site and delirium motor subtype) and multiple imputations for missing HRQoL values.

RESULTS

At 1-year follow-up, we obtained vital status for 96.2% and HRQoL data for 83.3% of the 1000 randomised patients. One-year mortality was 224/501 (44.7%) in the haloperidol group versus 251/486 (51.6%) in the placebo group, with an adjusted absolute risk difference of - 6.4%-points (95% confidence interval [CI] - 12.8%-points to - 0.2%-points; P = 0.045). These results were largely consistent across the secondary analyses. For HRQoL, the adjusted mean differences were 0.04 (95% CI - 0.03 to 0.11; P = 0.091) for EQ-5D-5L-5L index values, and 3.3 (95% CI - 9.3 to 17.5; P = 0.142) for EQ VAS.

CONCLUSIONS

In acutely admitted adult ICU patients with delirium, haloperidol treatment reduced mortality at 1-year follow-up, but did not statistically significantly improve HRQoL.