Delirium and quality of life in critically ill patients: a prospective cohort study

Prophylactic Minocycline for Delirium in Critically Ill Patients: A Randomized Controlled Trial

BACKGROUND

Delirium is a potentially severe form of acute encephalopathy. Minocycline has neuroprotective effects in animal models of neurologic diseases; however, data from human studies remain scarce.

RESEARCH QUESTION

Does the neuroprotective effect of minocycline prevent delirium occurrence in critically ill patients?

STUDY DESIGN AND METHODS

This study was a randomized, placebo-controlled, double-anonymized trial conducted in four ICUs. Patients aged 18 years or older were eligible and randomized to receive minocycline (100 mg, twice daily) or placebo. The primary outcome was delirium incidence within 28 days or before ICU discharge. Secondary outcomes included days in delirium during ICU stay, delirium/coma-free days, length of mechanical ventilation, ICU length of stay, ICU mortality, and hospital mortality. The kinetics of various inflammatory (IL-1β, IL-6, IL-10, and C-reactive protein) and brain-related biomarkers (brain-derived neurotrophic factor and S100B) were used as exploratory outcomes.

RESULTS

A total of 160 patients were randomized, but one patient in the placebo group died before treatment; thus the data from 159 patients were analyzed (minocycline, n = 84; placebo, n = 75). After the COVID-19 pandemic it was decided to stop patient inclusion early. There was a small but significant decrease in delirium incidence: 17 patients (20%) in the minocycline arm compared with 26 patients (35%) in the placebo arm (P = .043). No other delirium-related outcomes were modified by minocycline treatment. Unexpectedly, there was a significant decrease in hospital mortality (39% vs. 23%; P = .029). Among all analyzed biomarkers, only plasma levels of C-reactive protein decreased significantly after minocycline treatment (F = 0.75, P = .78, within time; F = 4.09, P = .045, group × time).

INTERPRETATION

Our findings in this rather small study signal a possible positive effect of minocycline on delirium incidence. Further studies are needed to confirm the benefits of this drug as a preventive measure in critically ill patients.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov; No.: NCT04219735; URL: www.

CLINICALTRIALS

gov.

Investigating the effect of implementing a sensory stimulation program by family members on delirium status of brain injury patients hospitalized in the intensive care unit: A randomized clinical trial

BACKGROUND

Delirium is the most common psychological disorder in brain injury patients hospitalized in the intensive care unit (ICU), one of the leading causes of which can be sensory deprivation or sensory overload. This study aimed to determine the effect of implementing a sensory stimulation program by family members on the delirium status of ICU-hospitalized brain injury patients.

MATERIALS AND METHODS

In this randomized controlled clinical trial, 66 brain injury patients hospitalized in the ICUs were assigned to intervention and control groups using stratified random sampling. For the intervention group, a sensory stimulation program was implemented by family members for 1 h a day during the ICU stay. The control group received routine care. Patients' delirium status was assessed daily using the confusion assessment method for the intensive care unit (CAM-ICU). Data were analyzed by the SPSS software version 22, using Chi-square, independent t-test, and Binary logistic regression model tests, at a significance level of 0.05.

RESULTS

Odds of delirium Incidence in the intervention group was 94% lower than in the control group (OR = 0.057, 95% CI 0.017, 0.19, P = 0.001). There is a significant difference between the two groups in terms of length of delirium (P = 0.001), stay in ICU (P = 0.001) and mechanical ventilation (P = 0.001). The mean of all three variables in the intervention group was lower than the control group.

CONCLUSIONS

Implementing of sensory stimulation program by the family members, as a non-pharmacological method, can reduce the incidence of delirium in brain injury patients admitted to ICU.

Characteristics and influence on quality of life of new-onset pain in critical COVID-19 survivors

Background

Pain is a clinical feature of COVID‐19, however, data about persistent pain after hospital discharge, especially among ICU survivors is scarce. The aim of this study was to explore the incidence and characteristics of new‐onset pain and its impact on Health‐Related Quality of Life (HRQoL), and to quantify the presence of mood disorders in critically ill COVID‐19 survivors.

Methods

This is a preliminary report of PAIN‐COVID trial (NCT04394169) presenting a descriptive analysis in critically ill COVID‐19 survivors, following in person interview 1 month after hospital discharge. Pain was assessed using the Brief Pain Inventory, the Douleur Neuropathique 4 questionnaire and the Pain Catastrophizing Scale. HRQoL was evaluated with the EQ 5D/5L, and mood disorders with the Hospital Anxiety and Depression Scale (HADS).

Results

From 27 May to 19 July 2020, 203 patients were consecutively screened for eligibility, and 65 were included in this analysis. Of these, 50.8% patients reported new‐onset pain; 38.5% clinically significant pain (numerical rating score ≥3 for average pain intensity); 16.9% neuropathic pain; 4.6% pain catastrophizing thoughts, 44.6% pain in ≥2 body sites and 7.7% widespread pain. Patients with new‐onset pain had a worse EQ‐VAS and EQ index value (p < 0.001). Pain intensity was negatively correlated to both the former (Spearman ρ: −0.546, p < 0.001) and the latter (Spearman ρ: −0.387, p = 0.001). HADS anxiety and depression values equal or above eight were obtained in 10.8% and 7.7% of patients, respectively.

Conclusion

New‐onset pain in critically ill COVID‐19 survivors is frequent, and it is associated with a lower HRQoL.

Trial registration No.: NCT04394169. Registered 19 May 2020. https://clinicaltrials.gov/ct2/show/NCT04394169.

Significance

A substantial proportion of severe COVID‐19 survivors may develop clinically significant persistent pain, post‐intensive care syndrome and chronic ICU‐related pain. Given the number of infections worldwide and the unprecedented size of the population of critical illness survivors, providing information about the incidence of new‐onset pain, its characteristics, and its influence on the patients’ quality of life might help establish and improve pain management strategies.

Cluster nursing can reduce postoperative delirium and improve the negative emotions and quality of life of elderly ICU patients

OBJECTIVE

To explore the application effect of cluster nursing in post-surgery elderly patients in intensive care units (ICU).

METHODS

From March 2019 to August 2020, a total of 167 elderly patients admitted to the ICU in Changzhou No. 2 People's Hospital, the Affiliated Hospital of Nanjing Medical University were recruited as the study cohort. They were divided into a test group (n=85) and a control group (n=82). The patients in the control group underwent routine nursing, and the patients in the test group underwent cluster nursing in addition to the nursing the control group underwent. The two groups' incidences of delirium, their quality of life, and their mental health were compared.

RESULTS

The total incidences of delirium in the test group were significantly lower than they were in the control group, and the delirium outcome rate was significantly higher than it was in the control group. A comparison of the Acute Physiology and Chronic Health Evaluation (APACHE ll) and Symptom Checklist-90 (SCL-90) scores before and after the nursing showed that the test group had notably lower scores than the control group. In addition, the nursing satisfaction rate in the test group was 88.24%, which was significantly higher than the rate in the control group (73.17%). The hospitalization expenses of the test group were lower, with a notably improved quality of life.

CONCLUSION

Cluster nursing can reduce the incidence of delirium and improve the quality of life and mental health of post-surgery elderly ICU patients.