Risk factors for long-term brain dysfunction after chronic critical Illness

Rationale: Factors associated with long-term brain dysfunction (LTBD) in survivors of chronic critical illness (CCI) have not been explored but may be important for clinical practice and planning by patients, families, and providers. Objectives: To identify risk factors for LTBD after treatment for CCI and to explore the association between acute delirium and coma during hospital treatment and LTBD. Methods: A prospective cohort stud of adults admitted to a respiratory care unit for treatment of CCI. Measurements and Main Results: Using the Confusion Assessment Method for ICU and the Richmond Agitation and Sedation Scale, we evaluated patients for delirium and coma during their hospi tal treatment for CCI. We collected data on other potential risk factors for LTBD by prospectively reviewing the patients' medical records and interviewing surrogates. We contacted survivors by telephone at 6 months after discharge to assess brain function using the telephone Confusion Assessment Method. Among 385 patients treated for CCI, 213 (56.1%) were dead at 6 months, and 108 of 167 (64.7%) of survivors were impaired. We used multinomial logistic regression in which the outcomes were (1) death, (2) br a in dysfunction, and (3) survival without LTBD. Older patients, patients with higher Acute Physiology Score, and those with multiple complications during treatment for CCI were more likely to have LTBD. Acute brain dysfunction during hospital treatment was also associated with an increased risk of LTBD (odds ratio, 2.14; 95% confidence interval, 1.02-4.52). Conclusions: LTBD after treatment for CCI is associated with brain dysfunction during such treatment as well as with older age and higher severity of il lness of the patients.