Brain problems can linger months after ICU stay

NEW YORK (Reuters Health) - Critically-ill people who end up spending days in an intensive care unit (ICU) often develop thinking and memory problems, according to a new study.

Even when people recover from their physical illness, those problems can persist for more than a year after their hospital stay, researchers said.

They found ICU patients who were delirious - severely confused and unable to focus - were especially likely to go on to have thinking and memory problems.

“The longer you are delirious, the more likely you are to have long-term cognitive impairment that looks like Alzheimer’s disease or traumatic brain injury,” Dr. Wes Ely of the Vanderbilt University Medical Center in Nashville, Tennessee, told Reuters Health.

“For a long time, we thought delirium was just something that happened because people were in the ICU and that, as soon as they got out of the ICU, they would be okay,” Dr. Karin Neufeld, a psychiatrist at Johns Hopkins University School of Medicine in Baltimore, told Reuters Health.

Now, she said, doctors are realizing being delirious could be a sign that a patient is more severely ill.

“We need to redouble our efforts to reduce the number of days people are delirious and prevent it if we can,” said Neufeld, who was unconnected with the research.

Doctors have known for years that certain patients are prone to some degree of thinking problems after hospital procedures.

For example, one study from last year found almost half of heart surgery patients developed delirium and their minds often remained dulled for a year.

What is new about this study is that cognitive problems were seen among patients with a wide range of illnesses, Neufeld said. However, she added, the people were alike in one way: they were all very sick.

Ely and his team studied 821 people who ended up in the ICU because of respiratory failure or shock.

Those patients were originally hospitalized for infections or lung or stomach problems. None were hospitalized for brain-related issues such as strokes.

Nearly three-quarters of the patients became delirious during their ICU stay, typically for a few days at a time.

Three months after leaving the hospital, 40 percent of them had thinking problems comparable to someone with moderate traumatic brain injury, the researchers found. And 26 percent had cognitive scores as low as someone with mild Alzheimer’s disease.

The problems barely faded with time.

At the one-year mark, 34 percent of patients were still functioning on the same level as someone with moderate traumatic brain injury and 24 percent at the level of a person with mild Alzheimer’s.

“Your odds are not great in terms of recovery,” said Ely. “Some will recover but most won’t, and that is scary.”

The longer patients had been delirious in the ICU, the worse their thinking problems tended to be months after discharge, the researchers reported in the New England Journal of Medicine.

They couldn’t link those problems to any particular medication and found that younger patients had risks similar to the group as a whole.

“Perhaps the scariest piece of all is that 30- and 40-year-olds coming in with no pre-existing disease are often leaving with profound cognitive impairment,” Ely said in a statement.

Neufeld said keeping ICU patients pain-free but away from sedatives as much as possible and getting those who are able walking around can lessen delirium.

“You can’t eliminate the problem, but maybe you can reduce it,” Ely said.

He stressed that the findings should not discourage people from getting the treatment they need.

What’s most important, he said, is that people are aware of these issues.

Even if people come into the hospital with no other underlying health problems, “if they get crazy sick and (end up) in an ICU, you have a new problem to consider when they leave,” Ely said.

“And if you didn’t consider that, they’re going to go back out into the world and have a lot of dysfunction in their life.”

SOURCE: New England Journal of Medicine, online October 2, 2013.