Post-ICU psychological morbidity in very long ICU stay patients with ARDS and delirium☆
We investigated the impact of delirium on illness severity, psychological state, and memory in acute respiratory distress syndrome patients with very long ICU stay.Materials and methods:
Prospective cohort study in the medical-surgical ICUs of 2 teaching hospitals. Very long ICU stay (>75 days) and prolonged delirium (≥40 days) thresholds were determined by ROC analysis. Subjects were ≥18 years, full-code, and provided informed consent. Illness severity was assessed using Acute Physiology and Chronic Health Evaluation IV, Simplified Acute Physiology Score-3, and Sequential Organ Failure Assessment scores. Psychological impact was assessed using the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, and the 14-question Post-Traumatic Stress Syndrome (PTSS-14). Memory was assessed using the ICU Memory Tool survey.Results:
181 subjects were included. Illness severity did not correlate with delirium duration. On logistic regression, only PTSS-14 < 49 correlated with delirium (p = 0.001; 95% CI 1.011, 1.041). 49% remembered their ICU stay clearly. 47% had delusional memories, 50% reported intrusive memories, and 44% reported unexplained feelings of panic or apprehension.Conclusion:
Delirium was associated with memory impairment and PTSS-14 scores suggestive of PTSD, but not illness severity.