Delirium and quality of life in critically ill patients: a prospective cohort study. / Delirium e qualidade de vida em pacientes críticos: um estudo de coorte prospectivo.

OBJECTIVE: To evaluate the association between the incidence of delirium in the intensive care unit and quality of life 1 month after hospital discharge. METHODS: This was a prospective cohort study conducted in the intensive care units of two medium-complexity hospitals from December 2015 to December 2016. Delirium was identified using the Confusion Assessment Method for the Intensive Care Unit scale. At the time of hospital discharge, functional capacity and cognition were assessed with the Barthel index and the Mini Mental State Examination, respectively. Thirty days after patient discharge, the World Health Organization Quality of Life-BREF questionnaire was administered by telephone. RESULTS: A total of 216 patients were included. Delirium was identified in 127 (58.8%) of them. Patients with delirium exhibited greater functional dependence (median Barthel index 50.0 [21.2 - 70.0] versus 80.0 [60.0 - 95.0]; p < 0.001) and lower cognition (Mini Mental State Examination score 12.9 ± 7.5 versus 20.7 ± 9.8; p < 0.001) at hospital discharge. There was no difference in any of the quality-of-life domains evaluated 1 month after hospital discharge between patients with and without delirium. CONCLUSION: Our findings suggest that patients with delirium in the intensive care unit do not have worse quality of life 1 month after hospital discharge, despite presenting greater cognitive impairment and functional disability at the time of hospital discharge.

OBJETIVO: Avaliar a associação entre a incidência de delirium na unidade de terapia intensiva e qualidade de vida 1 mês após a alta hospitalar. MÉTODOS: Trata-se de estudo de coorte prospectivo desenvolvido em unidades de terapia intensiva de dois hospitais de média complexidade durante o período de dezembro de 2015 a dezembro de 2016. Delirium foi identificado por meio da escala Confusion Assessment Method for the Intensive Care Unit. No momento da alta hospitalar, foram avaliadas capacidade funcional e cognição por meio do índice de Barthel e da escala de Mini Exame do Estado Mental, respectivamente. Após 30 dias da alta hospitalar do paciente, por meio de contato telefônico, aplicou-se o questionário World Health Organization Quality of Life-Bref. RESULTADOS: Foram incluídos 216 pacientes. Delirium foi identificado em 127 (58,8%) deles. Os pacientes com delirium apresentaram maior dependência funcional (mediana do índice de Barthel 50,0 [21,2 - 70,0] versus 80,0 [60,0 - 95,0]; p < 0,001) e menor cognição (escore do Mini Exame do Estado Mental 12,9 ± 7,5 versus 20,7 ± 9,8; p < 0,001) na alta hospitalar. Com relação à qualidade de vida, avaliada 1 mês após alta hospitalar, não houve diferença, em nenhum dos domínios, entre os pacientes com e sem delirium. CONCLUSÃO: Nossos achados sugerem que os pacientes com delirium na unidade de terapia intensiva não apresentam piora da qualidade de vida 1 mês após a alta hospitalar, apesar de apresentarem maior prejuízo cognitivo e incapacidade funcional no momento da alta hospitalar.

Delirium e qualidade de vida em pacientes críticos: um estudo de coorte prospectivo / Delirium and quality of life in critically ill patients: a prospective cohort study

RESUMO Objetivo: Avaliar a associação entre a incidência de delirium na unidade de terapia intensiva e qualidade de vida 1 mês após a alta hospitalar Métodos: Trata-se de estudo de coorte prospectivo desenvolvido em unidades de terapia intensiva de dois hospitais de média complexidade durante o período de dezembro de 2015 a dezembro de 2016. Delirium foi identificado por meio da escala Confusion Assessment Method for the Intensive Care Unit. No momento da alta hospitalar, foram avaliadas capacidade funcional e cognição por meio do índice de Barthel e da escala de Mini Exame do Estado Mental, respectivamente. Após 30 dias da alta hospitalar do paciente, por meio de contato telefônico, aplicou-se o questionário World Health Organization Quality of Life-Bref. Resultados: Foram incluídos 216 pacientes. Delirium foi identificado em 127 (58,8%) deles. Os pacientes com delirium apresentaram maior dependência funcional (mediana do índice de Barthel 50,0 [21,2 - 70,0] versus 80,0 [60,0 - 95,0]; p < 0,001) e menor cognição (escore do Mini Exame do Estado Mental 12,9 ± 7,5 versus 20,7 ± 9,8; p < 0,001) na alta hospitalar. Com relação à qualidade de vida, avaliada 1 mês após alta hospitalar, não houve diferença, em nenhum dos domínios, entre os pacientes com e sem delirium. Conclusão: Nossos achados sugerem que os pacientes com delirium na unidade de terapia intensiva não apresentam piora da qualidade de vida 1 mês após a alta hospitalar, apesar de apresentarem maior prejuízo cognitivo e incapacidade funcional no momento da alta hospitalar.

Abstract Objective: To evaluate the association between the incidence of delirium in the intensive care unit and quality of life 1 month after hospital discharge. Methods: This was a prospective cohort study conducted in the intensive care units of two medium-complexity hospitals from December 2015 to December 2016. Delirium was identified using the Confusion Assessment Method for the Intensive Care Unit scale. At the time of hospital discharge, functional capacity and cognition were assessed with the Barthel index and the Mini Mental State Examination, respectively. Thirty days after patient discharge, the World Health Organization Quality of Life-BREF questionnaire was administered by telephone. Results: A total of 216 patients were included. Delirium was identified in 127 (58.8%) of them. Patients with delirium exhibited greater functional dependence (median Barthel index 50.0 [21.2 - 70.0] versus 80.0 [60.0 - 95.0]; p < 0.001) and lower cognition (Mini Mental State Examination score 12.9 ± 7.5 versus 20.7 ± 9.8; p < 0.001) at hospital discharge. There was no difference in any of the quality-of-life domains evaluated 1 month after hospital discharge between patients with and without delirium. Conclusion: Our findings suggest that patients with delirium in the intensive care unit do not have worse quality of life 1 month after hospital discharge, despite presenting greater cognitive impairment and functional disability at the time of hospital discharge.

Inflammatory and perfusion markers as risk factors and predictors of critically ill patient readmission.

OBJECTIVE: To assess the performance of central venous oxygen saturation, lactate, base deficit, and C-reactive protein levels and SOFA and SWIFT scores on the day of discharge from the intensive care unit as predictors of patient readmission to the intensive care unit. METHODS: This prospective and observational study collected data from 1,360 patients who were admitted consecutively to a clinical-surgical intensive care unit from August 2011 to August 2012. The clinical characteristics and laboratory data of readmitted and non-readmitted patients after discharge from the intensive care unit were compared. Using a multivariate analysis, the risk factors independently associated with readmission were identified. RESULTS: The C-reactive protein, central venous oxygen saturation, base deficit, and lactate levels and the SWIFT and SOFA scores did not correlate with the readmission of critically ill patients. Increased age and contact isolation because of multidrug-resistant organisms were identified as risk factors that were independently associated with readmission in this study group. CONCLUSION: Inflammatory and perfusion parameters were not associated with patient readmission. Increased age and contact isolation because of multidrug-resistant organisms were identified as predictors of readmission to the intensive care unit.

Marcadores inflamatórios e perfusionais como preditores e fatores de risco para readmissão de pacientes gravemente enfermos / Inflammatory and perfusion markers as risk factors and predictors of critically ill patient readmission

Objetivo: Avaliar o desempenho da saturação venosa central, lactato, défice de bases, níveis de proteína C-reativa, escore SOFA e SWIFT do dia da alta da unidade de terapia intensiva como preditores para readmissão de pacientes na unidade de terapia intensiva. Métodos: Estudo prospectivo observacional com dados coletados de 1.360 pacientes internados consecutivamente no período de agosto de 2011 a agosto de 2012 em uma unidade de terapia intensiva clínico-cirúrgica. Foram comparadas as características clínicas e os dados laboratoriais dos pacientes readmitidos e dos pacientes não readmitidos após a alta da unidade de terapia intensiva. Por meio de análise multivariada, foram identificados os fatores de risco independentemente associados à readmissão. Resultados: A proteína C-reativa, a saturação venosa central, o défice de bases, o lactato, os escores SOFA e o SWIFT não foram associados à readmissão de pacientes graves. Pacientes mais idosos e a necessidade de isolamento de contato devido a germes multirresistentes foram identificados como fatores de risco independentemente associados à readmissão na população estudada. Conclusão: Os parâmetros inflamatórios e perfusionais não foram associados à readmissão. Idade e necessidade de isolamento de contato devido a germes multirresistentes foram identificados como preditores para readmissão na unidade de terapia intensiva. .

Objective: To assess the performance of central venous oxygen saturation, lactate, base deficit, and C-reactive protein levels and SOFA and SWIFT scores on the day of discharge from the intensive care unit as predictors of patient readmission to the intensive care unit. Methods: This prospective and observational study collected data from 1,360 patients who were admitted consecutively to a clinical-surgical intensive care unit from August 2011 to August 2012. The clinical characteristics and laboratory data of readmitted and non-readmitted patients after discharge from the intensive care unit were compared. Using a multivariate analysis, the risk factors independently associated with readmission were identified. Results: The C-reactive protein, central venous oxygen saturation, base deficit, and lactate levels and the SWIFT and SOFA scores did not correlate with the readmission of critically ill patients. Increased age and contact isolation because of multidrug-resistant organisms were identified as risk factors that were independently associated with readmission in this study group. Conclusion: Inflammatory and perfusion parameters were not associated with patient readmission. Increased age and contact isolation because of multidrug-resistant organisms were identified as predictors of readmission to the intensive care unit. .