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Deep sedation in ICU reduced cognition even a year later (needed more vitamin D) – Oct 2013

Comment by VitaminDWiki: ICU drugs. traumatic brain injury and Chemo-brain: all appear to need vitamin D

Long-Term Cognitive Impairment after Critical Illness

Survivors of critical illness often have a prolonged and disabling form of cognitive impairment that remains inadequately characterized.

N Engl J Med 2013; 369:1306-1316 October 3, 2013DOI: 10.1056/NEJMoa1301372
P.P. Pandharipande, T.D. Girard, J.C. Jackson, A. Morandi, J.L. Thompson, B.T. Pun, N.E. Brummel, C.G. Hughes, E.E. Vasilevskis, A.K. Shintani, K.G. Moons, S.K. Geevarghese, A. Canonico, R.O. Hopkins, G.R. Bernard, R.S. Dittus, and E.W. Ely for the BRAIN-ICU Study Investigators

Methods:We enrolled adults with respiratory failure or shock in the medical or surgical intensive care unit (ICU), evaluated them for in-hospital delirium, and assessed global cognition and executive function 3 and 12 months after discharge with the use of the Repeatable Battery for the Assessment of Neuropsychological Status (population age-adjusted mean ±SD score, 100±15, with lower values indicating worse global cognition) and the Trail Making Test, Part B (population age-, sex-, and education-adjusted mean score, 50±10, with lower scores indicating worse executive function). Associations of the duration of delirium and the use of sedative or analgesic agents with the outcomes were assessed with the use of linear regression, with adjustment for potential confounders.

Results: Of the 821 patients enrolled, 6% had cognitive impairment at baseline, and delirium developed in 74% during the hospital stay.
At 3 months, 40% of the patients had global cognition scores that were 1.5 SD below the population means (similar to scores for patients with moderate traumatic brain injury),
And 26% had scores 2 SD below the population means (similar to scores for patients with mild Alzheimer's disease).

Deficits occurred in both older and younger patients and persisted, with 34% and 24% of all patients with assessments at 12 months that were similar to scores for patients with moderate traumatic brain injury and scores for patients with mild Alzheimer's disease, respectively.

A longer duration of delirium was independently associated with worse global cognition at 3 and 12 months (P=0.001 and P=0.04, respectively) and worse executive function at 3 and 12 months (P=0.004 and P=0.007, respectively). Use of sedative or analgesic medications was not consistently associated with cognitive impairment at 3 and 12 months.

Conclusions: Patients in medical and surgical ICUs are at high risk for long-term cognitive impairment. A longer duration of delirium in the hospital was associated with worse global cognition and executive function scores at 3 and 12 months. (Funded by the National Institutes of Health and others; BRAIN-ICU ClinicalTrials.gov number, NCT00392795.)

Supported by grants from the National Institutes of Health (AG027472; HL111111, to Drs. Pandharipande, Hughes, Dittus, and Ely; AG035117, to Drs. Pandharipande, Bernard, Dittus, and Ely; AG034257, to Dr. Girard; AG031322, to Dr. Jackson; AG040157, to Dr. Vasilevskis; and NHLBI 2 T32 HL087738-06, to Drs. Brummel and Bernard) and the Veterans Affairs (VA) Clinical Science Research and Development Service (to Drs. Pandharipande, Dittus, and Ely), a Mentored Research Training Grant from the Foundation for Anesthesia Education and Research (to Dr. Hughes), and the VA Tennessee Valley Geriatric Research Education and Clinical Center (to Drs. Girard, Vasilevskis, Dittus, and Ely).

Address reprint requests to Dr. Pandharipande at 1211 21st Ave. S, MAB Ste. 526, Nashville, TN 37212, or at pratik.pandharipande at vanderbilt.edu.

Appendix
The authors' full names, degrees, and affiliations are as follows: Pratik P. Pandharipande, M.D., M.S.C.I., the Department of Anesthesiology, Division of Critical Care, Vanderbilt University School of Medicine, and the Anesthesia Service, Department of Veterans Affairs, Tennessee Valley Healthcare System — both in Nashville; Timothy D. Girard, M.D., M.S.C.I., the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, and the Center for Health Services Research, Vanderbilt University School of Medicine, and the Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs, Tennessee Valley Healthcare System — both in Nashville; James C. Jackson, Psy.D., the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, the Center for Health Services Research, and the Department of Psychiatry, Vanderbilt University School of Medicine, and the Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System — both in Nashville; Alessandro Morandi, M.D., M.P.H., the Rehabilitation and Aged Care Unit, Hospital Ancelle, Cremona, and the Geriatric Research Group, Brescia — both in Italy; Jennifer L. Thompson, M.P.H., the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville; Brenda T. Pun, R.N., M.S.N., the Center for Health Services Research, Vanderbilt University School of Medicine, Nashville; Nathan E. Brummel, M.D., M.S.C.I., the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, and the Center for Health Services Research, Vanderbilt University School of Medicine, Nashville; Christopher G. Hughes, M.D., the Department of Anesthesiology, Division of Critical Care, Vanderbilt University School of Medicine, and the Anesthesia Service, Department of Veterans Affairs, Tennessee Valley Healthcare System — both in Nashville; Eduard E. Vasilevskis, M.D., M.P.H., the Center for Health Services Research and the Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, and the GRECC, Department of Veterans Affairs, Tennessee Valley Healthcare System — both in Nashville; Ayumi K. Shintani, Ph.D., M.P.H., the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville; Karel G. Moons, Ph.D., the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, and the Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands; Sunil K. Geevarghese, M.D., M.S.C.I., the Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University School of Medicine, Nashville; Angelo Canonico, M.D., Saint Thomas Hospital, Nashville; Ramona O. Hopkins, Ph.D., the Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, and the Psychology Department and Neuroscience Center, Brigham Young University, Provo — both in Utah; Gordon R. Bernard, M.D., the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville; Robert S. Dittus, M.D., M.P.H., the Center for Health Services Research and the Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, and the GRECC, Department of Veterans Affairs, Tennessee Valley Healthcare System — both in Nashville; and E. Wesley Ely, M.D., M.P.H., the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, and the Center for Health Services Research, Vanderbilt University School of Medicine, and the GRECC, Department of Veterans Affairs, Tennessee Valley Healthcare System — both in Nashville.

Cost of article – $15


USA today item and video on this story clips are below

  • "Historically, we take care of all the other organs but we ignore the brain," said Dr. Pratik Pandharipande, a Vanderbilt professor of anesthesiology and critical care, who was the study's lead author.
  • The longer a patient suffers from delirium while in the hospital, the higher the risk for dementia once discharged, the study found.
  • The practice of putting critically ill patients into drug-induced comas can lengthen delirium.

Email by Dr. Leslie Matthews who pointed out this study

Vanderbilt doctors discovered that 75% of ICU patients have memory (cognitive ) impairments similar to traumatic brain injury patients even though the ICU patients did not have a brain injury. Inflammation/infection are the culprits. We treat all our ICU patients with vitamin D3 which is one of the most powerful anti-inflammatory agents on the planet.
One of his references: Treatment of Traumatic Brain Injuries with Vitamin D3/Omega 3 FA/glutamine/progesterone
http://www.ijcasereportsandimages.com/archive/provisional_articles/2013-03/02_IJCRI_287_CS_112012%20prov%20corrected.pdf
Same paper is in VitaminDWiki


See also VitaminDWiki

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