Pre-Existing Psychiatric Illness Is Associated With an Increased Risk of Delirium in Patients With Acute Respiratory Distress Syndrome

2021 ◽  
pp. 088506662110190
Author(s):  
Saminder Singh Kalra ◽  
Johnny Jaber ◽  
Bashar N. Alzghoul ◽  
Ryan Hyde ◽  
Sarina Parikh ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Psychiatric Illness ◽  
Distress Syndrome ◽  
Multivariable Logistic Regression Analysis ◽  
Psychiatric Illnesses ◽  
Increased Risk ◽  
Icu Delirium ◽  
The Impact

Background: Patients with acute respiratory distress syndrome (ARDS) are highly susceptible to developing delirium for a multitude of reasons. Previous studies have linked pre-existing depression with an increased risk of postoperative delirium in patients undergoing cardiac and non-cardiac surgery. However, the evidence regarding the association between pre-existing psychiatric illnesses and delirium in ARDS patients is unknown. In this study, we aim to determine the relationship between pre-existing psychiatric illness and the risk of development of delirium amongst ARDS patients. Study Design and Methods: We performed a retrospective study of a mixed group of patients admitted to the intensive care unit (ICU) between January 2016 and December 2019 with a diagnosis of ARDS per the Berlin definition. The study group was divided into 2 cohorts: subjects with delirium and subjects without delirium. Comparison between the 2 groups was conducted to examine the impact of pre-existing psychiatric illnesses including major depressive disorder (MDD), generalized anxiety disorder (GAD), bipolar disorder, schizophrenia, or post-traumatic stress disorder. Multivariable logistic regression analysis was performed adjusting for benzodiazepine use, sedatives, analgesics, sequential organ failure assessment score, and corticosteroid use to determine the association between pre-existing psychiatric disorders and delirium. Results: 286 patients with ARDS were identified; 124 (43%) of whom were diagnosed with ICU delirium. In patients diagnosed with ICU delirium, 49.2% were found to have preexisting psychiatric illnesses, compared to 34.0% without any preexisting psychiatric illness (OR = 1.94, P = 0.01). In a subgroup analysis of individual psychiatric illnesses, GAD and MDD were associated with the development of delirium (OR = 1.88, P = 0.04 and OR = 1.76, P = 0.05 respectively). Interpretation: ARDS patients with preexisting psychiatric illnesses, particularly GAD and MDD are associated with an increased risk of developing ICU delirium. Clinicians should be aware of the effect of psychiatric co-morbidities on developing delirium in critically ill patients.

Perioperative proADM-change is associated with the development of acute respiratory distress syndrome in critically ill cardiac surgery patients: a prospective cohort study

2019 ◽  
Vol 13 (13) ◽  
pp. 1081-1091
Author(s):  
Judith van Paassen ◽  
Jaap T van Dissel ◽  
Pieter S Hiemstra ◽  
Jaap Jan Zwaginga ◽  
Christa M Cobbaert ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Mixed Models ◽  
Distress Syndrome ◽  
Predictive Capacity ◽  
Post Surgery ◽  
Definition Of ◽  
The Impact

Aim: Biomarkers of acute respiratory distress syndrome (ARDS) after cardiac-surgery may help risk-stratification and management. Preoperative single-value proADM increases predictive capacity of scoring-system EuroSCORE. To include the impact of surgery, we aim to assess the predictive value of the perioperative proADM-change on development of ARDS in 40 cardiac-surgery patients. Materials & methods: ProADM was measured in nine sequential blood samples. The Berlin definition of ARDS was used. For data-analyses, a multivariate model of EuroSCORE and perioperative proADM-change, linear mixed models and logistic regression were used. Results: Perioperative proADM-change was associated with ARDS after cardiac-surgery, and it was superior to EuroSCORE. A perioperative proADM-change >1.5 nmol/l could predict ARDS. Conclusion: Predicting post-surgery ARDS with perioperative proADM-change enables clinicians to intensify lung-protective interventions and individualized fluid therapy to minimize secondary injury.

scholarly journals Early Prone Positioning in Acute Respiratory Distress Syndrome Related to COVID-19: A Propensity Score Analysis from the Multicentric Cohort COVID-ICU network. The ProneCOVID Study.

2021 ◽  
Author(s):  
Christophe LE TERRIER ◽  
Florian Sigaud ◽  
Said Lebbah ◽  
Luc Desmedt ◽  
David Hajage ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Propensity Score ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Propensity Score Analysis ◽  
Prone Positioning ◽  
Icu Admission ◽  
Significant Difference ◽  
The Impact

Abstract Background Delaying time to prone positioning (PP) may be associated with higher mortality in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). We evaluated the use and the impact of early PP on clinical outcomes in intubated patients hospitalized in intensive care units (ICUs) for COVID-19.Methods All intubated patients with ARDS due to COVID-19 were involved in a secondary analysis from a prospective multicenter cohort study of COVID-ICU network including 149 ICUs across France, Belgian and Switzerland. Patients were followed-up until Day-90. The primary outcome was survival at Day-60. Analysis used a Cox proportional hazard model including a propensity score. Results Among 2137 intubated patients, 1504 (70.4%) were placed in PP during their ICU stay, and 491 (23%) during the first 24 hrs following ICU admission. One hundred and eighty-one patients (36.9%) of the early PP group had a PaO2/FiO2 ratio > 150 mmHg when prone positioning was initiated. Among non-early PP group patients, 1013 (47.4%) patients had finally been placed in PP within a median delay of 3 days after ICU admission. Day-60 mortality in non-early PP group was 34.2% vs. 39.3% in the early PP group (p = 0.038). Day-28 and Day-90 mortality as well as the need for adjunctive therapies were more important in patients with early PP. After propensity score adjustment, no significant difference in survival at Day-60 was found between the two-study groups (HR 1.34 [0.96-1.68], p=0.09 and HR 1.19 [0.998-1.412], p=0.053 in complete case analysis or in multiple imputation analysis, respectively).Conclusions In a large multicentric international cohort of intubated ICU patients with ARDS due to COVID-19, PP has been used frequently as a main treatment. In this study, early PP started within 24 hrs after ICU admission was not associated with a survival benefit compared to PP after day 1.

Acute Respiratory Distress Syndrome

2019 ◽  
pp. 137-141
Author(s):  
Richard K. Patch ◽  
James Y. Findlay
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Clinical Syndrome ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Neurocognitive Dysfunction ◽  
Psychiatric Illnesses ◽  
Pulmonary Damage

Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by acute hypoxemic respiratory failure. Patients with ARDS have pulmonary damage from an acute, usually severe, diffuse inflammatory lung injury that leads to increased vascular permeability and loss of aerated tissue. Mortality from ARDS is estimated to range from 26% to 58%, and in-hospital mortality is high (46.1%) for those with severe ARDS. Survivors have extensive morbidity, including neurocognitive dysfunction, physical disabilities, and psychiatric illnesses such as depression, anxiety, and posttraumatic stress disorder. Lung function may be compromised for as long as 5 years.

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