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The Aftermath of Intensive Care Delirium. A one-year follow-up focusing on mortality, health-related quality of life, cognitive function and patient experiences.

B Mortensen, Camilla LU (2024) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Delirium is a serious and common condition in the intensive care unit (ICU), which affects 30-50 % of the
patients and is associated with increased mortality and morbidity in the context of long-term outcomes. No
evidence-based treatment for delirium exists, and currently, delirium is mainly treated pharmacologically with
haloperidol, a typical antipsychotic agent. The “Agents Intervening against Delirium in the Intensive Care Unit
(AID-ICU)“is a multicentre, randomised, placebo-controlled trial that explored the benefits and harms of
haloperidol in treating ICU patients with delirium. As limited evidence exists on the long-term outcomes of
haloperidol for treating patients with delirium, this thesis is part... (More)
Delirium is a serious and common condition in the intensive care unit (ICU), which affects 30-50 % of the
patients and is associated with increased mortality and morbidity in the context of long-term outcomes. No
evidence-based treatment for delirium exists, and currently, delirium is mainly treated pharmacologically with
haloperidol, a typical antipsychotic agent. The “Agents Intervening against Delirium in the Intensive Care Unit
(AID-ICU)“is a multicentre, randomised, placebo-controlled trial that explored the benefits and harms of
haloperidol in treating ICU patients with delirium. As limited evidence exists on the long-term outcomes of
haloperidol for treating patients with delirium, this thesis is part of a pre-planned follow-up of AID-ICU trial that
focuses on investigating the long-term outcomes, such as mortality, health-related quality of life (HRQoL),
cognitive function, and patient perspective, which are outlined in three studies with a protocol article to enhance
the transparency and validity of study I.
Study I assessed the long-term outcomes of mortality and HRQoL in acutely admitted adult patients with
delirium treated in ICU with haloperidol versus placebo. All analyses were pre-planned and obtained at 1-year
after randomisation to the AID-ICU, where 1000 patients participated. We assessed HRQoL using Euroqol’s
questionnaire: EQ-5D-5L and vital status was obtained through national registers. The results showed that
treatment with haloperidol in patients with delirium, reduced mortality at 1-year follow-up, but did not statistically
significantly improve their HRQoL.
Study II investigated the cognitive function of Danish patients from three participating sites one year after
randomisation to the AID-ICU. Cognitive functions were assessed using two neuropsychological tests, the
Repeatable Battery for Assessing Neuropsychological Status (RBANS) and Trail Making Tests A&B. These
were performed either in the hospital or at a home visit. The results showed no statistical difference between
the two groups but it was found that 42% of the patients had severe cognitive impairments one year later.
Study III explored everyday life experiences of critically ill patients with delirium during the ICU stay, from ICU
discharge until 1-year follow-up, focusing on their HRQoL and cognitive function using a qualitative research
design with interviews for data collection and the use of the Framework Analysis Method and inductive content
analysis. Nine women and eight men participated, all recruited from the AID-ICU. They reported that returning
to everyday life after critical illness was a struggle that no one had been aware of or were informed about.
In summary, the results showed that treatment with haloperidol in patients with delirium in the ICU had an
impact on long-term survival. In contrast, it did not influence the patients’ HRQoL or cognitive function one year
later. At the same time the patients reported that recovering from critical illness was a struggle from discharge
until one year later filled with many uncertainties and not knowing which actions to take. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Wöien, Hilde, University of Oslo
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Intensive Care, Delirium, Long-term outcomes
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2024:27
pages
81 pages
publisher
Lund University, Faculty of Medicine
defense location
Forum Medicum, plan 16, E16003, Sölvegatan 19 i Lund. Join by Zoom: URL https://lu-se.zoom.us/j/66117757679
defense date
2024-03-01 13:00:00
ISSN
1652-8220
ISBN
978-91-8021-520-6
language
English
LU publication?
yes
id
097ff355-0ca2-4d32-bdcf-94b6021c780d
date added to LUP
2024-02-08 11:18:02
date last changed
2024-02-09 10:45:55
@phdthesis{097ff355-0ca2-4d32-bdcf-94b6021c780d,
  abstract     = {{Delirium is a serious and common condition in the intensive care unit (ICU), which affects 30-50 % of the <br/>patients and is associated with increased mortality and morbidity in the context of long-term outcomes. No <br/>evidence-based treatment for delirium exists, and currently, delirium is mainly treated pharmacologically with <br/>haloperidol, a typical antipsychotic agent. The “Agents Intervening against Delirium in the Intensive Care Unit <br/>(AID-ICU)“is a multicentre, randomised, placebo-controlled trial that explored the benefits and harms of <br/>haloperidol in treating ICU patients with delirium. As limited evidence exists on the long-term outcomes of <br/>haloperidol for treating patients with delirium, this thesis is part of a pre-planned follow-up of AID-ICU trial that <br/>focuses on investigating the long-term outcomes, such as mortality, health-related quality of life (HRQoL), <br/>cognitive function, and patient perspective, which are outlined in three studies with a protocol article to enhance <br/>the transparency and validity of study I.<br/>Study I assessed the long-term outcomes of mortality and HRQoL in acutely admitted adult patients with <br/>delirium treated in ICU with haloperidol versus placebo. All analyses were pre-planned and obtained at 1-year <br/>after randomisation to the AID-ICU, where 1000 patients participated. We assessed HRQoL using Euroqol’s <br/>questionnaire: EQ-5D-5L and vital status was obtained through national registers. The results showed that <br/>treatment with haloperidol in patients with delirium, reduced mortality at 1-year follow-up, but did not statistically <br/>significantly improve their HRQoL.<br/>Study II investigated the cognitive function of Danish patients from three participating sites one year after <br/>randomisation to the AID-ICU. Cognitive functions were assessed using two neuropsychological tests, the <br/>Repeatable Battery for Assessing Neuropsychological Status (RBANS) and Trail Making Tests A&amp;B. These <br/>were performed either in the hospital or at a home visit. The results showed no statistical difference between <br/>the two groups but it was found that 42% of the patients had severe cognitive impairments one year later.<br/>Study III explored everyday life experiences of critically ill patients with delirium during the ICU stay, from ICU <br/>discharge until 1-year follow-up, focusing on their HRQoL and cognitive function using a qualitative research <br/>design with interviews for data collection and the use of the Framework Analysis Method and inductive content <br/>analysis. Nine women and eight men participated, all recruited from the AID-ICU. They reported that returning <br/>to everyday life after critical illness was a struggle that no one had been aware of or were informed about.<br/>In summary, the results showed that treatment with haloperidol in patients with delirium in the ICU had an <br/>impact on long-term survival. In contrast, it did not influence the patients’ HRQoL or cognitive function one year <br/>later. At the same time the patients reported that recovering from critical illness was a struggle from discharge <br/>until one year later filled with many uncertainties and not knowing which actions to take.}},
  author       = {{B Mortensen, Camilla}},
  isbn         = {{978-91-8021-520-6}},
  issn         = {{1652-8220}},
  keywords     = {{Intensive Care; Delirium; Long-term outcomes}},
  language     = {{eng}},
  number       = {{2024:27}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{The Aftermath of Intensive Care Delirium. A one-year follow-up focusing on mortality, health-related quality of life, cognitive function and patient experiences.}},
  url          = {{https://lup.lub.lu.se/search/files/170972419/Camilla_Bekker_Mortensen.pdf}},
  year         = {{2024}},
}