Critical Illness
Conditions
Keywords
Cortisol, Post-ICU syndrome, Cognitive impairment, Anxiety and depressive symptoms, Mechanical ventilated patients
Brief summary
Critical illness is a situation of severe and prolonged stress for patients with mechanical ventilation (MV). Between 40-80% of these patients present the Post-ICU syndrome, a set of physical, cognitive, psychological alterations at hospital discharge. In more than a third of the ICU survivors, these sequelae become chronic being observed months and even years after ICU stay. The characteristics of the Post-ICU syndrome have been related to different risk factors associated with the critical illness and its management. However, the impact of accumulated physiological stress is still unknown. The physiological response to prolonged stress generates high levels of cortisol that have been related to the loss of muscle tissue, cognitive and psychological alterations in both clinical populations and healthy subjects. The concentration of cortisol in plasma is not a measure of adequate physiological stress due to the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis during critical illness. Therefore, the objective of this study is to assess the levels of accumulated cortisol in human hair (CHH) during the different stages of the critical illness and its recovery, as well as to explore its relationship with the functional and neuropsychological sequelae observed in the ICU survivors.
Detailed description
A prospective pilot study has been proposed in 50 critical patients with\> 24 hours of mechanical ventilation. CHH levels will be recorded at admission, 1 month and 1 year after ICU discharge. In all survivors, the presence of delirium will be assessed during the ICU stay and the functional, cognitive and psychological status will be assessed at short (1 month after ICU discharge) and long term (1 year after ICU discharge).
Interventions
None listed
Sponsors
Corporacion Parc Tauli
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Critically ill patients with \>24hours of mechanical ventilation
Exclusion criteria
* Previous neurological and/or psychiatric pathology * Sensory alterations that prevent the application of the neurocognitive tests * Cognitive impairment prior to ICU admission (Score \>57 in the Short Form of the Informant Questionnaire on Cognitive. Decline -Short IQCODE-) * Sever alopecia * Rejection of voluntary participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Accumulated physiological stress | At admission | Levels of Cortisol in Human Hair (CHH) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Post-ICU syndrome psychological sequelae | 1 month after discharge | Psicological status (Anxiety & Depression score) |
| Delirium | From date of ICU admission until the date of ICU discharge or date of death from any cause, whichever came first, assessed up to 3 months | Confusion Assessment Method for ICU(CAM-ICU) |
| Comorbidity index | At ICU admission | Charlson comorbidity index |
| Frailty index | At ICU admission | Clinical frailty scale of Rockwood (Range 1 to 9 from 'Very fit patient' to ' Terminally ill patient' |
| Post-ICU syndrome physical sequelae | 1 month after discharge | Functional score (Muscle weakness - Grip strength) |
| Post-ICU syndrome functional sequelae | 1 month after discharge | Functional score (Functional Morbidity - Time Up&Go) |
| Post-ICU syndrome cognitive sequelae | 1 month after discharge | Neurocognitive score (Neurocognitive Indexes based in the neuropsychological tests) |
Other
| Measure | Time frame | Description |
|---|---|---|
| ICU stay | From date of ICU admission until the date of ICU discharge or date of death from any cause, whichever came first, assessed up to 24 months | Days in ICU |
| Hospital stay | From date of ICU discharge until the date of hospital discharge or date of death from any cause, whichever came first, assessed up to 24 months | Days in hospital after ICU discharge |
| Level of f alertness or agitation | From date of ICU admission until the date of ICU discharge or date of death from any cause, whichever came first, assessed up to 3 months | Richmond Agitation-Sedation Scale (RASS) |
| Dosis of sedatives and opioids | From date of ICU admission until the date of ICU discharge or date of death from any cause, whichever came first, assessed up to 3 months | Daily accumulated dosis of sedatives and opioids |
| Days of MV | From date of intubation in ICU until the date of extubation in ICU or date of death from any cause, whichever came first, assessed up to 3 months | Time with mechanical ventilation |
| Illness severity | At ICU admission | Acute Physiology and Chronic Health Evaluation (APACHE II) |
Countries
Spain
Outcome results
None listed