Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan 22;9(1):e85332.
doi: 10.1371/journal.pone.0085332. eCollection 2014.

The impact of acute brain dysfunction in the outcomes of mechanically ventilated cancer patients

Isabel C T Almeida  1 , Márcio Soares  2 , Fernando A Bozza  3 , Cassia Righy Shinotsuka  2 , Renata Bujokas  1 , Vicente Cés Souza-Dantas  1 , E Wesley Ely  4 , Jorge I F Salluh  2
Affiliations

The impact of acute brain dysfunction in the outcomes of mechanically ventilated cancer patients

Isabel C T Almeida et al. PLoS One. .

Abstract

Introduction: Delirium and coma are a frequent source of morbidity for ICU patients. Several factors are associated with the prognosis of mechanically ventilated (MV) cancer patients, but no studies evaluated delirium and coma (acute brain dysfunction). The present study evaluated the frequency and impact of acute brain dysfunction on mortality.

Methods: The study was performed at National Cancer Institute, Rio de Janeiro, Brazil. We prospectively enrolled patients ventilated >48 h with a diagnosis of cancer. Acute brain dysfunction was assessed during the first 14 days of ICU using RASS/CAM-ICU. Patients were followed until hospital discharge. Univariate and multivariable analysis were performed to evaluate factors associated with hospital mortality.

Results: 170 patients were included. 73% had solid tumors, age 65 [53-72 (median, IQR 25%-75%)] years. SAPS II score was 54[46-63] points and SOFA score was (7 [6-9]) points. Median duration of MV was 13 (6-21) days and ICU stay was 14 (7.5-22) days. ICU mortality was 54% and hospital mortality was 66%. Acute brain dysfunction was diagnosed in 161 patients (95%). Survivors had more delirium/coma-free days [4(1,5-6) vs 1(0-2), p<0.001]. In multivariable analysis the number of days of delirium/coma-free days were associated with better outcomes as they were independent predictors of lower hospital mortality [0.771 (0.681 to 0.873), p<0.001].

Conclusions: Acute brain dysfunction in MV cancer patients is frequent and independently associated with increased hospital mortality. Future studies should investigate means of preventing or mitigating acute brain dysfunction as they may have a significant impact on clinical outcomes.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: Jorge Salluh is a PLOS ONE Editorial Board member. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Study Flow Diagram.
Figure 2
Figure 2. Kaplan–Meier analysis depicting the impact of delirium and coma on hospital mortality.
Group 1- Less acute brain dysfunction represents patients with delirium/coma free-days >1 day. Group 2- More acute brain dysfunction represents patients with delirium/coma free-days ≤1.
Figure 3
Figure 3. Kaplan–Meier analysis depicting the impact of delirium/coma on hospital mortality.
See this image and copyright information in PMC

References

    1. Salluh JI, Soares M, Teles JM, Ceraso D, Raimondi N, et al. (2010) Delirium epidemiology in critical care (DECCA): an international study. Crit Care 14: R210 10.1186/cc9333 - DOI - PMC - PubMed
    1. Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, et al. (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291: 1753–1762 10.1001/jama.291.14.1753 - DOI - PubMed
    1. Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, et al. (2004) Costs associated with delirium in mechanically ventilated patients. Crit Care Med 32: 955–962. - PubMed
    1. Girard TD, Jackson JC, Pandharipande PP, Pun BT, Thompson JL, et al. (2010) Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 38: 1513–1520 10.1097/CCM.0b013e3181e47be1 - DOI - PMC - PubMed
    1. Saczynski JS, Marcantonio ER, Quach L, Fong TG, Gross A, et al. (2012) Cognitive trajectories after postoperative delirium. N Engl J Med 367: 30–39 10.1056/NEJMoa1112923 - DOI - PMC - PubMed

Publication types

MeSH terms