http://www.channelnewsasia.com/news/health/study-shows-brain-damage/834572.html
Many people hospitalised in intensive care for conditions like a
heart attack face lasting mental deficits similar to traumatic
brain injury, US researchers said Wednesday, urging families to
push for minimal sedation.
The problem is "very common," with a condition known as delirium
affecting about three-quarters of those treated in the ICU and
subsequent brain damage enduring for at least a year in up to one
in three of them, said the study in the New England Journal of
Medicine.
Many of these patients are left in a "private nightmare of their
own," since the medical community is largely unaware of the
phenomenon, said senior author Wes Ely, professor of medicine at
Vanderbilt University in Nashville, Tennessee.
"What a dilemma we have in medicine, with this many people
leaving our care with a form of brain injury, essentially, that was
completely unsuspected by the average medical professional," Ely
told AFP.
"We work so hard to help them survive, and we think that when
they get off life support and they get out of shock that we have
done our job and we can send them on their way," he said.
"These people may have survived, but they are leaving with an
entirely new set of problems."
Their struggles were associated with the length of time the
patients suffered from delirium, a confused mental state that
commonly occurs in seriously ill patients.
Previous research has shown delirium may lead to brain atrophy
by causing inflammation and killing neurons, though more study is
needed to understand why and how it works.
Researchers also know that delirium is more likely to occur when
higher amounts of drugs such as sedatives or painkillers are given
to patients.
The study included 821 patients, of whom just six percent were
believed to have some kind of cognitive impairment when entering
the hospital.
The patients, ranging in age from 18 to 99 with an average age
of 61, were rushed to intensive care for either a severe heart
attack, respiratory failure or septic shock.
Delirium developed in 74 percent of patients while they were in
the hospital and typically lasted about four days.
After a year, one in three patients scored similarly to people
with traumatic brain injury on mental tests, while nearly one in
four performed like people with Alzheimer's disease, regardless of
their age.
The longer the period of delirium they had suffered in the
hospital, the worse off they were mentally later on, according to
the findings.
"What was really striking was that the 30- and 40-year-olds had
just as many people in the traumatic brain injury range as the
older people," said Ely.
He added that families with loved ones in the ICU should ask the
doctors and nurses if they are monitoring for delirium.
"And can we have our mom as awake as possible? Keep her
comfortable, treat her pain, but let's not have her receiving
unnecessary amounts of these drugs," Ely said.
"We would rather have her awake than in a coma if we have the
alternative."
Maggie Zellner, director of the Neuropsychoanalysis Foundation
in New York, who was not involved with the study, described it as
"significant."
"This study demonstrates that a range of conditions which reduce
blood flow, oxygen, and other nutrients to the brain can lead to
cognitive impairment," she said in an email to AFP.
"Any patient who has lived through intensive care should be
offered psychological services following discharge."
