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

Sammanfattning: 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.