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Risk factors for delirium

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Delirium – an acute state of confusion – is common during critical illness and is associated with longer hospital stays, higher mortality and long-term cognitive impairment. Vascular endothelial dysfunction could contribute to delirium by changing brain blood flow and compromising the blood-brain barrier.

Christopher Hughes, M.D., and colleagues now report that higher plasma markers of endothelial activation and blood-brain barrier/neurological injury were associated with increased duration of delirium in critically ill patients.

The researchers enrolled 134 patients in the medical or surgical ICU with a range of diagnoses, measured plasma concentrations of markers of endothelial activation and blood-brain barrier injury and assessed the patients twice daily for delirium and coma.

The findings, reported in the September issue of Critical Care Medicine, support a potential pathologic role for endothelial dysfunction in delirium. Additional research is needed to explore this potential role and to determine whether therapies targeted at the endothelium can prevent and/or treat delirium during critical illness.

This research was supported by grants from the National Institutes of Health (TR000445, AG027472, HL111111, AG045085), the Foundation for Anesthesia Education and Research, and the American Geriatrics Society.

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