A cross-sectional nested case-control study

Summary

Delirium is a severe neuropsychiatric syndrome with core features of acute onset and fluctuating course of inattention. Affecting more than 50% of critically ill patients, delirium impact mortality, ICU length of stay (ICU-LOS), hospital LOS (H-LOS). Moreover, delirium increase the duration of mechanical ventilation and the liberation from mechanical ventilation process.

In recent years, there has been a blossoming of studies examining the alteration of CSF markers of neuroinflammation and neuro-transmission; alteration in neurotransmission, cytokines level as well as cortisol level have been associated with the presence of delirium. Most of these studies have been carried out in surgical setting (lumbar puncture in patients undergoing hip fracture replacement), exploring postoperative delirium, and in elderly patients. No specific brain markers, such as S100B, HMGB-1, and NSE have been studied in patients with delirium related to acute critical illness, especially in the hypoactive subtype. Only two studies investigate the rule of S100B in polytrauma patients receiving Dexmedetomidine and none of the above-mentioned studies correlated the CSF alteration neither with any brain functional imaging nor with electrical brain activity.

OBJECTIVES

Primary

#1. To investigate the change in resting-state functional MRI (fMRI) and hypoactive delirium in critically ill patients.

#2. To investigate the role of neuroinflammation in hypoactive delirium

Secondary

#1. To investigate the change in EEG (Electro-Encephalography), ENG and EMG in patients with hypoactive delirium.