April 15, 2013

A role for blood vessels in delirium?

Dysfunction of the endothelial cells that line blood vessels may contribute to delirium and coma in critically ill patients – and could be a target for therapy.


Acute brain dysfunction – delirium and coma – in critically ill patients is associated with longer hospital stays, higher mortality and long-term cognitive impairment. Vascular endothelial cell function, which is impaired in critical illness, could contribute to delirium by changing brain blood flow and blood brain barrier permeability.

Christopher Hughes, M.D., assistant professor of Anesthesiology, and colleagues studied the relationship between systemic endothelial function and acute brain dysfunction in critically ill patients. In a prospective study, they assessed endothelial function at enrollment using a noninvasive reactive hyperemia technique, and they assessed delirium and coma for 14 days. They found that critically ill patients with lower reactive hyperemia scores, indicative of worse systemic endothelial function, had more days with acute brain dysfunction.

The findings, reported in the March issue of Anesthesiology, suggest that endothelial dysfunction may play a role in the pathogenesis of acute brain dysfunction during critical illness. Further studies could point to therapies that modify endothelial function and improve short- and long-term cognitive outcomes in critically ill patients.

This research was supported by grants from the National Institutes of Health (RR024975, AG027472) and by an Innovation Grant from the Vanderbilt Department of Anesthesiology.