2026 Critical Care Congress Skip to main content
2026 Critical Care Congress Main banner
Final Program


Advance Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Session Icons
Thought Leader Session
Thought Leader Session
Guidelines Session
Guidelines Session
Aging Adult Track
Aging Adult Track
Additional Registration Fee
Additional Registration Fee

Star Research Presentations: Neuroscience

The Role of Blood-Brain Barrier Dysfunction in Intensive Care Unit Delirium

Monday, March 23, 2026
10:10 AM - 11:10 AM Central Time
Location: Connections Central Theater 1

  • Patrycja Popowicz, MD, MS

    Duke University

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • JT

    Jeffry Takla, MD

    Postdoctoral Associate
    Duke University School of Medicine

    Disclosure information not submitted.

  • NT

    Noah J. Timko, BS, MPH

    Clinical Research Coordinator
    Duke University School of Medicine

    Disclosure information not submitted.

  • MB

    Micheal Bennett, BS

    Clinical Research Specialist Sr
    Duke University School of Medicine

    Disclosure information not submitted.

  • MA

    Melissa Adams, BS

    Clinical Research Specialist Sr
    Duke University School of Medicine

    Disclosure information not submitted.

  • JS

    Jamarc Simon, BA

    Medical Student
    Duke University School of Medicine

    Disclosure information not submitted.

  • MS

    Mara A. Serbanescu, MD

    Assistant Professor
    Duke University School of Medicine

    Disclosure information not submitted.

  • ME

    Mohamed Elebasy, MBBCh

    Research Scholar
    Duke University School of Medicine

    Disclosure information not submitted.

  • RH

    Refaat Hassan, MBBCh

    Anesthesiology Resident
    University of Washington

    Disclosure information not submitted.

  • MM

    Michael Muehlbauer, PhD

    Senior Research Scientist
    Duke University School of Medicine

    Disclosure information not submitted.

  • JB

    James R. Bain, PhD

    Professor of Medicine
    Duke University School of Medicine

    Disclosure information not submitted.

  • BH

    Bethany J. Hsia, PhD

    Research Project Leader
    Duke University School of Medicine

    Disclosure information not submitted.

  • SC

    Shivam Chand, BS

    Graduate Student
    Duke University School of Medicine

    Disclosure information not submitted.

  • KM

    Kristen Monten, BS

    Medical Student
    Duke University School of Medicine

    Disclosure information not submitted.

  • ST

    Sam Teshome, BS

    Medical Student
    Duke University School of Medicine

    Disclosure information not submitted.

  • OA

    Omar Al-Qudsi, MBBS

    Assistant Professor
    Duke University School of Medicine

    Disclosure information not submitted.

  • BM

    Brian Mendelson, MD

    Assistant Professor
    Duke University School of Medicine

    Disclosure information not submitted.

  • CS

    Cina Sasannejad, MD

    Assistant Professor
    Duke University School of Medicine

    Disclosure information not submitted.

  • MT

    Miriam M. Treggiari, MD, PhD, MPH

    Professor
    Duke University School of Medicine

    Disclosure information not submitted.

  • Michael Devinney, MD (he/him/his)

    Duke University Hospital, North Carolina

    Disclosure information not submitted.

Introduction: Delirium occurs in ~70% of older ICU patients and is associated with an increased risk of subsequent long-term cognitive impairment. Although evidence from animal models and human plasma biomarkers suggest a role for blood-brain barrier (BBB) dysfunction in delirium, its role in ICU delirium is unclear. Here, we evaluated cerebrospinal fluid (CSF)-to-plasma albumin ratio (CPAR) and urea (CPUR) to investigate the role of BBB dysfunction in ICU delirium among older ICU patients on mechanical ventilation and/or vasopressors.


Methods: Patients were included from Complement Activation in Delirium and Subsequent Cognitive Impairment and Alzheimer's Disease in the ICU (CASCADE-ICU) study. CASCADE-ICU is an ongoing prospective cohort study that aims to determine the relationship of CSF complement activation with ICU delirium and subsequent dementia. In CASCADE-ICU, patients aged ≥ 65-years on mechanical ventilation and/or vasopressors undergo study LP (for CSF sampling) and blood sampling ≤72 hours after ICU admission. Exclusions include known acute brain injury, severe dementia, or LP contraindications. Delirium was assessed with Confusion Assessment Method (CAM) for the Intensive Care Unit (CAM-ICU; non-verbal) or 3-Minute Diagnostic CAM (3D-CAM; verbal) twice daily. A Richmond Agitation Sedation Scale score ≤ -4 was considered coma. A Beckman DxC 600 clinical analyzer measured albumin and urea levels. Spearman correlation of CPAR and CPUR with duration of delirium and/or coma was calculated.


Results: Of the 27 patients included, 19 (70.4%) experienced delirium. Mean age was 75.4 years with 63% female and 81.5% White. The most common ICU admission diagnosis was septic shock (52%), followed by respiratory failure (22%). CPAR was not correlated with CPUR (ρ=0.292, p=0.137), but was correlated with delirium and/or coma duration (ρ=0.386, p=0.047). CSF urea levels were correlated with delirium and/or coma duration (ρ=0.444, p=0.021), but CPUR was not (ρ=0.358, p=0.0664).


Conclusions: CPAR and CPUR may be distinct markers of BBB dysfunction in older ICU patients. Increased BBB permeability at ICU admission may play a role in ICU delirium, but further work using a panel of BBB markers in larger cohorts of ICU patients is needed to clarify these mechanisms.