Co-Occurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness*

Marra, Annachiara; Pandharipande, Pratik P.; Girard, Timothy D.; Patel, Mayur B.; Hughes, Christopher G.; Jackson, James C.; Thompson, Jennifer L.; Chandrasekhar, Rameela; Ely, E. Wesley; Brummel, Nathan E.

doi:10.1097/ccm.0000000000003218

Cited by 392 publications

(415 citation statements)

References 36 publications

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“…One Australian study showed that more than 50% of patients discharged from the ICU had developed ICU-acquired weakness, which was associated with death between ICU discharge and day 90 (TEAM Study Investigators, 2015). Early mobilisation is associated with more delirium-free days and improved cognitive outcome after ICU discharge (Devlin et al, 2018 (Berntzen et al, 2018;Cutler, Hayter, & Ryan, 2013;Laerkner et al, 2017;Marra et al, 2018). We still lack a systematic approach to help manage the discomfort described by the patients.…”

Section: Discussionmentioning

confidence: 99%

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Wøien

2020

Journal of Clinical Nursing

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Background Oversedation, delirium and immobilisation in the intensive care unit are associated with increased length of stay in the unit. Routines of systematic pain and sedation assessment and the use of valid tools are highly stressed in international guidelines. For improving the quality of pain treatment and sedation in a Norwegian intensive care unit, in 2009–2015, we compared supplementation with an analgosedation approach and the existing systematic approach, measured by the adherence to current international pain, sedation and delirium guidelines. Methods In a longitudinal study following the Standards for Reporting Implementation Studies, pain, sedation, delirium and mobilisation data from patients' complete intensive care unit stays, encompassing three separate periods of 4–6 months, were compared. The primary outcome was adherence to current protocol including assessment and documentation of patients' level of pain, sedation and prevalence of delirium at least every 8 hr, early mobilisation and titration towards a light level of sedation. Results We included 205 patients, corresponding to 1,607 patient intensive care unit days. The patient sedation levels, measured by the Richmond Agitation and Sedation Scale, decreased significantly, from −2.2 in 2009–−1.7 in 2015, so did the amount of administrated propofol. Mean pain scores measured by the numeric rating scale during activity were maximum 3.1 in 2014, decreasing to 2.2 in 2015. In patients not able to self‐report, pain mean scores were 1.7 in 2014 and 1.6 in 2015, measured by the Critical Care Pain Observational Tool. The number of patients unable to assess for delirium decreased significantly. By discounting the group of patients unable to assess, the prevalence of delirium varied from 32%, 25% and 33%. Conclusion The goal of having an awake patient able to cooperate, with acceptable levels of pain, was gradually achieved during a 6‐year period. The results showed that pain treatment and sedation in the intensive care unit primarily succeeded in the setting of an established routine of systematic assessment and documentation. Relevance to clinical practice The results of the study draw attention to pain treatment, sedation and delirium in intensive care patients, as well as implementation strategies aimed at achieving healthcare personnel's adherence to international guidelines in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Wøien

2020

Journal of Clinical Nursing

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“…Beyond cognitive impairment, mental and physical health are often also impaired after ARDS and critical illness, more generally (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Mental health issues include depression, anxiety, and/or post-traumatic stress disorder.…”

Section: Morbidity Of Ards Survivorsmentioning

confidence: 99%

“…Mental health issues include depression, anxiety, and/or post-traumatic stress disorder. Functional impairment and physical decline are common after ARDS (22)(23)(24)(25). Specifically, two of three ARDS survivors experience difficulty with activities of daily living such as: using the telephone, shopping, preparing meals, doing housework, laundering clothes, utilizing transportation, taking medications, and/or money management (26).…”

Section: Morbidity Of Ards Survivorsmentioning

confidence: 99%

“…Additional, potentially modifiable PICS risk factors relevant to acute respiratory failure patients include: hypoxemia (16,17), lower central venous pressures (17), shock (19), duration of delirium (33)(34), glucose dysregulation (35), and prolonged bed rest (i.e., immobility). In addition, several non-modifiable risk factors associated with developing PICS after critical illness include: less years of education and frailty (23).…”

Section: Pics and Pics-family (Pics-f)mentioning

confidence: 99%

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Acute Respiratory Distress Syndrome as a Precursor to Post–Intensive Care Syndrome

McPeake

Veith

Maley

et al. 2019

Clinical Pulmonary Medicine

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“…More recently, we have demonstrated that a lower-dose subchronic systemic immune challenge results in memory deficits that emerge and persist at least three months after the end of the immune challenge (Tchessalova and Tronson, 2019). These long-lasting memory deficits are likely mediated by changes in neuroimmune and neuronal function that persist long after immune activation and likely contribute to cognitive decline, affective dysregulation, and increased risk of dementia and Alzheimer's disease long after recovery from major illnesses including sepsis and heart attack (Semmler et al, 2007;Gharacholou et al, 2011;Marra et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Enduring and sex-specific changes in hippocampal gene expression after a subchronic immune challenge

Tchessalova

Tronson

2019

Preprint

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Acknowledgements:We would like to acknowledge the University of Michigan Bioinformatics core for their expertise and data analysis of differentially expressed genes and the University of Michigan DNA sequencing core for their processing of samples. We would like to sincerely thank Dr. Shigeki Iwase and Christina Vallianatos for their advice, support, and assistance with prepping of the RNA samples. We would also very much like to thank them for allowing us to use their laboratory equipment for RNA extraction.We thank Ms. Brynne Raines, Ms. Melanie Gil, and Ms. Caitlin Posillico for their extensive feedback on this manuscript. ABSTRACTMajor illnesses, including major surgery, heart attack, and sepsis, can cause long-lasting cognitive impairments, depression, and progressive memory decline that persist well after recovery from the original illness. Similarly, in animal models, immune challenge results in impairments of learning and memory as well as increased depression-like behaviors. Although neuroimmune signaling is now well established as playing a crucial role in the modulation of neural functions, how transient immune signaling mediates enduring changes in cognition, memory, and emotion remains unknown. We have recently demonstrated that a series of intermittent injections of lipopolysaccharides over a two-week period resulted in sex-specific patterns of memory deficits that persist at least several months after the end of the immune challenge. Here, we examined the persistent changes in hippocampal gene expression three months after this subchronic systemic immune challenge in males and in females. We used RNA-sequencing as a large-scale, unbiased approach to identify both persistent changes in gene expression long after an immune challenge, and changes in transcriptional response to a subsequent immune challenge. Males and females differed in number and patterns of gene expression in the hippocampus. In males, we observed enduring dysregulation of gene expression three months after the end of a subchronic immune challenge, in the absence of an additional insult. In contrast, females showed few persistent changes under basal conditions, but striking dysregulation of gene expression in response to an additional acute LPS injection. Striking sex differences in the specific genes, pathways, and biological processes affected were observed both after subchronic immune challenge and after a subsequent insult. Thus, subchronic systemic immune activation has enduring and sex-specific consequences for gene expression and response to subsequent stimuli. Such persistent changes in neural functions further suggest that in both males and females, neuroimmune signaling during illness contributes to subsequent vulnerability or resilience to cognitive decline, memory impairments, and affective disorders.

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Co-Occurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness*

Cited by 392 publications

References 36 publications

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Acute Respiratory Distress Syndrome as a Precursor to Post–Intensive Care Syndrome

Enduring and sex-specific changes in hippocampal gene expression after a subchronic immune challenge

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