Cognitive dysfunction after critical illness: measurement, rehabilitation, and disclosure

Abstract

A growing consensus seems to be emerging that neurocognitive outcomes are poor for patients who have been critically ill with acute respiratory distress syndrome and multiple organ failure. However, intensive care unit delirium, post-traumatic stress disorder, and other outcomes must be considered as potentially confounding factors. Once the uncertainty around the causes of postmorbid cognitive functioning is acknowledged, there are practical implications for appropriate rehabilitative interventions and there are ethical implications for the kinds of appropriate disclosure to patients.

Negotiating hope with chronic obstructive pulmonary disease patients: a qualitative study of patients and healthcare professionals

“…Patients and HCPs agreed that the appropriate time to raise such discussions was during a period of relative clinical stability. The poor recollection of the acute hospital experience suggests possible cognitive impairment is present at times of extreme sickness, which would limit the ability to partake in complex discussions 16 . Our study further indicates that discussions around goals of care and prognosis should be raised as a matter of routine following the appropriate trigger, such as following admission requiring assisted ventilation, and patients look to their doctors to raise these issues in the context of an ongoing relationship.…”

NICE CG83 – rehabilitation after critical illness: implementation across a network

“…It is considered that this would support the notion of Dixon et al (2009) who suggests that patients who lack the knowledge, skill and confidence to manage their own recovery will find it difficult to cope, but, if given the knowledge by professionals, they can learn to cope through understanding. This idea is confirmed by Misak (2009, p. 312) who draws on personal experience and found evidence in support of her opinion that ‘Hospitals fail some of their most fragile patients if they are not sent out of the ICU equipped with some substantial information about what is likely to come’.…”

Narrative evidence and evidence‐based medicine

“…Finally, I make some arguments about methodology. In ‘Cognitive Dysfunction After Critical Illness’[14] I argue that confounding factors related to the emotional, psychological and physical fallout of critical illness abound in the testing of post‐morbid cognitive function. That is, the low scores that are being found in testing of post‐ICU patients might in part be due to these factors rather than brain injury.…”