Impact of Sedation on Cognitive Function in Mechanically Ventilated Patients

Abstract

The practice of sedation dosing strategy in mechanically ventilated patient has a profound effect on cognitive function. We conducted a comprehensive review of outcome of sedation on mental health function in critically ill patients on mechanical ventilation in the intensive care unit (ICU). We specifically evaluated current sedative dosing strategy and the development of delirium, post-traumatic stress disorders (PTSDs) and agitation. Based on this review, heavy dosing sedation strategy with benzodiazepines contributes to cognitive dysfunction. However, outcome for mental health dysfunction is mixed in regard to newer sedatives agents such as dexmedetomidine and propofol. Moreover, studies that examine the impact of sedatives for persistence of PTSD/delirium and its long-term cognitive and functional outcomes for post-ICU patients are frequently underpowered. Most studies suffer from low sample sizes and methodological variations. Therefore, larger randomized controlled trials are needed to properly assess the impact of sedation dosing strategy on cognitive function.

Depressive, Angst- und posttraumatische Belastungsstörungen als Konsequenzen intensivmedizinischer Behandlung

“…B. Midazolam, Lorazepam) fördern die SchlafstadienI und II,sie unterdrückenabertiefere Schlafstadien und REM-Schlaf. Sie reduzieren den zerebralen Blutfluss und sind wahrscheinlich nicht nur mit häufigeren Deliren und kognitiven Dysfunktionen [46], sondern auch mit einer höheren Rate an depressiven und posttraumatischen Symptomen assoziiert [2,3,25].…”

Recovery After ICU Discharge: Post–Intensive Care Syndrome

“…Mental status symptoms include anxiety, depression, post traumatic stress disorder, insomnia and/or sleep disturbances, and flashbacks. 2,5,7 Patients have differing levels of severity of the reported symptoms and adverse effects on his or her quality of life.…”

“…9 The lowest dose of sedation agent should be administered to achieve patient comfort, and when possible, benzodiazepine agents should be limited or avoided. [1][2][3][4][5]9 Frequently assessing the patient's readiness to wean from mechanical ventilation is another intervention that may be used to reduce the risk of PICS. Performing daily spontaneous awakening trials coupled with spontaneous breathing trials is important to allow a reduction in sedation agents, perform a neurologic assessment, and evaluate the patient's readiness to extubate.…”

“…Patients who experience ICU delirium are at a greater risk of long-term cognitive complications and PICS. 4,5 Encouraging mobility of the patient is also a nursedriven strategy to help reduce PICS as well as the adverse effects of immobility. Progressive mobilization of the patient as soon as possible (moving from an in-bed sitting position to side of bed to chair to walking) can have multiple positive physiologic and mental status benefits for the patient.…”

“…Recent studies estimate 25% to 75% of ICU survivors report challenges with depressive symptoms, anxiety, cognitive impairment, and/or posttraumatic stress disorder. 2,[4][5][6][7] Survivors also report physical disabilities that limit their ability to return to work or perform simple activities of daily living. 6 Post-intensive care syndrome (PICS) is a recently termed condition that encompasses new or worsening impairments in the patient's physical, cognitive, or mental status arising after critical illness and persisting beyond the acute hospitalization.…”