Long-term cognitive outcomes among unselected ventilated and non-ventilated ICU patients

Azevedo, José Raimundo A. de; Montenegro, Widlani Sousa; Rodrigues, Djane Pereira; Souza, Suellen Christine de Carvalho; Araujo, Vanessa F. S.; Paula, Margareth Pereira de; Prazeres, Patricia H. C. P.; Leitão, A da Luz; Mendonça, Adriana Valéria Neves

doi:10.1186/s40560-017-0213-4

Cited by 21 publications

(19 citation statements)

References 21 publications

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“…Study design and characteristics are summarized in Table 1. [11][12][13] The definition of cognitive impairment varied in different studies, and there was a wide range of neuropsychological tools used to evaluate cognitive function (Table 1). Most of the studies performed both univariate and multivariate analyses adjusted for age and severity of acute illness.…”

Section: Resultsmentioning

confidence: 99%

“…5,18 Multiple other evaluated factors were not found to influence the likelihood of post-ICU cognitive impairment, including use of sedatives and analgesic medications, extracorporeal membrane oxygenation, trophic feeding, intraoperative hypotension, and hypoxia. 12,23,[28][29][30]32 Although our study focused on the influence of potentially modifiable risk factors during critical illness on long-term cognitive impairment after discharge, it is pertinent to note that nonmodifiable factors, such as age, level of education, comorbidities, severity of illness and injury, and sepsis, can affect the risk of cognitive impairment. Age was significantly associated with long-term cognitive dysfunction in a prospective cohort study of 167 survivors of chronic critical illness.…”

Section: Discussionmentioning

confidence: 99%

“…24 In unselected population of 413 ventilated and nonventilated ICU patients, delirium did not seem to contribute the development of long-term cognitive impairment. 12…”

Section: Delirium and Duration Of Deliriummentioning

confidence: 99%

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Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment After Critical Illness: A Systematic Review

Sakusic

O’Horo

Dziadzko

et al. 2018

Mayo Clinic Proceedings

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Long-term cognitive impairment is common in survivors of critical illness. Little is known about the etiology of this serious complication. We sought to summarize current scientific knowledge about potentially modifiable risk factors during intensive care unit (ICU) treatment that may play a substantial role in the development of long-term cognitive impairment. All searches were run on October 1, 2017. The search strategy included Ovid MEDLINE, Ovid Embase, Ovid CDR, Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effect, Scopus, and Web of Science, and included MeSH headings and keywords related to intensive care, critical care, and cognitive disorders. Searches were restricted to adult subjects. Inclusion required follow-up cognitive evaluation at least 2 months after ICU discharge. Studies assessing patients with cardiac arrest, traumatic brain injury, and cardiac surgery history were excluded. The search strategy resulted in 3180 studies. Of these, 28 studies (.88%) met our inclusion criteria and were analyzed. Delirium and duration of delirium were associated with long-term cognitive impairment after ICU admission in 6 of 9 studies in which this factor was analyzed. Weaker and more inconsistent associations have been reported with hypoglycemia, hyperglycemia, fluctuations in serum glucose levels, and in-hospital acute stress symptoms. Instead, most of the studies did not find significant associations between long-term cognitive impairment and mechanical ventilation; use of sedatives, vasopressors, or analgesic medications; enteral feeding; hypoxia; extracorporeal membrane oxygenation; systolic blood pressure; pulse rate; or length of ICU stay. Prolonged delirium may be a risk factor for long-term cognitive impairment after critical illness, though this association has not been entirely consistent across studies. Other potentially preventable factors have not been shown to have strong or consistent associations with long-term cognitive dysfunction in survivors of critical illness.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment After Critical Illness: A Systematic Review

Sakusic

O’Horo

Dziadzko

et al. 2018

Mayo Clinic Proceedings

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“…Two data points were not included in the aggregate scores because they reported cognitive outcomes across multiple time points. de Azevedo and colleagues reported cognitive outcomes in the mixed population of ICU survivors at 3-18 (average, 11) months after discharge and found that half of their sample was classified as cognitively impaired on the basis of a comprehensive battery of tests (7). Similarly, Mikkelsen and colleagues (8) found that among 27 ARDS survivors, more than half were classified as cognitively impaired at variable time points up to 24 months after discharge (8).…”

Section: Frequency Of Objective Cognitive Impairment In Icu Survivorsmentioning

confidence: 99%

Natural History of Cognitive Impairment in Critical Illness Survivors. A Systematic Review

Honarmand¹,

Lalli²,

Priestap³

et al. 2020

Am J Respir Crit Care Med

104

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Long-term cognitive impairment is common among ICU survivors, but its natural history remains unclear. In this systematic review, we report the frequency of cognitive impairment in ICU survivors across various time points after ICU discharge that were extracted from 46 of the 3,350 screened records. Prior studies used a range of cognitive instruments, including subjective assessments (10 studies), single or screening cognitive test such as Mini-Mental State Examination or Trail Making Tests A and B (23 studies), and comprehensive cognitive batteries (26 studies). The mean prevalence of cognitive impairment was higher with objective rather than subjective assessments (54% [95% confidence interval (CI), 51-57%] vs. 35% [95% CI, 29-41%] at 3 months after ICU discharge) and when comprehensive cognitive batteries rather than Mini-Mental State Examination were used (ICU discharge: 61% [95% CI, 38-100%] vs. 36% [95% CI, 15-63%]; 12 months after ICU discharge: 43% [95% CI, 10-78%] vs. 18% [95% CI, 10-20%]). Patients with acute respiratory distress syndrome had higher prevalence of cognitive impairment than mixed ICU patients at ICU discharge (82% [95% CI, 78-86%] vs. 48% [95% CI, 44-52%]). Although some studies repeated tests at more than one time point, the time intervals between tests were arbitrary and dictated by operational limitations of individual studies or chosen cognitive instruments. In summary, the prevalence and temporal trajectory of ICU-related cognitive impairment varies depending on the type of cognitive instrument used and the etiology of critical illness. Future studies should use modern comprehensive batteries to better delineate the natural history of cognitive recovery across ICU patient subgroups and determine which acute illness and treatment factors are associated with better recovery trajectories.

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“…Of note, the length of delirium is the only proven risk factor for the development of long-term cognitive dysfunction so far and may also be associated with lower brain volume [10,12,14,15]. Against this, mechanical ventilation, hypoxia, sedatives, intra-operative hypotension, and use of analgesics were not associated with long-term cognitive dysfunction [16][17][18][19][20]. However, most of the previously mentioned studies did not distinguish between sepsis survivors and survivors following critical illness in general.…”

Section: Acute Phase Of Sae-deliriummentioning

confidence: 97%

Sepsis-Associated Encephalopathy: From Delirium to Dementia?

Chung

Wickel

Brunkhorst

et al. 2020

JCM

150

126

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Sepsis is a major cause of death in intensive care units worldwide. The acute phase of sepsis is often accompanied by sepsis-associated encephalopathy, which is highly associated with increased mortality. Moreover, in the chronic phase, more than 50% of surviving patients suffer from severe and long-term cognitive deficits compromising their daily quality of life and placing an immense burden on primary caregivers. Due to a growing number of sepsis survivors, these long-lasting deficits are increasingly relevant. Despite the high incidence and clinical relevance, the pathomechanisms of acute and chronic stages in sepsis-associated encephalopathy are only incompletely understood, and no specific therapeutic options are yet available. Here, we review the emergence of sepsis-associated encephalopathy from initial clinical presentation to long-term cognitive impairment in sepsis survivors and summarize pathomechanisms potentially contributing to the development of sepsis-associated encephalopathy.

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Long-term cognitive outcomes among unselected ventilated and non-ventilated ICU patients

Cited by 21 publications

References 21 publications

Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment After Critical Illness: A Systematic Review

Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment After Critical Illness: A Systematic Review

Natural History of Cognitive Impairment in Critical Illness Survivors. A Systematic Review

Sepsis-Associated Encephalopathy: From Delirium to Dementia?

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