1
|
Zhang Y, Xu Y, Cao Z, Zhang Y, Yang Y, Li J, Ding X, Hu F, Ma J. Analysis of the factors influencing of sleep quality in intensive care unit awake patients based on a structural equation model: A cross-sectional study. J Clin Nurs 2024. [PMID: 38797951 DOI: 10.1111/jocn.17311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE The objective of this study was to construct and validate a structural equation model (SEM) to identify factors associated with sleep quality in awake patients in the intensive care unit (ICU) and to assist in the development of clinical intervention strategies. RESEARCH METHODS/SETTING In this cross-sectional study, 200 awake patients who were cared for in the ICU of a tertiary hospital in China were surveyed via several self-report questionnaires and wearable actigraphy sleep monitoring devices. Based on the collected data, structural equation modelling analysis was performed using SPSS and AMOS statistical analysis software. The study is reported using the STROBE checklist. RESULTS The fit indices of the SEM were acceptable: χ2/df = 1.676 (p < .001) and RMSEA = .058 (p < 0.080). Anxiety/depression had a direct negative effect on the sleep quality of awake patients cared for in the ICU (β = -.440, p < .001). In addition, disease-freeness progress had an indirect negative effect on the sleep quality of awake patients cared for in the ICU (β = -.142, p < .001). Analgesics had an indirect negative effect on the sleep quality of awake patients cared for in the ICU through pain and sedatives (β = -.082, p < .001). Sedation had a direct positive effect on the sleep quality of conscious patients cared for in the ICU (β = .493; p < .001). CONCLUSION The results of the SEM showed that the sleep quality of awake patients cared for in the ICU is mainly affected by psychological and disease-related factors, especially anxiety, depression and pain, so we can improve the sleep quality of patients through psychological intervention and drug intervention.
Collapse
Affiliation(s)
- Yanting Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Ying Xu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Zheng Cao
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Yuan Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Yihua Yang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Jin Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Xinbo Ding
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Jing Ma
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| |
Collapse
|
2
|
Wang S, Zhu R, Cai H, Mao J, Zhou W, Zhang C, Lv M, Meng H, Guo L. Prevalence and risk factors of depression and anxiety symptoms in intensive care unit patients with cardiovascular disease: A cross-sectional study. J Clin Nurs 2024. [PMID: 38706438 DOI: 10.1111/jocn.17203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/21/2024] [Accepted: 04/27/2024] [Indexed: 05/07/2024]
Abstract
AIMS To investigate the prevalence of anxiety and depression symptoms in intensive care unit (ICU) patients with cardiovascular disease (CVD) and to explore which elements are risk factors for the development of anxiety and depression symptoms. DESIGN A cross-sectional study. METHODS A total of 1028 ICU patients with CVD were enrolled in this cross-sectional study. Logistic regression was used to assess risk factors and associations between anxiety and depression symptoms, and mediation analysis was used to explore the effect of risk factors on the association between anxiety and depression symptoms. Reporting of the study followed the STROBE checklist. RESULTS The results showed that among ICU patients with CVD, 38.1% had anxiety symptoms, 28.7% had depression symptoms and 19.3% had both anxiety and depression symptoms, and there was a significant association between anxiety and depression symptoms. We also identified female gender, hypertension, hyperlipidemia and cardiac function class IV as independent risk factors for anxiety and depression symptoms. Importantly, these factors also mediated the association between anxiety and depression symptoms, emphasising their role in the psychological well-being of this patient group. CONCLUSION ICU patients with CVD were prone to anxiety and depression symptoms. Female gender, hypertension, hyperlipidemia and cardiac function class IV were identified as independent risk factors that also served as mediators in the relationship between anxiety and depression symptoms. Especially, cardiac function class IV emerged as a critical factor in this association. RELEVANCE TO CLINICAL PRACTICE It is imperative for critical care professionals to recognize the elevated risk of depression and anxiety among ICU patients with severe CVD, especially those with cardiac function class IV, hypertension, hyperlipidemia and females. Proactive and supportive measures are essential for this vulnerable group during their ICU stay to safeguard their mental health and prevent negative outcomes. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
Collapse
Affiliation(s)
- Saikun Wang
- Department of Rehabilitation, School of Nursing, Jilin University, Changchun, China
| | - Ruiting Zhu
- Department of Rehabilitation, School of Nursing, Jilin University, Changchun, China
| | - Hongwei Cai
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Jing Mao
- Department of Rehabilitation, School of Nursing, Jilin University, Changchun, China
| | - Wei Zhou
- The First Hospital of Jilin University, Changchun, China
| | - Changyue Zhang
- Department of Rehabilitation, School of Nursing, Jilin University, Changchun, China
| | - Mengjiao Lv
- Department of Rehabilitation, School of Nursing, Jilin University, Changchun, China
| | - Hongli Meng
- Department of Rehabilitation, School of Nursing, Jilin University, Changchun, China
| | - Lirong Guo
- Department of Rehabilitation, School of Nursing, Jilin University, Changchun, China
| |
Collapse
|
3
|
Ma Y, Zhang H, Bai J, Zhu J. EEG Characteristics Before and After Dexmedetomidine Treatment in Severe Patients: A Prospective Study. Clin EEG Neurosci 2024; 55:384-390. [PMID: 36540002 DOI: 10.1177/15500594221144570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. Bedside electroencephalography (EEG) can monitor the changes in brain function in critical patients. Light sedation is recommended in intensive care unit (ICU) patients, but sedation might confuse the EEG readings. There are few studies on the changes of EEG in severe patients with dexmedetomidine. This study aimed to explore the EEG characteristics before and after dexmedetomidine in severe patients in the ICU. Methods. This prospective study enrolled severe patients with sepsis who needed light sedation, we sedated the patients with dexmedetomidine. EEG was recorded for at least 60 min using a quantitative EEG (qEEG) bedside monitor. Amplitude-EEG (aEEG), relative spectral energy, alpha variation, and spectral entropy were recorded and compared before/after dexmedetomidine. Results. Sixty-three participants were enrolled. The relative spectral energy and alpha variation were not different before and after the use of dexmedetomidine (P > .05). The amplitude of the upper and lower boundaries in aEEG and spectral entropy were significantly lower after light sedation with dexmedetomidine compared with before (P < .05). When grouped according to the Glasgow Coma Scale (GCS), the amplitude of qEEG in participants with moderate GCS decreased significantly(P < .05), but not in mild or severe GCS. Conclusion. Relative spectral energy and alpha variation derived from qEEG could be used to evaluate the state of brain function even under light sedation with dexmedetomidine in severe patients during their ICU stay.
Collapse
Affiliation(s)
- Yujie Ma
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Hongbin Zhang
- 942nd Hospital of Chinese People's Liberation Army Joint Service Support Force, Yinchuan, Ningxia, China
| | - Jijia Bai
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jinyuan Zhu
- General Hospital of Ningxia Medical University, Yinchuan, China
| |
Collapse
|
4
|
LaBuzetta JN, Bongbong DN, Mlodzinski E, Sheth R, Trando A, Ibrahim N, Yip B, Malhotra A, Dinglas VD, Needham DM, Kamdar BB. Survivorship After Neurocritical Care: A Scoping Review of Outcomes Beyond Physical Status. Neurocrit Care 2024:10.1007/s12028-024-01965-9. [PMID: 38622487 DOI: 10.1007/s12028-024-01965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/21/2024] [Indexed: 04/17/2024]
Abstract
Following intensive care unit hospitalization, survivors of acute neurological injury often experience debilitating short-term and long-term impairments. Although the physical/motor impairments experienced by survivors of acute neurological injury have been described extensively, fewer studies have examined cognitive, mental health, health-related quality of life (HRQoL), and employment outcomes. This scoping review describes the publication landscape beyond physical and/or motor sequelae in neurocritical care survivors. Databases were searched for terms related to critical illness, intensive care, and outcomes from January 1970 to March 2022. English-language studies of critically ill adults with a primary neurological diagnosis were included if they reported on at least one outcome of interest: cognition, mental health, HRQoL or employment. Data extraction was performed in duplicate for prespecified variables related to study outcomes. Of 16,036 abstracts screened, 74 citations were identified for inclusion. The studies encompassed seven worldwide regions and eight neurocritical diagnosis categories. Publications reporting outcomes of interest increased from 3 before the year 2000 to 71 after. Follow-up time points included ≤ 1 (n = 15 [20%] citations), 3 (n = 28 [38%]), 6 (n = 28 [38%]), and 12 (n = 21 [28%]) months and 1 to 5 (n = 19 [26%]) and > 5 years (n = 8 [11%]), with 28 (38%) citations evaluating outcomes at multiple time points. Sixty-six assessment tools were used to evaluate the four outcomes of interest: 22 evaluating HRQoL (56 [76%] citations), 21 evaluating cognition (20 [27%] citations), 21 evaluating mental health (18 [24%] citations), and 2 evaluating employment (9 [12%] citations). This scoping review aimed to better understand the literature landscape regarding nonphysical outcomes in survivors of neurocritical care. Although a rising number of publications highlight growing awareness, future efforts are needed to improve study consistency and comparability and characterize outcomes in a disease-specific manner, including outlining of a minimum core outcomes set and associated assessment tools.
Collapse
Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA.
| | - Dale N Bongbong
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Eric Mlodzinski
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Richa Sheth
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Aaron Trando
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Nicholas Ibrahim
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Brandon Yip
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Biren B Kamdar
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| |
Collapse
|
5
|
Hongo T, Yumoto T, Inaba M, Taito S, Yorifuji T, Nakao A, Naito H. Long-term, patient-centered, frailty-based outcomes of older critical illness survivors from the emergency department: a post hoc analysis of the LIFE Study. BMC Geriatr 2024; 24:257. [PMID: 38491464 PMCID: PMC10941380 DOI: 10.1186/s12877-024-04881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/08/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Evidence indicates frailty before intensive care unit (ICU) admission leads to poor outcomes. However, it is unclear whether quality of life (QOL) and activities of daily living (ADL) for survivors of critical illness admitted to the ICU via the emergency department remain consistent or deteriorate in the long-term compared to baseline. This study aimed to evaluate long-term QOL/ADL outcomes in these patients, categorized by the presence or absence of frailty according to Clinical Frailty Scale (CFS) score, as well as explore factors that influence these outcomes. METHODS This was a post-hoc analysis of a prospective, multicenter, observational study conducted across Japan. It included survivors aged 65 years or older who were admitted to the ICU through the emergency department. Based on CFS scores, participants were categorized into either the not frail group or the frail group, using a threshold CFS score of < 4. Our primary outcome was patient-centered outcomes (QOL/ADL) measured by the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the Barthel Index six months post-ICU admission, comparing results from baseline. Secondary outcomes included exploration of factors associated with QOL/ADL six months post-ICU admission using multiple linear regression analyses. RESULTS Of 514 candidates, 390 participants responded to the EQ-5D-5L questionnaire, while 237 responded to the Barthel Index. At six months post-admission, mean EQ-5D-5L values declined in both the not frail and frail groups (0.80 to 0.73, p = 0.003 and 0.58 to 0.50, p = 0.002, respectively); Barthel Index scores also declined in both groups (98 to 83, p < 0.001 and 79 to 61, p < 0.001, respectively). Multiple linear regression analysis revealed that baseline frailty (β coefficient, -0.15; 95% CI, - 0.23 to - 0.07; p < 0.001) and pre-admission EQ-5D-5L scores (β coefficient, 0.14; 95% CI, 0.02 to 0.26; p = 0.016) affected EQ-5D-5L scores at six months. Similarly, baseline frailty (β coefficient, -12.3; 95% CI, - 23.9 to - 0.80; p = 0.036) and Barthel Index scores (β coefficient, 0.54; 95% CI, 0.30 to 0.79; p < 0.001) influenced the Barthel Index score at six months. CONCLUSIONS Regardless of frailty, older ICU survivors from the emergency department were more likely to experience reduced QOL and ADL six months after ICU admission compared to baseline.
Collapse
Affiliation(s)
- Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Mototaka Inaba
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shunsuke Taito
- Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3 Minamiku Kasumi, Hiroshima, 734-0037, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| |
Collapse
|
6
|
Du Z, Liu X, Li Y, Wang L, Tian J, Zhang L, Yang L. Depressive symptoms over time among survivors after critical illness: A systematic review and meta-analysis. Gen Hosp Psychiatry 2024; 87:41-47. [PMID: 38306945 DOI: 10.1016/j.genhosppsych.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Critical illness survivors frequently experience various degrees of depressive symptoms, which hinder their recovery and return to daily life. However, substantial variability in the prevalence of depressive symptoms has been reported among critical illness survivors. The exact prevalence remains uncertain. METHODS A systematic search was performed in PubMed, Embase, CINAHL, and PsycINFO from inception to August 2023 for observational studies that reported depressive symptoms in adult critical illness survivors. The random-effects model was used to estimate the prevalence of depressive symptoms. Subgroup analysis and meta-regression were conducted to explore potential moderators of heterogeneity. Study quality was evaluated using the Joanna Briggs Institute's tool and the GRADE approach. RESULTS Fifty-two studies with 24,849 participants met the inclusion criteria. Overall prevalence estimate of depressive symptoms was 21.1% (95% CI, 18.3-24.1%). The prevalence of depressive symptoms remains stable over time. Point prevalence estimates were 21.3% (95% CI, 9.9-35.4%), 19.9% (95% CI, 14.6-25.9%), 18.5% (95% CI, 9.6-29.2%), 21.0% (95% CI, 16.8-25.5%), and 22.6% (95% CI, 14.4-31.8%) at <3, 3, 6, 12, and > 12 months after discharge from intensive care unit (ICU), respectively. CONCLUSIONS Depressive symptoms may impact 1 in 5 adult critically ill patients within 1 year or more following ICU discharge. An influx of rehabilitation service demand is expected, and risk stratification to make optimal clinical decisions is essential. More importantly, to propose measures for the prevention and improvement of depressive symptoms in patients after critical care, given the continuous, dynamic management of ICU patients, including ICU stay, transition to general wards, and post-hospital.
Collapse
Affiliation(s)
- Zhongyan Du
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Xiaojun Liu
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Yuanyuan Li
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, China
| | - Lina Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Jiaqi Tian
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Ling Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Lijuan Yang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China; Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, China.
| |
Collapse
|
7
|
Park YS, Joo HJ, Jang YS, Jeon H, Park EC, Shin J. Socioeconomic Status and Dementia Risk Among Intensive Care Unit Survivors: Using National Health Insurance Cohort in Korea. J Alzheimers Dis 2024; 97:273-281. [PMID: 38143351 DOI: 10.3233/jad-230715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND In aging populations, more elderly patients are going to the intensive care unit (ICU) and surviving. However, the specific factors influencing the occurrence of post-intensive care syndrome in the elderly remain uncertain. OBJECTIVE To investigate the association between socioeconomic status (SES) and risk of developing dementia within two years following critical care. METHODS This study included participants from the Korean National Health Insurance Service Cohort Database who had not been diagnosed with dementia and had been hospitalized in the ICU from 2003 to 2019. Dementia was determined using specific diagnostic codes (G30, G31) and prescription of certain medications (rivastigmine, galantamine, memantine, or donepezil). SES was categorized into low (medical aid beneficiaries) and non-low (National Health Insurance) groups. Through a 1:3 propensity score matching based on sex, age, Charlson comorbidity index, and primary diagnosis, the study included 16,780 patients. We used Cox proportional hazard models to estimate adjusted hazard ratios (HR) of dementia. RESULTS Patients with low SES were higher risk of developing dementia within 2 years after receiving critical care than those who were in non-low SES (HR: 1.23, 95% CI: 1.04-1.46). Specifically, patients with low SES and those in the high-income group exhibited the highest incidence rates of developing dementia within two years after receiving critical care, with rates of 3.61 (95% CI: 3.13-4.17) for low SES and 2.58 (95% CI: 2.20-3.03) for high income, respectively. CONCLUSIONS After discharge from critical care, compared to the non-low SES group, the low SES group was associated with an increased risk of developing dementia.
Collapse
Affiliation(s)
- Yu Shin Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hye Jin Joo
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Gachon University College of Medicine, Seoul, Republic of Korea
| | - Yun Seo Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hajae Jeon
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeyong Shin
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
8
|
Liu Y, Cai X, Fang R, Peng S, Luo W, Du X. Future directions in ventilator-induced lung injury associated cognitive impairment: a new sight. Front Physiol 2023; 14:1308252. [PMID: 38164198 PMCID: PMC10757930 DOI: 10.3389/fphys.2023.1308252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024] Open
Abstract
Mechanical ventilation is a widely used short-term life support technique, but an accompanying adverse consequence can be pulmonary damage which is called ventilator-induced lung injury (VILI). Mechanical ventilation can potentially affect the central nervous system and lead to long-term cognitive impairment. In recent years, many studies revealed that VILI, as a common lung injury, may be involved in the central pathogenesis of cognitive impairment by inducing hypoxia, inflammation, and changes in neural pathways. In addition, VILI has received attention in affecting the treatment of cognitive impairment and provides new insights into individualized therapy. The combination of lung protective ventilation and drug therapy can overcome the inevitable problems of poor prognosis from a new perspective. In this review, we summarized VILI and non-VILI factors as risk factors for cognitive impairment and concluded the latest mechanisms. Moreover, we retrospectively explored the role of improving VILI in cognitive impairment treatment. This work contributes to a better understanding of the pathogenesis of VILI-induced cognitive impairment and may provide future direction for the treatment and prognosis of cognitive impairment.
Collapse
Affiliation(s)
- Yinuo Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Clinical Medical College of Nanchang University, Nanchang, China
| | - Xintong Cai
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Clinical Medical College of Nanchang University, Nanchang, China
| | - Ruiying Fang
- The Clinical Medical College of Nanchang University, Nanchang, China
| | - Shengliang Peng
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaohong Du
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
9
|
Kumar N. Advances in post intensive care unit care: A narrative review. World J Crit Care Med 2023; 12:254-263. [DOI: 10.5492/wjccm.v12.i5.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/29/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023] Open
Abstract
As the treatment options, modalities and technology have grown, mortality in intensive care unit (ICU) has been on the decline. More and more patients are being discharged to wards and in the care of their loved ones after prolonged treatment at times and sometimes in isolation. These survivors have a lower life expectancy and a poorer quality of life. They can have substantial familial financial implications and an economic impact on the healthcare system in terms of increased and continued utilisation of services, the so-called post intensive care syndrome (PICS). But it is not only the patient who is the sufferer. The mental health of the loved ones and family members may also be affected, which is termed as PICS-family. In this review, we shall be reviewing the definition, epidemiology, clinical features, diagnosis and evaluation, treatment and follow up of PICS. We shall also focus on measures to prevent, rehabilitate and understand the ICU stay from patients’ perspective on how to redesign the ICU, post ICU care needs for a better patient outcome.
Collapse
Affiliation(s)
- Nishant Kumar
- Department of Anaesthesiology and Critical Care, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, India
| |
Collapse
|
10
|
Shehata AH, Anter AF, Ahmed ASF. Role of SIRT1 in sepsis-induced encephalopathy: Molecular targets for future therapies. Eur J Neurosci 2023; 58:4211-4235. [PMID: 37840012 DOI: 10.1111/ejn.16167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
Sepsis induces neuroinflammation, BBB disruption, cerebral hypoxia, neuronal mitochondrial dysfunction, and cell death causing sepsis-associated encephalopathy (SAE). These pathological consequences lead to short- and long-term neurobehavioural deficits. Till now there is no specific treatment that directly improves SAE and its associated behavioural impairments. In this review, we discuss the underlying mechanisms of sepsis-induced brain injury with a focus on the latest progress regarding neuroprotective effects of SIRT1 (silent mating type information regulation-2 homologue-1). SIRT1 is an NAD+ -dependent class III protein deacetylase. It is able to modulate multiple downstream signals (including NF-κB, HMGB, AMPK, PGC1α and FoxO), which are involved in the development of SAE by its deacetylation activity. There are multiple recent studies showing the neuroprotective effects of SIRT1 in neuroinflammation related diseases. The proposed neuroprotective action of SIRT1 is meant to bring a promising therapeutic strategy for managing SAE and ameliorating its related behavioural deficits.
Collapse
Affiliation(s)
- Alaa H Shehata
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Aliaa F Anter
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Al-Shaimaa F Ahmed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Minia University, Minia, Egypt
| |
Collapse
|
11
|
Doherty C, Feder S, Gillespie-Heyman S, Akgün KM. Easing Suffering for ICU Patients and Their Families: Evidence and Opportunities for Primary and Specialty Palliative Care in the ICU. J Intensive Care Med 2023:8850666231204305. [PMID: 37822226 DOI: 10.1177/08850666231204305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Intensive care unit (ICU) admissions are often accompanied by many physical and existential pressure points that can be extraordinarily wearing on patients and their families and surrogate decision makers (SDMs). Multidisciplinary palliative support, including physicians, advanced practice nurses, nutritionists, chaplains and other team members, may alleviate many of these sources of potential suffering. However, the palliative needs of ICU patients undoubtedly exceed the bandwidth of current consultative specialty palliative medicine teams. Informed by standard-of-care palliative medicine domains, we review common ICU symptoms (pain, dyspnea and thirst) and their prevalence, sources and their treatment. We then identify palliative needs and impacts in the domains of communication, SDM support and transitions of care for patients and their families through their journey in the ICU, from discharge and recovery at home to chronic critical illness, post-ICU disability or death. Finally, we examine the evidence for strategies to incorporate specialty palliative medicine and palliative principles into ICU care for the improvement of patient- and family-centered care. While randomized controlled studies have failed to demonstrate measurable improvement in pre-determined outcomes for patient- and family-relevant outcomes, embracing the principles of palliative medicine and assuring their delivery in the ICU is likely to translate to overall improvement in humanistic, person-centered care that supports patients and their SDMs during and following critical illness.
Collapse
Affiliation(s)
- Christine Doherty
- Department of Internal Medicine New Haven, Yale New Haven Hospital, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Shelli Feder
- Yale University School of Nursing, Orange, CT, USA
| | | | - Kathleen M Akgün
- Yale School of Medicine, New Haven, CT, USA
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, VA-Connecticut and Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
12
|
Bark L, Larsson IM, Wallin E, Simrén J, Zetterberg H, Lipcsey M, Frithiof R, Rostami E, Hultström M. Central nervous system biomarkers GFAp and NfL associate with post-acute cognitive impairment and fatigue following critical COVID-19. Sci Rep 2023; 13:13144. [PMID: 37573366 PMCID: PMC10423244 DOI: 10.1038/s41598-023-39698-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 07/29/2023] [Indexed: 08/14/2023] Open
Abstract
A high proportion of patients with coronavirus disease 2019 (COVID-19) experience post-acute COVID-19, including neuropsychiatric symptoms. Objective signs of central nervous system (CNS) damage can be investigated using CNS biomarkers such as glial fibrillary acidic protein (GFAp), neurofilament light chain (NfL) and total tau (t-tau). We have examined whether CNS biomarkers can predict fatigue and cognitive impairment 3-6 months after discharge from the intensive care unit (ICU) in critically ill COVID-19 patients. Fifty-seven COVID-19 patients admitted to the ICU were included with analysis of CNS biomarkers in blood at the ICU and at follow up. Cognitive dysfunction and fatigue were assessed with the Montreal Cognitive Assessment (MoCA) and the Multidimensional Fatigue inventory (MFI-20). Elevated GFAp at follow-up 3-6 months after ICU discharge was associated to the development of mild cognitive dysfunction (p = 0.01), especially in women (p = 0.005). Patients who experienced different dimensions of fatigue at follow-up had significantly lower GFAp in both the ICU and at follow-up, specifically in general fatigue (p = 0.009), physical fatigue (p = 0.004), mental fatigue (p = 0.001), and reduced motivation (p = 0.001). Women showed a more pronounced decrease in GFAp compared to men, except for in mental fatigue where men showed a more pronounced GFAp decrease compared to women. NfL concentration at follow-up was lower in patients who experienced reduced motivation (p = 0.004). Our findings suggest that GFAp and NfL are associated with neuropsychiatric outcome after critical COVID-19.Trial registration The study was registered à priori (clinicaltrials.gov: NCT04316884 registered on 2020-03-13 and NCT04474249 registered on 2020-06-29).
Collapse
Affiliation(s)
- Lovisa Bark
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University Hospital, Uppsala University, Entr. 70, Floor 2, 75185, Uppsala, Sweden.
| | - Ing-Marie Larsson
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University Hospital, Uppsala University, Entr. 70, Floor 2, 75185, Uppsala, Sweden
| | - Ewa Wallin
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University Hospital, Uppsala University, Entr. 70, Floor 2, 75185, Uppsala, Sweden
| | - Joel Simrén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Miklos Lipcsey
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University Hospital, Uppsala University, Entr. 70, Floor 2, 75185, Uppsala, Sweden
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University Hospital, Uppsala University, Entr. 70, Floor 2, 75185, Uppsala, Sweden
| | - Elham Rostami
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Michael Hultström
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University Hospital, Uppsala University, Entr. 70, Floor 2, 75185, Uppsala, Sweden
- Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
- Lady Davis Institute of Medical Research, Jewish General Hospital, Montréal, QC, Canada
| |
Collapse
|
13
|
Rengel KF, Mart MF, Wilson JE, Ely EW. Thinking Clearly: The History of Brain Dysfunction in Critical Illness. Crit Care Clin 2023; 39:465-477. [PMID: 37230551 DOI: 10.1016/j.ccc.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Brain dysfunction during critical illness (ie, delirium and coma) is extremely common, and its lasting effect has only become increasingly understood in the last two decades. Brain dysfunction in the intensive care unit (ICU) is an independent predictor of both increased mortality and long-term impairments in cognition among survivors. As critical care medicine has grown, important insights regarding brain dysfunction in the ICU have shaped our practice including the importance of light sedation and the avoidance of deliriogenic drugs such as benzodiazepines. Best practices are now strategically incorporated in targeted bundles of care like the ICU Liberation Campaign's ABCDEF Bundle.
Collapse
Affiliation(s)
- Kimberly F Rengel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, 4th Floor, Nashville, TN 37203, USA; Department of Anesthesiology, Division of Anesthesia Critical Care Medicine, Vanderbilt University Medical Center, 1211 21st Avenue South, MAB 422, Nashville, TN 37213, USA.
| | - Matthew F Mart
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, 4th Floor, Nashville, TN 37203, USA; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN 37232, USA; Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Veterans Affairs Health System, VA Tennessee Valley Healthcare system, 1310 24th Avenue South, Nashville, TN 37212, USA
| | - Jo Ellen Wilson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, 4th Floor, Nashville, TN 37203, USA; Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Veterans Affairs Health System, VA Tennessee Valley Healthcare system, 1310 24th Avenue South, Nashville, TN 37212, USA; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Vanderbilt Psychiatric Hospital, 1601 23rd Avenue South, Nashville, TN 37212, USA
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, 4th Floor, Nashville, TN 37203, USA; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN 37232, USA; Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Veterans Affairs Health System, VA Tennessee Valley Healthcare system, 1310 24th Avenue South, Nashville, TN 37212, USA
| |
Collapse
|
14
|
de Groot BO, Biserni C, Fuermaier ABM, Enriquez-Geppert S. Untreated if unrecognized: A cognitive profile of sustained subjective executive dysfunctions in COVID-19. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 37334922 DOI: 10.1080/23279095.2023.2223329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
& STATEMENT OF IMPACTSARS-COV-2 infection can result in acute and long-lasting cognitive complaints, causing ongoing impairments in daily life which poses a challenge to society. Consequently, the evaluation and characterization of cognitive complaints, specifically in the domain of executive functions (EFs) affecting daily life, is imperative in formulating an effective neuropsychological response.In total 442 participants aged 18-65+ years from the Netherlands, Germany, Mexico, and Spain were included in an online questionnaire. Among others, the questionnaire consisted of demographics, the Behavior Rating Inventory of Executive Functioning for Adults (BRIEF-A), measures of subjective disease progression severity and experienced subjective impairment in daily activities. To assess whether daily life activities are affected by EF impairments, the main BRIEF-A composite score (GEC) was analyzed. To determine whether disease-related COVID-19 factors predict EFs complaints in daily life, a stepwise regression analysis was performed with i) experienced disease severity, ii) time since disease, and iii) health risk factor as predictors.The study revealed noteworthy differences in the occurrence of EFs problems in daily life between both groups, as indicated by the GEC, which exhibited a medium effect size even 6 months post-COVID-19 diagnosis even in mild disease progression. The scores of the BRIEF-A subscales follow a domain-specific profile, and includes clinically relevant impairments in: Working memory, Plan/Organize, Task Monitor, Shift, which are affected by the experienced severity of the disease. This cognitive profile has important implications for targeted cognitive training in rehabilitation and has the potential for an applicability to other viruses as well.
Collapse
Affiliation(s)
- Bob O de Groot
- Department of Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands
| | - Chiara Biserni
- Department of Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands
| | - Stefanie Enriquez-Geppert
- Department of Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
15
|
De Bels D, Bousbiat I, Perriens E, Blackman S, Honoré PM. Sedation for adult ICU patients: A narrative review including a retrospective study of our own data. Saudi J Anaesth 2023; 17:223-235. [PMID: 37260674 PMCID: PMC10228859 DOI: 10.4103/sja.sja_905_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/06/2023] [Accepted: 01/19/2023] [Indexed: 06/02/2023] Open
Abstract
The optimization of patients' treatment in the intensive care unit (ICU) needs a lot of information and literature analysis. Many changes have been made in the last years to help evaluate sedated patients by scores to help take care of them. Patients were completely sedated and had continuous intravenous analgesia and neuromuscular blockades. These three drug classes were the main drugs used for intubated patients in the ICU. During these last 20 years, ICU management went from fully sedated to awake, calm, and nonagitated patients, using less sedatives and choosing other drugs to decrease the risks of delirium during or after the ICU stay. Thus, the usefulness of these three drug classes has been challenged. The analgesic drugs used were primarily opioids but the use of other drugs instead is increasing to lessen or wean the use of opioids. In severe acute respiratory distress syndrome patients, neuromuscular blocking agents have been used frequently to block spontaneous respiration for 48 hours or more; however, this has recently been abolished. Optimizing a patient's comfort during hemodynamic or respiratory extracorporeal support is essential to reduce toxicity and secondary complications.
Collapse
Affiliation(s)
- David De Bels
- Intensive Care Unit, Brugmann University Hospital, Brussels, Belgium
| | - Ibrahim Bousbiat
- Intensive Care Unit, Brugmann University Hospital, Brussels, Belgium
| | - Emily Perriens
- Intensive Care Unit, Brugmann University Hospital, Brussels, Belgium
| | - Sydney Blackman
- Intensive Care Unit, Brugmann University Hospital, Brussels, Belgium
| | - Patrick M Honoré
- Department of Intensive Care, CHU UCL Godinne Namur, UCL Louvain Medical School, Yvoir, Belgium
| |
Collapse
|
16
|
Ramnarain D, Pouwels S, Fernández-Gonzalo S, Navarra-Ventura G, Balanzá-Martínez V. Delirium-related psychiatric and neurocognitive impairment and the association with post-intensive care syndrome-A narrative review. Acta Psychiatr Scand 2023; 147:460-474. [PMID: 36744298 DOI: 10.1111/acps.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Delirium is common among patients admitted to the intensive care unit (ICU) and its impact on the neurocognitive and psychiatric state of survivors is of great interest. These new-onset or worsening conditions, together with physical alterations, are called post-intensive care syndrome (PICS). Our aim is to update on the latest screening and follow-up options for psychological and cognitive sequelae of PICS. METHOD This narrative review discusses the occurrence of delirium in ICU settings and the relatively new concept of PICS. Psychiatric and neurocognitive morbidities that may occur in survivors of critical illness following delirium are addressed. Future perspectives for practice and research are discussed. RESULTS There is no "gold standard" for diagnosing delirium in the ICU, but two extensively validated tools, the confusion assessment method for the ICU and the intensive care delirium screening checklist, are often used. PICS complaints are frequent in ICU survivors who have suffered delirium and have been recognized as an important public health and socio-economic problem worldwide. Depression, anxiety, post-traumatic stress disorder, and long-term cognitive impairment are recurrently exhibited. Screening tools for these deficits are discussed, as well as the suggestion of early assessment after discharge and at 3 and 12 months. CONCLUSIONS Delirium is a complex but common phenomenon in the ICU and a risk factor for PICS. Its diagnosis is challenging with potential long-term adverse outcomes, including psychiatric and cognitive difficulties. The implementation of screening and follow-up protocols for PICS sequelae is warranted to ensure early detection and appropriate management.
Collapse
Affiliation(s)
- Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of Intensive Care Medicine, Saxenburgh Medical Center, Hardenberg, The Netherlands.,Departmentof Medical and Clinical Psychology, Center of Research on Psychological and Somatic disease (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of General, Abdominal and Minimally Invasive Surgery, Helios Klinikum, Krefeld, Germany
| | - Sol Fernández-Gonzalo
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Guillem Navarra-Ventura
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Vicent Balanzá-Martínez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
| |
Collapse
|
17
|
Brunker LB, Boncyk CS, Rengel KF, Hughes CG. Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges. Clin Interv Aging 2023; 18:93-112. [PMID: 36714685 PMCID: PMC9879046 DOI: 10.2147/cia.s365968] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/12/2023] [Indexed: 01/23/2023] Open
Abstract
There is a growing population of older adults requiring admission to the intensive care unit (ICU). This population outpaces the ability of clinicians with geriatric training to assist in their management. Specific training and education for intensivists in the care of older patients is valuable to help understand and inform clinical care, as physiologic changes of aging affect each organ system. This review highlights some of these aging processes and discusses clinical implications in the vulnerable older population. Other considerations when caring for these older patients in the ICU include functional outcomes and morbidity, as opposed to merely a focus on mortality. An overall holistic approach incorporating physiology of aging, applying current evidence, and including the patient and their family in care should be used when caring for older adults in the ICU.
Collapse
Affiliation(s)
- Lucille B Brunker
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina S Boncyk
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly F Rengel
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher G Hughes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
18
|
Muacevic A, Adler JR, Mainali K, Bhalala U. Post-intensive Care Syndrome in a Heterogeneous Pediatric Population. Cureus 2022; 14:e32928. [PMID: 36699782 PMCID: PMC9872940 DOI: 10.7759/cureus.32928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/26/2022] Open
Abstract
Background In this study, we aimed to measure the incidence of post-intensive care syndrome among children (PICS-p) who received critical care treatment in our hospital and evaluate patient characteristics and critical care interventions associated with the development of PICS-p. Methodology We conducted a retrospective cohort review of all surviving pediatric patients admitted to an urban, academic, tertiary intensive care unit between July 2017 and June 2018. Based on the existing literature on PICS, we excluded children whose length of stay in the pediatric intensive care unit (PICU) was less than four days. We collected demographic data, clinical data, and data related to outcomes in our study cohort. We defined PICS-p a priori as a change in the Functional Status Scale (FSS) score of three or greater between pre-admission and discharge. Using Student's t-tests and Wilcoxon rank-sum tests, we compared outcomes among those with PICS-p versus those without PICS-p. Results Of the 183 patients, 36 (19.6%) were diagnosed with PICS in our study. Aside from pre-admission FSS (7 vs. 8), analysis of the two groups revealed no statistically significant difference before or at the time of admission. Upon admission to the PICU, statistically significant differences between the PICS and no PICS groups were noted in the hospital length of stay (33.5 days vs. 14.7 days), ventilation-free days (8.3 days vs. 5.2 days), and the number of procedural interventions (2.6 vs. 1). Conclusions Utilizing the FSS to determine PICS is a viable method to standardize the measurement of functional outcomes for critically ill children. In our single-center, retrospective review, nearly one out of five pediatric patients developed PICS with associated factors that included a decreased pre-hospital FSS score, increased hospital length of stay, fewer ventilation-free days, and increased number of procedural interventions. Significant opportunities exist regarding the social and psychiatric domains of PICS-p.
Collapse
|
19
|
Inoue S, Nakanishi N, Sugiyama J, Moriyama N, Miyazaki Y, Sugimoto T, Fujinami Y, Ono Y, Kotani J. Prevalence and Long-Term Prognosis of Post-Intensive Care Syndrome after Sepsis: A Single-Center Prospective Observational Study. J Clin Med 2022; 11:jcm11185257. [PMID: 36142904 PMCID: PMC9505847 DOI: 10.3390/jcm11185257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 01/08/2023] Open
Abstract
Post-intensive care syndrome (PICS) comprises physical, mental, and cognitive disorders following a severe illness. The impact of PICS on long-term prognosis has not been fully investigated. This study aimed to: (1) clarify the frequency and clinical characteristics of PICS in sepsis patients and (2) explore the relationship between PICS occurrence and 2-year survival. Patients with sepsis admitted to intensive care unit were enrolled. Data on patient background; clinical information since admission; physical, mental, and cognitive impairments at 3-, 6-, and 12-months post-sepsis onset; 2-year survival; and cause of death were obtained from electronic medical records and telephonic interviews with patients and their families. At 3 months, comparisons of variables were undertaken in the PICS group and the non-PICS group. Among the 77 participants, the in-hospital mortality rate was 11% and the 2-year mortality rate was 52%. The frequencies of PICS at 3, 6, and 12 months were 70%, 60%, and 35%, respectively. The 2-year survival was lower in the PICS group than in the non-PICS group (54% vs. 94%, p < 0.01). More than half of the survivors had PICS at 3 and 6 months after sepsis. Among survivors with sepsis, those who developed PICS after 3 months had a lower 2-year survival.
Collapse
Affiliation(s)
- Shigeaki Inoue
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
- Correspondence: ; Tel.: +81-78-3826521; Fax: +81-78-3415254
| | - Nobuto Nakanishi
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Jun Sugiyama
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Naoki Moriyama
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Yusuke Miyazaki
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Takashi Sugimoto
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Yoshihisa Fujinami
- Department of Emergency Medicine, Kakogawa Chuo Hospital, Honmachi 439, Kakogawa 675-8611, Japan
| | - Yuko Ono
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Joji Kotani
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| |
Collapse
|
20
|
Survivorship After Critical Illness and Post-Intensive Care Syndrome. Clin Chest Med 2022; 43:551-561. [PMID: 36116822 DOI: 10.1016/j.ccm.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Improvements in critical care medicine have led to a marked increase in survivors of the intensive care unit (ICU). These survivors encounter many difficulties following ICU discharge. The term post -intensive care syndrome (PICS) provides a framework for identifying the most common symptoms which fall into three domains: cognitive, physical, and mental health. There are numerous risk factors for the development of PICS including premorbid conditions and specific elements of ICU hospitalizations. Management is complex and should take an individualized approach with interdisciplinary care. Future research should focus on prevention, identification, and treatment of this unique population.
Collapse
|
21
|
Cognitive function in non-hospitalized patients 8–13 months after acute COVID-19 infection: A cohort study in Norway. PLoS One 2022; 17:e0273352. [PMID: 35994448 PMCID: PMC9394790 DOI: 10.1371/journal.pone.0273352] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/05/2022] [Indexed: 01/22/2023] Open
Abstract
Studies have reported reduced cognitive function following COVID-19 illness, mostly from hospital settings with short follow-up times. This study recruited non-hospitalized COVID-19 patients from a general population to study prevalence of late cognitive impairment and associations with initial symptoms. We invited patients with PCR-confirmed COVID-19. A postal questionnaire addressed basic demographics, initial COVID-19 symptoms and co-morbidity about 4 months after diagnosis. About 7 months later, we conducted cognitive tests using the Cambridge Neuropsychological Test Automated Battery, comprising four tests for short-term memory, attention and executive function. We present descriptive statistics using z-scores relative to UK population norms and defined impairment as z-score <-1.5. We used multivariable logistic regression with impairment as outcome. Continuous domain scores were analysed by multiple linear regression. Of the initial 458 participants; 305 were invited, and 234 (77%) completed cognitive testing. At median 11 (range 8–13) months after PCR positivity, cognitive scores for short term memory, visuospatial processing, learning and attention were lower than norms (p≤0.001). In each domain, 4–14% were cognitively impaired; 68/232 (29%) were impaired in ≥ 1 of 4 tests. There was no association between initial symptom severity and impairment. Multivariable linear regression showed association between spatial working memory and initial symptom load (6–9 symptoms vs. 0–5, coef. 4.26, 95% CI: 0.65; 7.86). No other dimension scores were associated with symptom load. At median 11 months after out-of-hospital SARS-Cov-2 infection, minor cognitive impairment was seen with little association between COVID-19 symptom severity and outcome.
Collapse
|
22
|
Seyffert S, Moiz S, Coghlan M, Balozian P, Nasser J, Rached EA, Jamil Y, Naqvi K, Rawlings L, Perkins AJ, Gao S, Hunter JD, Khan S, Heiderscheit A, Chlan LL, Khan B. Decreasing delirium through music listening (DDM) in critically ill, mechanically ventilated older adults in the intensive care unit: a two-arm, parallel-group, randomized clinical trial. Trials 2022; 23:576. [PMID: 35854358 PMCID: PMC9295531 DOI: 10.1186/s13063-022-06448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Delirium is a highly prevalent and morbid syndrome in mechanically ventilated intensive care unit (ICU) patients. Music is a promising non-pharmacological intervention with beneficial effects on anxiety and stress, while its effects on delirium duration and severity are not well understood. Methods/design Our study is a two-arm, randomized parallel-group, clinical trial to evaluate the efficacy of music intervention compared to a silence-track attention control on delirium/coma duration in mechanically ventilated critically ill older adults. One hundred sixty mechanically ventilated adults 50 years of age or older will be randomized to one of two arms within 72 h of ICU admission: (1) 1-h music listening sessions twice daily through noise-canceling headphones, or (2) 1-h sessions of a silence track twice daily through noise-canceling headphones. Our primary aim is to compare delirium/coma-free days after randomization during the 7-day study intervention phase using the Confusion Assessment Method for the ICU (CAM ICU) and the Richmond Agitation Sedation Scale (RASS) for delirium and coma. Secondary outcomes include pain and anxiety evaluated twice daily during the intervention phase and throughout the duration of ICU stay using the Critical Care Pain Observation Tool (CPOT) and visual analog scale-anxiety (VAS-A). Enrolled participants will be followed after hospital discharge to further measure cognition as well as screening for depression and anxiety using the following telephone-based instruments: Indiana University Telephone-Based Assessment of Neuropsychological Status (IU TBANS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Discussion This randomized clinical trial will measure the efficacy of a music listening intervention for delirium and coma duration early in the intensive care unit among older adults. Trial registration. ClinicalTrials.gov. NCT04182334. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06448-w.
Collapse
Affiliation(s)
- Sarah Seyffert
- Department of Medicine, IU School of Medicine, Indianapolis, IN, USA.
| | - Salwa Moiz
- IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN, USA
| | - Matthew Coghlan
- Department of Medicine, IU School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | - Kiran Naqvi
- IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN, USA
| | - Lori Rawlings
- IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN, USA
| | - Anthony J Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sujuan Gao
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Sikandar Khan
- IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN, USA.,Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Linda L Chlan
- Department of Nursing, Nursing Research Division, Mayo Clinic, Rochester, MN, USA
| | - Babar Khan
- IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN, USA.,Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
23
|
Bertuccelli M, Ciringione L, Rubega M, Bisiacchi P, Masiero S, Del Felice A. Cognitive impairment in people with previous COVID-19 infection: A scoping review. Cortex 2022; 154:212-230. [PMID: 35780756 PMCID: PMC9187867 DOI: 10.1016/j.cortex.2022.06.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/15/2022] [Accepted: 06/02/2022] [Indexed: 11/28/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 is a worldwide public health issue. Almost 2 years into the pandemic, the persistence of symptoms after the acute phase is a well-recognized phenomenon. We conducted a scoping review to map cognitive domain impairments, their frequency, and associated psycho-affective disorders in people with a previous COVID-19 infection. We searched PubMed/MEDLINE, Scopus, and PsycInfo to identify relevant reports published between December 1, 2019 and February 21, 2022. We followed the PRISMA (Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analyses) extension for scoping review guidelines. Three independent reviewers selected and charted 25 records out of 922. Memory, attention, and executive functions appeared to be the most affected domains. Delayed recall and learning were the most impaired domains of memory. Among the executive functions, abstraction, inhibition, set shifting, and sustained and selective attention were most commonly impaired. Language and visuo-spatial abilities were rarely affected, although this finding might be biased by the scarcity of reports. Neurological and respiratory conditions were often reported in association with cognitive deficits. Results on psycho-affective conditions were inconclusive due to the low frequency of reported data. Admission to an intensive care unit is not related to cognitive deficits. This review highlighted a potential effect of a previous post-COVID-19 infection on a pattern of memory, attention, and executive functions impairments. These findings need to be confirmed on larger cohorts with comprehensive neuropsychological batteries and correlated to neurophysiological and neurobiological substrates.
Collapse
Affiliation(s)
- Margherita Bertuccelli
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; Padova Neuroscience Center, University of Padova, 35131 Padova, Italy
| | - Luciana Ciringione
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Maria Rubega
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Patrizia Bisiacchi
- Padova Neuroscience Center, University of Padova, 35131 Padova, Italy; Department of General Psychology, University of Padova, Padova, Italy
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; Padova Neuroscience Center, University of Padova, 35131 Padova, Italy
| | - Alessandra Del Felice
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; Padova Neuroscience Center, University of Padova, 35131 Padova, Italy.
| |
Collapse
|
24
|
Palladini M, Bravi B, Colombo F, Caselani E, Di Pasquasio C, D'Orsi G, Rovere-Querini P, Poletti S, Benedetti F, Mazza MG. Cognitive remediation therapy for post-acute persistent cognitive deficits in COVID-19 survivors: A proof-of-concept study. Neuropsychol Rehabil 2022:1-18. [PMID: 35583357 DOI: 10.1080/09602011.2022.2075016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ABSTRACTCognitive impairments figure prominently in COVID-19 survivors. Cognitive remediation therapy (CRT) improves functional outcomes reducing long-term cognitive deficits in several neurological and psychiatric conditions. Our case-control study investigates the efficacy of a CRT programme administered to COVID-19 survivors in the post-acute phase of the illness. Seventy-three COVID-19 survivors presenting cognitive impairments at one-month follow-up were enrolled. Among them, 15 patients were treated with a two-month CRT programme, and 30 non-treated patients were matched conditional to their baseline cognitive functioning. Cognitive functions were assessed before and after treatment. Depression and quality of life were also evaluated. Mixed model ANOVA revealed a significant effect over time of the CRT programme on global cognitive functioning (F = 4.56, p = 0.039), while no significant effect was observed in the untreated group. We observed a significant effect of the improvement in verbal fluency (χ2 = 7.20, p = 0.007) and executive functions (χ2 = 13.63, p < 0.001) on quality of life. A positive significant correlation was found between depressive symptomatology and verbal fluency (r = -0.35), working memory (r = -0.44), psychomotor coordination (r = -0.42), and executive functions (r = -0.33). Our results could pave the way to a plausible innovative treatment targeting cognitive impairments and ameliorating the quality of life of COVID-19 survivors.
Collapse
Affiliation(s)
- Mariagrazia Palladini
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy.,PhD Program in Cognitive Neuroscience, University Vita-Salute San Raffaele, Milan, Italy
| | - Beatrice Bravi
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy.,PhD Program in Cognitive Neuroscience, University Vita-Salute San Raffaele, Milan, Italy
| | - Federica Colombo
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy.,PhD Program in Cognitive Neuroscience, University Vita-Salute San Raffaele, Milan, Italy
| | - Elisa Caselani
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Camilla Di Pasquasio
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Greta D'Orsi
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milano, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Poletti
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy
| | - Francesco Benedetti
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy
| | - Mario Gennaro Mazza
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy.,PhD Program in Cognitive Neuroscience, University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
25
|
Critical role of acute hypoxemia on the cognitive impairment after severe COVID-19 pneumonia: a multivariate causality model analysis. Neurol Sci 2022; 43:2217-2229. [PMID: 35022935 PMCID: PMC8754526 DOI: 10.1007/s10072-021-05798-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/01/2021] [Indexed: 12/15/2022]
Abstract
Background A high proportion of coronavirus disease 2019 (COVID-19) survivors may develop long-term cognitive impairment. We aimed to develop a multivariate causal model exposing the links between COVID-19-associated biomarkers, illness-related variables, and their effects on cognitive performance. Methods In this prospective study, we assess the potential drivers for the development of cognitive impairment in patients with severe COVID-19 pneumonia aged ≥ 18 years at 6-month follow-up after hospital discharge, using the Montreal Cognitive Assessment (MoCA). Patients with pre-existing cognitive impairment were excluded. Laboratory results at hospital admission were clustered by principal component analysis (PCA) and included in a path analysis model evaluating the causal relationship between age, comorbidities, hypoxemia, invasive mechanical ventilation (IMV) requirement, in-hospital delirium, and cognitive performance. Results We studied 92 patients: 54 (58.7%) men and 38 (41.3%) women, with median age of 50 years (interquartile range 42–55), among whom 50 (54.4%) tested positive for cognitive impairment at 6-month follow-up. Path analysis revealed a direct link between the thrombo-inflammatory component of PCA (C-reactive protein, fibrinogen, and neutrophils) and hypoxemia severity at hospital admission. Our model showed that low PaO2/FiO2 ratio values, unlike the thrombo-inflammatory component, had a direct effect on cognitive performance, independent from age, in-hospital delirium, and invasive mechanical ventilation. Conclusion In this study, biomarkers of thrombo-inflammation in COVID-19 and low PaO2/FiO2 had a negative effect on cognitive performance 6 months after hospital discharge. These results highlight the critical role of hypoxemia as a driver for impaired cognition in the mid-term. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05798-8.
Collapse
|
26
|
Guo P, Benito Ballesteros A, Yeung SP, Liu R, Saha A, Curtis L, Kaser M, Haggard MP, Cheke LG. COVCOG 2: Cognitive and Memory Deficits in Long COVID: A Second Publication From the COVID and Cognition Study. Front Aging Neurosci 2022; 14:804937. [PMID: 35370620 PMCID: PMC8967943 DOI: 10.3389/fnagi.2022.804937] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/17/2022] [Indexed: 12/14/2022] Open
Abstract
COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been often characterized as a respiratory disease. However, it is increasingly being understood as an infection that impacts multiple systems, and many patients report neurological symptoms. Indeed, there is accumulating evidence for neural damage in some individuals, with recent studies suggesting loss of gray matter in multiple regions, particularly in the left hemisphere. There are several mechanisms by which the COVID-19 infection may lead to neurological symptoms and structural and functional changes in the brain, and cognitive problems are one of the most commonly reported symptoms in those experiencing Long COVID - the chronic illness following the COVID-19 infection that affects between 10 and 25% of patients. However, there is yet little research testing cognition in Long COVID. The COVID and Cognition Study is a cross-sectional/longitudinal study aiming to understand cognitive problems in Long COVID. The first paper from the study explored the characteristics of our sample of 181 individuals who had experienced the COVID-19 infection, and 185 who had not, and the factors that predicted ongoing symptoms and self-reported cognitive deficits. In this second paper from the study, we assess this sample on tests of memory, language, and executive function. We hypothesize that performance on "objective" cognitive tests will reflect self-reported cognitive symptoms. We further hypothesize that some symptom profiles may be more predictive of cognitive performance than others, perhaps giving some information about the mechanism. We found a consistent pattern of memory deficits in those that had experienced the COVID-19 infection, with deficits increasing with the severity of self-reported ongoing symptoms. Fatigue/Mixed symptoms during the initial illness and ongoing neurological symptoms were predictive of cognitive performance.
Collapse
Affiliation(s)
- Panyuan Guo
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | | | - Sabine P. Yeung
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Ruby Liu
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Arka Saha
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Lyn Curtis
- School of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Muzaffer Kaser
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Mark P. Haggard
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Lucy G. Cheke
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
27
|
Vrettou CS, Mantziou V, Vassiliou AG, Orfanos SE, Kotanidou A, Dimopoulou I. Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review. Life (Basel) 2022; 12:life12010107. [PMID: 35054500 PMCID: PMC8778667 DOI: 10.3390/life12010107] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/21/2022] Open
Abstract
Current achievements in medical science and technological advancements in intensive care medicine have allowed better support of critically ill patients in intensive care units (ICUs) and have increased survival probability. Post-intensive care syndrome (PICS) is a relatively new term introduced almost 10 years ago, defined as "new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization". A significant percentage of critically ill patients suffer from PICS for a prolonged period of time, with physical problems being the most common. The exact prevalence of PICS is unknown, and many risk factors have been described well. Coronavirus disease 2019 (COVID-19) survivors seem to be at especially high risk for developing PICS. The families of ICU survivors can also be affected as a response to the stress suffered during the critical illness of their kin. This separate entity is described as PICS family (PICS-F). A multidisciplinary approach is warranted for the treatment of PICS, involving healthcare professionals, clinicians, and scientists from different areas. Improving outcomes is both challenging and imperative for the critical care community. The review of the relevant literature and the study of the physical, cognitive, and mental sequelae could lead to the prevention and timely management of PICS and the subsequent improvement of the quality of life for ICU survivors.
Collapse
|
28
|
Harris BR, Beesley SJ, Hopkins RO, Hirshberg EL, Wilson E, Butler J, Oniki TA, Kuttler KG, Orme JF, Brown SM. Heart rate variability and subsequent psychological distress among family members of intensive care unit patients. J Int Med Res 2021; 49:3000605211057829. [PMID: 34846178 PMCID: PMC8649465 DOI: 10.1177/03000605211057829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective To determine whether heart rate variability (HRV; a physiological measure of
acute stress) is associated with persistent psychological distress among
family members of adult intensive care unit (ICU) patients. Methods This prospective study investigated family members of patients admitted to a
study ICU. Participants’ variability in heart rate tracings were measured by
low frequency (LF)/high frequency (HF) ratio and detrended fluctuation
analysis (DFA). Questionnaires were completed 3 months after enrollment to
ascertain outcome rates of anxiety, depression, and post-traumatic stress
disorder (PTSD). Results Ninety-nine participants were enrolled (median LF/HF ratio, 0.92
[interquartile range, 0.64–1.38]). Of 92 participants who completed the
3-month follow-up, 29 (32%) had persistent anxiety. Logistic regression
showed that LF/HF ratio (odds ratio [OR] 0.85, 95% confidence interval [CI]
0.43, 1.53) was not associated with 3-month outcomes. In an exploratory
analysis, DFA α (OR 0.93, 95% CI 0.87, 0.99), α1 (OR 0.97, 95% CI
0.94, 0.99), and α2 (OR 0.94, 95% CI 0.88, 0.99) scaling
components were associated with PTSD development. Conclusion Almost one-third of family members experienced anxiety at three months after
enrollment. HRV, measured by LF/HF ratio, was not a predictor of psychologic
distress, however, exploratory analyses indicated that DFA may be associated
with PTSD outcomes.
Collapse
Affiliation(s)
- Benjamin Re Harris
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sarah J Beesley
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ramona O Hopkins
- Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Psychology Department and Neuroscience Center, 6756Brigham Young University, Brigham Young University, Provo, UT, USA
| | - Eliotte L Hirshberg
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA
| | - Emily Wilson
- Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jorie Butler
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Geriatrics and Psychology, University of Utah and Salt Lake City Veterans Administration Hospital, Salt Lake City, UT, USA
| | - Thomas A Oniki
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Care Transformation Information Systems, 7061Intermountain Healthcare, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Kathryn G Kuttler
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Care Transformation Information Systems, 7061Intermountain Healthcare, Intermountain Healthcare, Salt Lake City, UT, USA
| | - James F Orme
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Samuel M Brown
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
29
|
Ramnarain D, Aupers E, den Oudsten B, Oldenbeuving A, de Vries J, Pouwels S. Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counseling and treatment strategies. Expert Rev Neurother 2021; 21:1159-1177. [PMID: 34519235 DOI: 10.1080/14737175.2021.1981289] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Post-intensive care syndrome (PICS) has only recently been recognized as a new clinical entity in patients surviving their intensive care unit (ICU) stay due to critical illness. With increasing survival rates of ICU patients worldwide, there is a rising interest regarding post-ICU recovery. AREAS COVERED First, based on the current literature a definition is provided of PICS, including the domains of impairments that comprise PICS along with the etiology and risk factors. Second, preventive measures and possible treatment strategies integrated in the follow-up care are described. Third, the authors will discuss the current SARS-Cov-2 pandemic and the increased risk of PICS in these post-ICU patients and their families. EXPERT OPINION PICS is a relatively new entity, which not only encompasses various physical, cognitive, and psychological impairments but also impacts global health due to long-lasting detrimental socioeconomic burdens. Importantly, PICS also relates to caregivers of post-ICU patients. Strategies to reduce this burden will not only be needed within the ICU setting but will also have to take place in an interdisciplinary, multifaceted approach in primary care settings. Additionally, the SARS-Cov-2 pandemic has a high burden on post-ICU patients and their relatives.
Collapse
Affiliation(s)
- Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Department of Intensive Care Medicine, Saxenburg Medisch Centrum Hardenberg, The Netherlands
| | - Emily Aupers
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Brenda den Oudsten
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands
| | - Annemarie Oldenbeuving
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Board, ADRZ (Admiraal De Ruyter Ziekenhuis), Goes, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| |
Collapse
|
30
|
Schmidt LE, Patel S, Stollings JL. The pharmacist's role in implementation of the ABCDEF bundle into clinical practice. Am J Health Syst Pharm 2021; 77:1751-1762. [PMID: 32789461 DOI: 10.1093/ajhp/zxaa247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To summarize published data regarding implementation of the ABCDEF bundle, a multicomponent process for avoidance of oversedation and prolonged ventilation in intensive care unit (ICU) patients; discuss pertinent literature to support each bundle element; and discuss the role of the pharmacist in coordinating bundle elements and implementation of the ABCDEF bundle into clinical practice. SUMMARY Neuromuscular weakness and ICU-acquired weakness are common among critically ill patients and associated with significant cost and societal burdens. Recent literature supporting early liberation from mechanical ventilation and early mobilization has demonstrated improved short- and long-term outcomes. With expanded use of pharmacy services in the ICU setting, pharmacists are well positioned to advocate for best care practices in ICUs. A dedicated, interprofessional team is necessary for the implementation of the ABCDEF bundle in inpatient clinical practice settings. As evidenced by a number of studies, successful implementation of the ABCDEF bundle derives from involvement by motivated and highly trained individuals, timely completion of individual patient care tasks, and effective leadership to ensure proper implementation and ongoing support. Factors commonly identified by clinicians as barriers to bundle implementation in clinical practice include patient instability and safety concerns, lack of knowledge, staff concerns, unclear protocol criteria, and lack of interprofessional team care coordination. This narrative review discusses research on bundle elements and recommendations for application by pharmacists in clinical practice. CONCLUSIONS Despite the benefits associated with implementation of the ABCDEF bundle, evidence suggests that the recommended interventions may not be routinely used within the ICU. The pharmacist provides the expertise and knowledge for adoption of the bundle into everyday clinical practice.
Collapse
Affiliation(s)
- Lauren E Schmidt
- Department of Pharmacy, Penn Presbyterian Medical Center, Philadelphia, PA
| | - Sneha Patel
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN
| | - Joanna L Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN.,Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
31
|
Moorley C, Ferrante J, Jennings K, Dangerfield A. Decolonizing care of Black, Asian and Minority Ethnic patients in the critical care environment: A practical guide. Nurs Crit Care 2021; 25:324-326. [PMID: 32815297 DOI: 10.1111/nicc.12537] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Calvin Moorley
- Nursing Research and Diversity in Care, London South Bank University, London, UK
| | | | | | | |
Collapse
|
32
|
Ali Awan H, Najmuddin Diwan M, Aamir A, Ali M, Di Giannantonio M, Ullah I, Shoib S, De Berardis D. SARS-CoV-2 and the Brain: What Do We Know about the Causality of 'Cognitive COVID? J Clin Med 2021; 10:3441. [PMID: 34362224 PMCID: PMC8347421 DOI: 10.3390/jcm10153441] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 12/22/2022] Open
Abstract
The second year of the COVID-19 (coronavirus disease) pandemic has seen the need to identify and assess the long-term consequences of a SARS-CoV-2 infection on an individual's overall wellbeing, including adequate cognitive functioning. 'Cognitive COVID' is an informal term coined to interchangeably refer to acute changes in cognition during COVID-19 and/or cognitive sequelae with various deficits following the infection. These may manifest as altered levels of consciousness, encephalopathy-like symptoms, delirium, and loss of various memory domains. Dysexecutive syndrome is a peculiar manifestation of 'Cognitive COVID' as well. In the previous major outbreaks of viruses like SARS-CoV, MERS-CoV and Influenza. There have been attempts to understand the underlying mechanisms describing the causality of similar symptoms following SARS-CoV-2 infection. This review, therefore, is attempting to highlight the current understanding of the various direct and indirect mechanisms, focusing on the role of neurotropism of SARS-CoV-2, the general pro-inflammatory state, and the pandemic-associated psychosocial stressors in the causality of 'Cognitive COVID.' Neurotropism is associated with various mechanisms including retrograde neuronal transmission via olfactory pathway, a general hematogenous spread, and the virus using immune cells as vectors. The high amounts of inflammation caused by COVID-19, compounded with potential intubation, are associated with a deleterious effect on the cognition as well. Finally, the pandemic's unique psychosocial impact has raised alarm due to its possible effect on cognition. Furthermore, with surfacing reports of post-COVID-vaccination cognitive impairments after vaccines containing mRNA encoding for spike glycoprotein of SARS-CoV-2, we hypothesize their causality and ways to mitigate the risk. The potential impact on the quality of life of an individual and the fact that even a minor proportion of COVID-19 cases developing cognitive impairment could be a significant burden on already overwhelmed healthcare systems across the world make it vital to gather further evidence regarding the prevalence, presentation, correlations, and causality of these events and reevaluate our approach to accommodate early identification, management, and rehabilitation of patients exhibiting cognitive symptoms.
Collapse
Affiliation(s)
- Hashir Ali Awan
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan; (H.A.A.); (M.N.D.); (A.A.); (M.A.)
| | - Mufaddal Najmuddin Diwan
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan; (H.A.A.); (M.N.D.); (A.A.); (M.A.)
| | - Alifiya Aamir
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan; (H.A.A.); (M.N.D.); (A.A.); (M.A.)
| | - Muneeza Ali
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan; (H.A.A.); (M.N.D.); (A.A.); (M.A.)
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, 66100 Chieti, Italy;
| | - Irfan Ullah
- Department of Internal Medicine, Kabir Medical College, Gandhara University, Peshawar 25000, Pakistan;
| | - Sheikh Shoib
- Department of Internal Medicine, Jawahar Lal Nehru Memorial Hospital, Srinagar 190003, India;
| | - Domenico De Berardis
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, 66100 Chieti, Italy;
- Department of Internal Medicine, Jawahar Lal Nehru Memorial Hospital, Srinagar 190003, India;
- NHS, National Health Service, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital “G. Mazzini,” ASL 4, 64100 Teramo, Italy
| |
Collapse
|
33
|
Mart MF, Pun BT, Pandharipande P, Jackson JC, Ely EW. ICU Survivorship-The Relationship of Delirium, Sedation, Dementia, and Acquired Weakness. Crit Care Med 2021; 49:1227-1240. [PMID: 34115639 PMCID: PMC8282752 DOI: 10.1097/ccm.0000000000005125] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The advent of modern critical care medicine has revolutionized care of the critically ill patient in the last 50 years. The Society of Critical Care Medicine (was formed in recognition of the challenges and need for specialized treatment for these fragile patients. As the specialty has grown, it has achieved impressive scientific advances that have reduced mortality and saved lives. With those advances, however, came growing recognition that the burden of critical illness did not end at the doorstep of the hospital. Delirium, once thought to be a mere by-product of critical illness, was found to be an independent predictor of mortality, prolonged mechanical ventilation, and long-lasting cognitive impairment. Similarly, deep sedation and immobility, so often used to keep patients "comfortable" and to facilitate mechanical ventilation and recovery, worsen mortality and lead to the development of ICU-acquired weakness. The realization that these outcomes are inextricably linked to one another and how we manage our patients has helped us recognize the need for culture change. We, as a specialty, now understand that although celebrating the successes of survival, we now also have a duty to focus on those who survive their diseases. Led by initiatives such as the ICU Liberation Campaign of the Society of Critical Care Medicine, the natural progression of the field is now focused on getting patients back to their homes and lives unencumbered by disability and impairment. Much work remains to be done, but the futures of our most critically ill patients will continue to benefit if we leverage and build on the history of our first 50 years.
Collapse
Affiliation(s)
- Matthew F Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
| | - Brenda T Pun
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
| | - Pratik Pandharipande
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - James C Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
| | - E Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
| |
Collapse
|
34
|
Peer Support Group for Intensive Care Unit Survivors: Perceptions on Supportive Recovery in the Era of Social Distancing. Ann Am Thorac Soc 2021; 18:177-182. [PMID: 33108225 PMCID: PMC7780980 DOI: 10.1513/annalsats.202007-799rl] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
35
|
Incidence and influencing factors of post-intensive care cognitive impairment. Intensive Crit Care Nurs 2021; 67:103106. [PMID: 34246526 DOI: 10.1016/j.iccn.2021.103106] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/27/2021] [Accepted: 05/14/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the incidence and risks factors of short-term post-intensive care (ICU) cognitive impairment. DESIGN Prospective, observational study. SETTING Closed university-affiliated intensive care unit. PATIENTS We enrolled consecutive patients >18 yrs of age expected to be in intensive care unit for ≥24 hours. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The score of Montreal Cognitive Assessment (MoCA) less than 26 was defined as cognitive impairment at hospital discharge and short-term post-ICU cognitive impairment was diagnosed in 185 of 409 assessed patients (45.2%). According to univariate analysis, age, years of education, occupation, past medical history, main ICU diagnosis, Acute Physiology and Chronic Evaluation Scoring System (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, Charlson comorbidity index, ICU length-of-stay (LOS), total hospital LOS, sedation, vasoactive agents, muscle relaxants, mechanical ventilation and duration of mechanical ventilation, constraints, early active mobilisation, hypoxemia, frequency and severity of delirium, blood pressure, rescue experience, and infection were significant predictors of post-ICU cognitive impairment. Multivariate analysis results showed that the frequency and severity of delirium, and advanced age were risk factors of post-ICU cognitive impairment; high years of education and early active mobilisation were protective factors. CONCLUSIONS Incidence of post-ICU cognitive impairment is at a high level, which is similar to former researches' results; the frequency and severity of delirium, and advanced age were risk factors of post-ICU cognitive impairment; high years of education and early active mobilisation were protective factors of post-ICU cognitive impairment.
Collapse
|
36
|
Nordness MF, Hayhurst CJ, Pandharipande P. Current Perspectives on the Assessment and Management of Pain in the Intensive Care Unit. J Pain Res 2021; 14:1733-1744. [PMID: 34163231 PMCID: PMC8214553 DOI: 10.2147/jpr.s256406] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 12/02/2022] Open
Abstract
Critical illness is often painful, both from the underlying source of illness, as well as necessary procedures performed for the monitoring and care of these patients. Pain is often under-recognized in the critically ill, especially among those who cannot self-report, so accurate assessment and management continue to be major consideration in their care. Pain management in the intensive care unit (ICU) is an evolving practice, with a focus on accurate and frequent pain assessment, and targeted pharmacologic and non-pharmacologic treatment methods to maximize analgesia and minimize sedation. In this review, we will evaluate several validated methods of pain assessment in the ICU and present management options. We will review the evidence-based recommendations put forth by the largest critical care societies and several high-quality studies related to both the in-hospital approach to pain, as well as the short- and long-term consequences of untreated pain in ICU patients. We conclude with future directions.
Collapse
Affiliation(s)
- Mina F Nordness
- Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina J Hayhurst
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pratik Pandharipande
- Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
37
|
[Post-intensive care syndrome]. Rev Med Interne 2021; 42:855-861. [PMID: 34088516 DOI: 10.1016/j.revmed.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/29/2021] [Accepted: 05/09/2021] [Indexed: 11/23/2022]
Abstract
Post-intensive care syndrome is an entity defined in 2010 and covering any sequelae following an extended hospitalization in intensive care unit. It comprises psychological, cognitive and physical disorders (neuromyopathy, respiratory dysfunction, joint stiffness, among others). These sequelae have important consequences on autonomy and quality of life of these patients, as well as on their healthcare consumption and on mortality. Psychological sequelae can also be seen in hospitalized patients' relatives. Screening and management of these disorders is more and more frequent but no method has formally proven effective. The number of patients surviving an intensive care unit hospitalization is increasing, and management of post-intensive care syndrome is a major issue. It seems important that the internist be aware of this syndrome, given his pivotal role in global management of patients and frequent implication into care after the intensive care unit.
Collapse
|
38
|
Abstract
OBJECTIVES Critical illness can cause severe cognitive impairments. The objective of this trial was to assess the effect of nonsedation versus sedation with a daily wake-up call during mechanical ventilation on cognitive function in adult survivors of critical illness. DESIGN Single-center substudy of the multicenter, randomized Non-sedation Versus Sedation With a Daily Wake-up Trial in Critically Ill Patients Receiving Mechanical Ventilation trial. Three months after ICU-discharge participants were tested for cognitive function by a neuropsychologist. SETTING Mixed 14-bed ICU in teaching hospital. PATIENTS A total of 205 critically ill, orally intubated, and mechanically ventilated adults. INTERVENTIONS Patients were randomized within the first 24 hours from intubation to either nonsedation with sufficient analgesia or light sedation with a daily wake-up call during mechanical ventilation. MEASUREMENTS AND MAIN RESULTS A total of 118 patients survived to follow-up and 89 participated (75%). The participating survivors in the two groups did not differ regarding baseline data or premorbid cognitive impairments. Sedated patients had received more sedatives, whereas doses of morphine and antipsychotics were equal. The primary outcome was that no significant difference was found in the number of patients with mild/moderate cognitive impairments (six nonsedated patients vs four sedated patients) or severe cognitive impairments (16 nonsedated patients vs 17 sedated patients; p = 0.71). Secondary outcomes were cognitive test scores, and no differences were found between the scores in nonsedated and sedated patients. Hypothetical worst case scenarios where all patients, who had not participated in follow-up assessment, were assumed to have severe cognitive impairments were analyzed, but still no difference between the groups was found. We found more patients with delirium in the sedated group (96% vs 69% of patients; p = 0.002) and increased duration of delirium in sedated patients (median 5 vs 1 d; p < 0.001). Delirium subtypes were equally distributed between the groups, with hypoactive delirium most frequent (61%), followed by mixed delirium (39%). CONCLUSIONS Nonsedation did not affect cognitive function 3 months after ICU-discharge.
Collapse
|
39
|
Abstract
Sleep is fundamental for everyday functioning, yet it is often negatively impacted in critically ill patients by the intensive care setting. With a focus on the neurological intensive care unit (NeuroICU), this narrative review summarizes methods of measuring sleep and addresses common causes of sleep disturbance in the hospital including environmental, pharmacological, and patient-related factors. The effects of sleep deprivation on the cardiovascular, pulmonary, immune, endocrine, and neuropsychological systems are discussed, with a focus on short-term deprivation in critically ill populations. Where evidence is lacking in the literature, long-term sleep deprivation studies and the effects of sleep deprivation in healthy individuals are also referenced. Lastly, strategies for the promotion of sleep in the NeuroICU are presented.
Collapse
|
40
|
Propofol shows less negative effects on cognitive performances than dexmedetomidine in elderly intensive care unit patients. Neurol Sci 2021; 42:3767-3774. [PMID: 33449243 DOI: 10.1007/s10072-020-04994-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/11/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Due to the improved clinical management of aging population and the consequently declined mortality among patients with critical illnesses, the number of survivors from intensive care units (ICUs) keeps rising. Studies to examine the association of cognitive impairment analgesic and sedation strategies would be beneficial to improve the quality of life of ICU survivors. METHODS A prospective clinical trial was designed to compare the effects of two drugs, propofol, and dexmedetomidine, on short-term cognitive impairment after sedation in elderly ICU survivors by evaluating the extent of independence limited by the dementia-related activities of daily livings (ADLs). The plasma concentrations of brain injury biomarkers including S100β and neuron-specific enolase (NSE) were determined using an enzyme immunoassay. There were 136 patients allocated into both the dexmedetomidine group and the propofol group, respectively, with matched demographic characteristics. RESULTS The dementia scale of the patients in the dexmedetomidine group was significantly higher than the propofol group at weeks 1-4. Moreover, the changes in S100β and NSE concentrations in the dexmedetomidine group were significantly more pronounced than the propofol group. ICU patients who received dexmedetomidine intervention showed higher cognitive impairment than patients who received propofol, and this protective effect of propofol was not associated with the levels of brain injury markers S100β and NSE. CONCLUSION Our study compared the effects of commonly used medications on short-term cognitive impairment in elderly ICU patients, which would aid the selection of sedation plan for the benefit of ICU patients.
Collapse
|
41
|
Huang M, Gedansky A, Hassett CE, Price C, Fan TH, Stephens RS, Nyquist P, Uchino K, Cho SM. Pathophysiology of Brain Injury and Neurological Outcome in Acute Respiratory Distress Syndrome: A Scoping Review of Preclinical to Clinical Studies. Neurocrit Care 2021; 35:518-527. [PMID: 34297332 PMCID: PMC8299740 DOI: 10.1007/s12028-021-01309-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/21/2021] [Indexed: 02/05/2023]
Abstract
Acute respiratory distress syndrome (ARDS) has been associated with secondary acute brain injury (ABI). However, there is sparse literature on the mechanism of lung-mediated brain injury and prevalence of ARDS-associated secondary ABI. We aimed to review and elucidate potential mechanisms of ARDS-mediated ABI from preclinical models and assess the prevalence of ABI and neurological outcome in ARDS with clinical studies. We conducted a systematic search of PubMed and five other databases reporting ABI and ARDS through July 6, 2020 and included studies with ABI and neurological outcome occurring after ARDS. We found 38 studies (10 preclinical studies with 143 animals; 28 clinical studies with 1175 patients) encompassing 9 animal studies (n = 143), 1 in vitro study, 12 studies on neurocognitive outcomes (n = 797), 2 clinical observational studies (n = 126), 1 neuroimaging study (n = 15), and 13 clinical case series/reports (n = 15). Six ARDS animal studies demonstrated evidence of neuroinflammation and neuronal damage within the hippocampus. Five animal studies demonstrated altered cerebral blood flow and increased intracranial pressure with the use of lung-protective mechanical ventilation. High frequency of ARDS-associated secondary ABI or poor neurological outcome was observed ranging 82-86% in clinical observational studies. Of the clinically reported ABIs (median age 49 years, 46% men), the most common injury was hemorrhagic stroke (25%), followed by hypoxic ischemic brain injury (22%), diffuse cerebral edema (11%), and ischemic stroke (8%). Cognitive impairment in patients with ARDS (n = 797) was observed in 87% (range 73-100%) at discharge, 36% (range 32-37%) at 6 months, and 30% (range 25-45%) at 1 year. Mechanisms of ARDS-associated secondary ABI include primary hypoxic ischemic injury from hypoxic respiratory failure, secondary injury, such as lung injury induced neuroinflammation, and increased intracranial pressure from ARDS lung-protective mechanical ventilation strategy. In summary, paucity of clinical data exists on the prevalence of ABI in patients with ARDS. Hemorrhagic stroke and hypoxic ischemic brain injury were commonly observed. Persistent cognitive impairment was highly prevalent in patients with ARDS.
Collapse
Affiliation(s)
- Merry Huang
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH USA
| | - Aron Gedansky
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH USA
| | - Catherine E. Hassett
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH USA
| | - Carrie Price
- Albert S. Cook Library, Towson University, Towson, MD USA
| | - Tracey H. Fan
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH USA
| | - R. Scott Stephens
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Paul Nyquist
- Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University, 600 N. Wolfe Street, Phipps 455, Baltimore, MD USA
| | - Ken Uchino
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH USA
| | - Sung-Min Cho
- Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University, 600 N. Wolfe Street, Phipps 455, Baltimore, MD USA
| |
Collapse
|
42
|
Giordano G, Pugliese F, Bilotta F. Neuroinflammation, neuronal damage or cognitive impairment associated with mechanical ventilation: A systematic review of evidence from animal studies. J Crit Care 2020; 62:246-255. [PMID: 33454552 DOI: 10.1016/j.jcrc.2020.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/25/2020] [Accepted: 12/19/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Long-term cognitive impairment is a complication of critical illness survivors. Beside its lifesaving role, mechanical ventilation has potential complications. The aim of this study is to systematically review the evidence collected in animal studies that correlate mechanical ventilation with neuroinflammation, neuronal damage and cognitive impairment. METHODS We searched MEDLINE and EMBASE databases for studies published from inception until August 31st, 2020, that enrolled mechanically ventilated animals and reported on neuroinflammation or neuronal damage markers changes or cognitive-behavioural impairment. RESULTS Of 5583 studies, 11 met inclusion criteria. Mice, rats, pigs were used. Impact of MV: 4 out of 7 studies reported higher neuroinflammation markers in MV-treated animals and 3 studies reported no differences; 7 out of 8 studies reported a higher neuronal damage and 1 reported no differences; 2 out of 2 studies reported cognitive decline up to 3 days after MV. Higher Tidal volumes are associated with higher changes in brain or serum markers. CONCLUSION Preclinical evidence suggests that MV induces neuroinflammation, neuronal damage and cognitive impairment and these are worsened if sub-optimal MV settings are applied. Future studies, with appropriate methodology, are necessary to evaluate for serum monitoring strategies. TRIAL REGISTRATION NUMBER CRD42019148935.
Collapse
Affiliation(s)
- Giovanni Giordano
- Department of Anaesthesia and Intensive Care, Sapienza University of Rome, Roma, Italy.
| | - Francesco Pugliese
- Department of Anaesthesia and Intensive Care, Sapienza University of Rome, Roma, Italy
| | - Federico Bilotta
- Department of Anaesthesia and Intensive Care, Sapienza University of Rome, Roma, Italy
| |
Collapse
|
43
|
Nora GJ, Reddy CC. Acute Delirium and Post-Delirium Encephalopathy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
44
|
Fernández-Gonzalo S, Navarra-Ventura G, Bacardit N, Gomà Fernández G, de Haro C, Subirà C, López-Aguilar J, Magrans R, Sarlabous L, Aquino Esperanza J, Jodar M, Rué M, Ochagavía A, Palao DJ, Fernández R, Blanch L. Cognitive phenotypes 1 month after ICU discharge in mechanically ventilated patients: a prospective observational cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:618. [PMID: 33087171 PMCID: PMC7579874 DOI: 10.1186/s13054-020-03334-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/06/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND ICU patients undergoing invasive mechanical ventilation experience cognitive decline associated with their critical illness and its management. The early detection of different cognitive phenotypes might reveal the involvement of diverse pathophysiological mechanisms and help to clarify the role of the precipitating and predisposing factors. Our main objective is to identify cognitive phenotypes in critically ill survivors 1 month after ICU discharge using an unsupervised machine learning method, and to contrast them with the classical approach of cognitive impairment assessment. For descriptive purposes, precipitating and predisposing factors for cognitive impairment were explored. METHODS A total of 156 mechanically ventilated critically ill patients from two medical/surgical ICUs were prospectively studied. Patients with previous cognitive impairment, neurological or psychiatric diagnosis were excluded. Clinical variables were registered during ICU stay, and 100 patients were cognitively assessed 1 month after ICU discharge. The unsupervised machine learning K-means clustering algorithm was applied to detect cognitive phenotypes. Exploratory analyses were used to study precipitating and predisposing factors for cognitive impairment. RESULTS K-means testing identified three clusters (K) of patients with different cognitive phenotypes: K1 (n = 13), severe cognitive impairment in speed of processing (92%) and executive function (85%); K2 (n = 33), moderate-to-severe deficits in learning-memory (55%), memory retrieval (67%), speed of processing (36.4%) and executive function (33.3%); and K3 (n = 46), normal cognitive profile in 89% of patients. Using the classical approach, moderate-to-severe cognitive decline was recorded in 47% of patients, while the K-means method accurately classified 85.9%. The descriptive analysis showed significant differences in days (p = 0.016) and doses (p = 0.039) with opioid treatment in K1 vs. K2 and K3. In K2, there were more women, patients were older and had more comorbidities (p = 0.001) than in K1 or K3. Cognitive reserve was significantly (p = 0.001) higher in K3 than in K1 or K2. CONCLUSION One month after ICU discharge, three groups of patients with different cognitive phenotypes were identified through an unsupervised machine learning method. This novel approach improved the classical classification of cognitive impairment in ICU survivors. In the exploratory analysis, gender, age and the level of cognitive reserve emerged as relevant predisposing factors for cognitive impairment in ICU patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier:NCT02390024; March 17,2015.
Collapse
Affiliation(s)
- Sol Fernández-Gonzalo
- Critical Care Center, Parc Taulí Hospital Universitari, Fundació- I3PT, UAB, Sabadell, Spain. .,Centro de Investigación Biomédica En Red en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain. .,Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
| | - Guillem Navarra-Ventura
- Critical Care Center, Parc Taulí Hospital Universitari, Fundació- I3PT, UAB, Sabadell, Spain.,Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Neus Bacardit
- Mental Health Department, Fundació Althaia - Xarxa Assistencial I Universitaria, Manresa, Spain
| | - Gemma Gomà Fernández
- Critical Care Center, Parc Taulí Hospital Universitari, Fundació- I3PT, UAB, Sabadell, Spain
| | - Candelaria de Haro
- Critical Care Center, Parc Taulí Hospital Universitari, Fundació- I3PT, UAB, Sabadell, Spain.,Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Carles Subirà
- Critical Care Center, Fundació Althai, Universitat Internacional de Catalunya, Manresa, Spain
| | - Josefina López-Aguilar
- Critical Care Center, Parc Taulí Hospital Universitari, Fundació- I3PT, UAB, Sabadell, Spain.,Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Leonardo Sarlabous
- Critical Care Center, Parc Taulí Hospital Universitari, Fundació- I3PT, UAB, Sabadell, Spain
| | - Jose Aquino Esperanza
- Critical Care Center, Parc Taulí Hospital Universitari, Fundació- I3PT, UAB, Sabadell, Spain.,Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Mercè Jodar
- Centro de Investigación Biomédica En Red en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.,Neurology Department, Parc Taulí Hospital Universitari, I3PT, UAB, Sabadell, Spain
| | - Montse Rué
- Departament of Basic Medical Sciences, Universitat de Lleida, Lleida, Spain.,Health Services Research Network in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Ana Ochagavía
- Critical Care Center, Parc Taulí Hospital Universitari, Fundació- I3PT, UAB, Sabadell, Spain.,Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Diego J Palao
- Centro de Investigación Biomédica En Red en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Mental Health Department, Parc Taulí Hospital Universitari, I3PT, UAB, Sabadel, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Rafael Fernández
- Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Critical Care Center, Fundació Althai, Universitat Internacional de Catalunya, Manresa, Spain
| | - Lluís Blanch
- Critical Care Center, Parc Taulí Hospital Universitari, Fundació- I3PT, UAB, Sabadell, Spain.,Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
45
|
Long-term cognitive impairment after ICU treatment: a prospective longitudinal cohort study (Cog-I-CU). Sci Rep 2020; 10:15518. [PMID: 32968099 PMCID: PMC7511316 DOI: 10.1038/s41598-020-72109-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/21/2020] [Indexed: 01/16/2023] Open
Abstract
In this prospective cohort study we aimed to investigate the trajectory of the cognitive performance of patients after discharge from an intensive care unit (ICU). Special consideration was given to patients with suspected premorbid cognitive impairment who might be at risk for the development of dementia. Clinical characteristics were collected until discharge. The premorbid cognitive state was estimated by a structured interview with a close relative. Cognitive outcome was assessed using the Consortium to Establish a Registry of Alzheimer’s Disease (CERAD) Plus battery and the Stroop Color and Word Test at the time of discharge from ICU and 9 months later. The results of the study group were compared to an established healthy control group and to normative data. A total number of 108 patients were finally included. At the time of discharge, patients underperformed the healthy control group. In linear regression models, delirium during the ICU stay and the factor premorbid cognitive impairment were associated with poorer cognitive outcome (p = 0.047 and p = 0.001). After 9 months, in 6% of patients without evidence of premorbid cognitive impairment long-lasting deficits were found. In patients with suspected premorbid cognitive impairment, performance in tests of executive function failed to improve.
Collapse
|
46
|
Rabinovitz B, Jaywant A, Fridman CB. Neuropsychological functioning in severe acute respiratory disorders caused by the coronavirus: Implications for the current COVID-19 pandemic. Clin Neuropsychol 2020; 34:1453-1479. [PMID: 32901580 DOI: 10.1080/13854046.2020.1803408] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: The coronavirus class of respiratory viruses - including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) - has been associated with central nervous system (CNS) disease. In fact, multiple mechanisms of CNS involvement have been proposed, making it difficult to identify a unitary syndrome that can be the focus of clinical work and research. Neuropsychologists need to understand the potential cognitive and psychological sequelae of COVID-19 and the impact of the interventions (e.g., ICU, ventilation) that have been used in treating patients with severe forms of the illness.Method: We briefly review the literature regarding the neurological and neuropsychological effects of similar coronaviruses, the limited information that has been published to date on COVID-19, and the literature regarding the long-term cognitive and psychological effects of undergoing treatment in the intensive care unit (ICU).Results: We discuss the roles that neuropsychologists can play in assessing and treating the cognitive difficulties and psychiatric symptoms described.Conclusions: At this time, the mechanisms, correlates, and effects of COVID-19 are poorly understood, but information gleaned from the literature on similar viruses and utilized interventions should help inform neuropsychologists as they begin to work with this population.
Collapse
Affiliation(s)
- Beth Rabinovitz
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Abhishek Jaywant
- Departments of Rehabilitation Medicine and Psychiatry, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Chaya B Fridman
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
47
|
Kohler J, Borchers F, Endres M, Weiss B, Spies C, Emmrich JV. Cognitive Deficits Following Intensive Care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:627-634. [PMID: 31617485 DOI: 10.3238/arztebl.2019.0627] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/06/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Illnesses that necessitate intensive care can impair cognitive function severely over the long term, leaving patients less able to cope with the demands of everyday living and markedly lowering their quality of life. There has not yet been any comprehensive study of the cognitive sequelae of critical illness among non- surgical patients treated in intensive care. The purpose of this review is to present the available study findings on cognitive deficits in such patients, with particular at- tention to prevalence, types of deficit, clinical course, risk factors, prevention, and treatment. METHODS This review is based on pertinent publications retrieved by a selective search in MEDLINE. RESULTS The literature search yielded 3360 hits, among which there were 14 studies that met our inclusion criteria. 17-78% of patients had cognitive deficits after dis- charge from the intensive care unit; most had never had a cognitive deficit before. Cognitive impairment often persisted for up to several years after discharge (0.5 to 9 years) and tended to improve over time. The only definite risk factor is delirium. CONCLUSION Cognitive dysfunction is a common sequela of the treatment of non-surgical patients in intensive care units. It is a serious problem for the affected persons and an increasingly important socio-economic problem as well. The effective management of delirium is very important. General conclusions are hard to draw from the available data because of heterogeneous study designs, varying methods of measurement, and differences among patient cohorts. Further studies are needed so that study designs and clinical testing procedures can be standard- ized and effective measures for prevention and treatment can be identified.
Collapse
Affiliation(s)
- Joel Kohler
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin; Department of Anesthesiology and Operative Intensive Care Medicine at Campus Benjamin Franklin Charité-Universitätsmedizin Berlin
| | | | | | | | | | | |
Collapse
|
48
|
Seidel G, Gaser C, Götz T, Günther A, Hamzei F. Accelerated brain ageing in sepsis survivors with cognitive long-term impairment. Eur J Neurosci 2020; 52:4395-4402. [PMID: 32498123 DOI: 10.1111/ejn.14850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/20/2020] [Indexed: 01/23/2023]
Abstract
In the last years, cognitive impairment was emphasized to be a prominent long-term sequelae of sepsis. The level of cognitive impairment is comparable with that in mild cognitive impairment (MCI) patients. Whether sepsis survivors also show a comparable brain atrophy is still unclear. For the analysis of brain atrophy, a novel method named brain age gap estimation (BrainAGE) was used. In this analysis approach, an algorithm identifies age-specific atrophy across the whole brain and calculates a BrainAGE score in years. In case of accelerated brain atrophy, the BrainAGE score is increased in comparison to the healthy age reference group, indicating a difference in estimated chronological age. 20 survivors of severe sepsis (longer than 2 years post sepsis) with persistent cognitive deficits were investigated with a battery of neuropsychological tests. Their MRI images were compared to an age- and sex-matched control group. Sepsis survivors showed a significant higher BrainAGE score of 4.5 years compared to healthy controls. We also found a close relationship between the BrainAGE score and severity of cognitive impairment (a higher BrainAGE score was associated with more severe cognitive impairment). Consequently, sepsis survivors with persistent cognitive impairment showed an accelerated brain ageing, which was closely associated with the severity of cognitive impairment (similar to MCI patients).
Collapse
Affiliation(s)
- Gundula Seidel
- Moritz Klinik Bad Klosterlausnitz, Bad Klosterlausnitz, Germany.,Section of Neurorehabilitation, Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Christian Gaser
- Structural Brain Mapping Group, Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.,Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Theresa Götz
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Albrecht Günther
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Farsin Hamzei
- Moritz Klinik Bad Klosterlausnitz, Bad Klosterlausnitz, Germany.,Section of Neurorehabilitation, Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| |
Collapse
|
49
|
Schulte PJ, Warner DO, Martin DP, Deljou A, Mielke MM, Knopman DS, Petersen RC, Weingarten TN, Warner MA, Rabinstein AA, Hanson AC, Schroeder DR, Sprung J. Association Between Critical Care Admissions and Cognitive Trajectories in Older Adults. Crit Care Med 2020; 47:1116-1124. [PMID: 31107280 DOI: 10.1097/ccm.0000000000003829] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Patients requiring admission to an ICU may subsequently experience cognitive decline. Our objective was to investigate longitudinal cognitive trajectories in older adults hospitalized in ICUs. We hypothesized that individuals hospitalized for critical illness develop greater cognitive decline compared with those who do not require ICU admission. DESIGN A retrospective cohort study using prospectively collected cognitive scores of participants enrolled in the Mayo Clinic Study of Aging and ICU admissions retrospectively ascertained from electronic medical records. A covariate-adjusted linear mixed effects model with random intercepts and slopes assessed the relationship between ICU admissions and the slope of global cognitive z scores and domains scores (memory, attention/executive, visuospatial, and language). SETTING ICU admissions and cognitive scores in the Mayo Clinic Study of Aging from October 1, 2004, to September 11, 2017. PATIENTS Nondemented participants age 50 through 91 at enrollment in the Mayo Clinic Study of Aging with an initial cognitive assessment and at least one follow-up visit. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 3,673 participants, 372 had at least one ICU admission with median (25-75th percentile) follow-up after first ICU admission of 2.5 years (1.2-4.4 yr). For global cognitive z score, admission to an ICU was associated with greater decline in scores over time compared with participants not requiring ICU admission (difference in annual slope = -0.028; 95% CI, -0.044 to -0.012; p < 0.001). ICU admission was associated with greater declines in memory (-0.029; 95% CI, -0.047 to -0.011; p = 0.002), attention/executive (-0.020; 95% CI, -0.037 to -0.004; p = 0.016), and visuospatial (-0.013; 95% CI, -0.026 to -0.001; p = 0.041) domains. ICU admissions with delirium were associated with greater declines in memory (interaction p = 0.006) and language (interaction p = 0.002) domains than ICU admissions without delirium. CONCLUSIONS In older adults, ICU admission was associated with greater long-term cognitive decline compared with patients without ICU admission. These findings were more pronounced in those who develop delirium while in the ICU.
Collapse
Affiliation(s)
- Phillip J Schulte
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - David O Warner
- Department of Anesthesiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - David P Martin
- Department of Anesthesiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Atousa Deljou
- Department of Anesthesiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN.,Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - David S Knopman
- Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN.,Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Toby N Weingarten
- Department of Anesthesiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Matthew A Warner
- Department of Anesthesiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Alejandro A Rabinstein
- Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Andrew C Hanson
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Darrell R Schroeder
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Juraj Sprung
- Department of Anesthesiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| |
Collapse
|
50
|
Mazeraud A, Righy C, Bouchereau E, Benghanem S, Bozza FA, Sharshar T. Septic-Associated Encephalopathy: a Comprehensive Review. Neurotherapeutics 2020; 17:392-403. [PMID: 32378026 PMCID: PMC7283452 DOI: 10.1007/s13311-020-00862-1] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Septic-associated encephalopathy (SAE) is a key manifestation of sepsis, ranging from delirium to coma and occurring in up to 70% of patients admitted to the ICU. SAE is associated with higher ICU and hospital mortality, and also with poorer long-term outcomes, including cognitive and functional outcomes. The pathophysiology of SAE is complex, and it may involve neurotransmitter dysfunction, inflammatory and ischemic lesions to the brain, microglial activation, and blood-brain barrier dysfunction. Delirium (which is included in the SAE spectrum) is mostly diagnosed with validated scales in the ICU population. There is no established treatment for SAE; benzodiazepines should generally be avoided in this setting. Nonpharmacological prevention and management is key for treating SAE; it includes avoiding oversedation (mainly with benzodiazepines), early mobilization, and sleep promotion.
Collapse
Affiliation(s)
- Aurélien Mazeraud
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1, rue Cabanis, 75014, Paris, France
- Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
- Université de Paris, 75006, Paris, France
| | - Cássia Righy
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1, rue Cabanis, 75014, Paris, France
- Instituto Estadual do Cérebro Paul Niemeyer, Rio de Janeiro, Brazil
| | - Eleonore Bouchereau
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1, rue Cabanis, 75014, Paris, France
- Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
- Université de Paris, 75006, Paris, France
| | - Sarah Benghanem
- Université de Paris, 75006, Paris, France
- Médecine Intensive et Réanimation, Centre Hospitalier Universitaire Cochin, Paris, France
| | | | - Tarek Sharshar
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1, rue Cabanis, 75014, Paris, France.
- Université de Paris, 75006, Paris, France.
| |
Collapse
|