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Long-term Cognitive and Functional Impairments After Critical Illness.
Anesth Analg. 2019 04; 128(4):772-780.A&A

Abstract

As critical illness survivorship increases, patients and health care providers are faced with management of long-term sequelae including cognitive and functional impairment. Longitudinal studies have demonstrated impairments persisting at least 1-5 years after hospitalization for critical illness. Cognitive domains impacted include memory, attention, and processing speed. Functional impairments include physical weakness, reduced endurance, and dependence on others for basic tasks of daily living such as bathing or feeding. In characterizing the trajectory of long-term recovery, multiple risk factors have been identified for subsequent impairment, including increased severity of illness and severe sepsis, prolonged mechanical ventilation, and delirium. Preadmission status including frailty, high level of preexisting comorbidities, and baseline cognitive dysfunction are also associated with impairment after critical illness. Development of cognitive and functional impairment is likely multifactorial, and multiple mechanistic theories have been proposed. Neuroinflammation, disruption of the blood-brain barrier, and structural alterations in the brain have all been observed in patients with long-term cognitive dysfunction. Systemic inflammation has also been associated with alterations in muscle integrity and function, which is associated with intensive care unit-acquired weakness and prolonged functional impairment. Efforts to ease the burden of long-term impairments include prevention strategies and rehabilitation interventions after discharge. Delirium is a well-established risk factor for long-term cognitive dysfunction, and using delirium-prevention strategies may be important for cognitive protection. Current evidence favors minimizing overall sedation exposure, careful selection of sedation agents including avoidance of benzodiazepines, and targeted sedation goals to avoid oversedation. Daily awakening and spontaneous breathing trials and early mobilization have shown benefit in both cognitive and functional outcomes. Multifactorial prevention bundles are useful tools in improving care provided to patients in the intensive care unit. Data regarding cognitive rehabilitation are limited, while studies on functional rehabilitation have conflicting results. Continued investigation and implementation of prevention strategies and rehabilitation interventions will hopefully improve the quality of life for the ever-increasing population of critical illness survivors.

Authors+Show Affiliations

From the Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30883422

Citation

Rengel, Kimberly F., et al. "Long-term Cognitive and Functional Impairments After Critical Illness." Anesthesia and Analgesia, vol. 128, no. 4, 2019, pp. 772-780.
Rengel KF, Hayhurst CJ, Pandharipande PP, et al. Long-term Cognitive and Functional Impairments After Critical Illness. Anesth Analg. 2019;128(4):772-780.
Rengel, K. F., Hayhurst, C. J., Pandharipande, P. P., & Hughes, C. G. (2019). Long-term Cognitive and Functional Impairments After Critical Illness. Anesthesia and Analgesia, 128(4), 772-780. https://doi.org/10.1213/ANE.0000000000004066
Rengel KF, et al. Long-term Cognitive and Functional Impairments After Critical Illness. Anesth Analg. 2019;128(4):772-780. PubMed PMID: 30883422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term Cognitive and Functional Impairments After Critical Illness. AU - Rengel,Kimberly F, AU - Hayhurst,Christina J, AU - Pandharipande,Pratik P, AU - Hughes,Christopher G, PY - 2019/3/19/entrez PY - 2019/3/19/pubmed PY - 2019/12/31/medline SP - 772 EP - 780 JF - Anesthesia and analgesia JO - Anesth Analg VL - 128 IS - 4 N2 - As critical illness survivorship increases, patients and health care providers are faced with management of long-term sequelae including cognitive and functional impairment. Longitudinal studies have demonstrated impairments persisting at least 1-5 years after hospitalization for critical illness. Cognitive domains impacted include memory, attention, and processing speed. Functional impairments include physical weakness, reduced endurance, and dependence on others for basic tasks of daily living such as bathing or feeding. In characterizing the trajectory of long-term recovery, multiple risk factors have been identified for subsequent impairment, including increased severity of illness and severe sepsis, prolonged mechanical ventilation, and delirium. Preadmission status including frailty, high level of preexisting comorbidities, and baseline cognitive dysfunction are also associated with impairment after critical illness. Development of cognitive and functional impairment is likely multifactorial, and multiple mechanistic theories have been proposed. Neuroinflammation, disruption of the blood-brain barrier, and structural alterations in the brain have all been observed in patients with long-term cognitive dysfunction. Systemic inflammation has also been associated with alterations in muscle integrity and function, which is associated with intensive care unit-acquired weakness and prolonged functional impairment. Efforts to ease the burden of long-term impairments include prevention strategies and rehabilitation interventions after discharge. Delirium is a well-established risk factor for long-term cognitive dysfunction, and using delirium-prevention strategies may be important for cognitive protection. Current evidence favors minimizing overall sedation exposure, careful selection of sedation agents including avoidance of benzodiazepines, and targeted sedation goals to avoid oversedation. Daily awakening and spontaneous breathing trials and early mobilization have shown benefit in both cognitive and functional outcomes. Multifactorial prevention bundles are useful tools in improving care provided to patients in the intensive care unit. Data regarding cognitive rehabilitation are limited, while studies on functional rehabilitation have conflicting results. Continued investigation and implementation of prevention strategies and rehabilitation interventions will hopefully improve the quality of life for the ever-increasing population of critical illness survivors. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/30883422/Long_term_Cognitive_and_Functional_Impairments_After_Critical_Illness_ L2 - https://doi.org/10.1213/ANE.0000000000004066 DB - PRIME DP - Unbound Medicine ER -