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Long-term Cognitive and Functional Impairments After Critical Illness
Kimberly F Rengel1, Christina J Hayhurst, Pratik P Pandharipande
1From the Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
Anesthesia and Analgesia
|March 19, 2019
Summary
Critical illness survivors often face lasting cognitive and functional impairments. Early interventions like delirium prevention and mobilization can improve recovery and quality of life for these patients.
Area of Science:
- Critical care medicine
- Neuroscience
- Rehabilitation medicine
Background:
- Increasing survival from critical illness leads to a growing population of patients experiencing long-term cognitive and functional impairments.
- These impairments, including memory, attention, processing speed, and physical weakness, can persist for years after hospitalization.
- Risk factors include illness severity, sepsis, mechanical ventilation, delirium, frailty, comorbidities, and pre-existing cognitive issues.
Purpose of the Study:
- To review the long-term sequelae of critical illness, focusing on cognitive and functional impairments.
- To identify risk factors associated with these long-term deficits.
- To discuss potential prevention strategies and rehabilitation interventions.
Main Methods:
- Review of longitudinal studies and existing literature on critical illness survivorship.
- Analysis of identified risk factors and proposed mechanistic theories (e.g., neuroinflammation, blood-brain barrier disruption, systemic inflammation).
- Evaluation of current evidence for prevention strategies (delirium prevention, sedation management, early mobilization) and rehabilitation interventions.
Main Results:
- Longitudinal studies confirm persistent cognitive and functional deficits 1-5 years post-critical illness.
- Severity of illness, mechanical ventilation duration, delirium, and pre-admission status are key risk factors.
- Delirium prevention, minimized sedation, daily awakening, spontaneous breathing trials, and early mobilization show promise for improving outcomes.
- Cognitive rehabilitation data is limited; functional rehabilitation results are conflicting.
Conclusions:
- Long-term cognitive and functional impairments are significant challenges for critical illness survivors.
- Multifactorial prevention strategies, particularly delirium prevention and early mobilization, are crucial for mitigating these deficits.
- Further research into effective rehabilitation interventions is needed to enhance survivors' quality of life.
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