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Name of Media:

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

Author(s):

Amra Sakusic, MD; John C. O’Horo, MD, MPH; Mikhail Dziadzko, MD, PhD;Dziadzko Volha, MD; Rashid Ali, MD; Tarun D. Singh, MBBS; Rahul Kashyap, MBBS;Ann M. Farrell, MLS; John D. Fryer, PhD; Ronald Petersen, MD, PhD;Ognjen Gajic, MD, MSc; and Alejandro A. Rabinstein, MD

Publisher or Source:

Mayo Clinic Proceedings

Type of Media:

Medical Journal

Media Originally for:

Critical Care Physicians

Country of Origin:

United States of America (the)

Primary Focus of Media:

Pre-Use of PICS Designation

COVID-19 Related:

No

Description:

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

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