Hello my Friends:

After the incredible yesterday football match (thanks to Barcelona supporters for fair play), I would like to share another article.

This one has been revised by Dr. Björn Weiss in ESICM.

 
Pandharipande and colleagues revealed that every fourth critically ill patient has a long-term cognitive impairment comparable to mild Alzheimer’s disease one year after discharge. Their article was published in New England Journal of Medicine (NEJM). 


They addressed the question of whether patients of a heterogeneous ICU-population would suffer from cognitive impairment after critical illness at 3 and 12 months after discharge. Additionally, they tested the hypothesis that the duration of delirium and higher doses of sedatives and analgesics would be associated with long-term cognitive outcome.

The investigators conducted a prospective multi-centre cohort study (BRAIN-ICU) and included a broad spectrum of medical and surgical critically ill adults. Long-term cognitive outcome was examined using the “Repeatable Battery for the Assessment of Neuropsychological Status” (RBANS), executive function using the “Trail Making Test, Part B” (Trails B), and delirium using the “Confusion Assessment Method for the ICU” (CAM-ICU).

At 3 months after discharge, 40% of the study participants had RBANS results that were worse than those from patients suffering from moderate traumatic brain injury. Moreover, a quarter had scores that are similar to those of patients suffering from a mild form of Alzheimer’s disease. These impairments were still detectable one year after hospital discharge in most of the patients (34% vs. 24%). The long-term cognitive impairment could be shown in all age groups, not only in elderly people. In addition, the investigators were able to show that an increased duration of ICU-delirium was an independent risk factor for a cognitive impairment after 3 and 12 months.

The results of the BRAIN-ICU study should alert us and lead to a higher awareness regarding patients’ cognitive performance. There are several measures to prevent delirium as well as effective symptom-oriented treatments. As delirium is associated with more complications and a higher mortality, there is no doubt that these measures should be taken. Ultimately, there is a high demand for cognitive rehabilitation and additional support after ICU-discharge.

Clinical implications of this trial:

•  A significant number of survivors from critical illness suffer from long-term cognitive impairment.
•  Patients of all age groups are vulnerable to long-term cognitive impairment.
•  Patients should have access to cognitive rehabilitation and the in- and outpatient sector should be aware of the impact of critical illness on cognitive functions.
•  Delirium should be detected and treated according to guideline-recommendations to avoid long-term cognitive ramifications.
References:
1. Hopkins, R. O. et al. Am J Respir Crit Care Med 160, 50-56 (1999).
2. Pandharipande, P. P. et al. N Engl J Med 369, 1306-1316 (2013).
3. Barr, J. et al. Crit Care Med 41, 263-306, (2013).
4. Martin, J. et al. Ger Med Sci 8, Doc02 (2010).