Introduction: Critical care survivors sustain a variety of sequelae after intensive care medicine (ICM) admission, and the Coronavirus Disease 2019 (COVID-19) pandemic has added further challenges. Specifically, ICM memories play a significant role, and delusional memories are associated with poor outcomes post-discharge including a delayed return to work and sleep problems. Deep sedation has been associated with a greater risk of perceiving delusional memories, bringing a move toward lighter sedation. However, there are limited reports on post-ICM memories in COVID-19, and influence of deep sedation has not been fully defined. Therefore, we aimed to evaluate ICM-memory recall in COVID-19 survivors and their relation with deep sedation. Materials/Methods: Adult COVID-19 ICM survivors admitted to a Portuguese University Hospital between October 2020 and April 2021 (second/third “waves”) were evaluated 1 to 2 months post-discharge using “ICU Memory Tool,” to assess real, emotional, and delusional memories. Results: The study included 132 patients (67% male; median age = 62 years, Acute Physiology and Chronic Health Evaluation [APACHE]-II = 15, Simplified Acute Physiology Score [SAPS]-II = 35, ICM stay = 9 days). Approximately 42% received deep sedation (median duration = 19 days). Most participants reported real (87%) and emotional (77%) recalls, with lesser delusional memories (36.4%). Deeply sedated patients reported significantly fewer real memories (78.6% vs 93.4%, P = .012) and increased delusional memories (60.7% vs 18.4%, P < .001), with no difference in emotional memories (75% vs 80.4%, P = .468). In multivariate analysis, deep sedation had a significant, independent association with delusional memories, increasing their likelihood by a factor of approximately 6 (OR = 6.274; 95% confidence interval = 1.165-33.773, P = .032), without influencing real ( P = .545) or emotional ( P = .133) memories. Conclusions: This study contributes to a better understanding of the potential adverse effects of deep sedation on ICM memories in critical COVID-19 survivors, indicating a significant, independent association with the incidence of delusional recalls. Although further studies are needed to support these findings, they suggest that strategies targeted to minimize sedation should be favored, aiming to improve long-term recovery.
Background Studies have pointed towards the presence of neuropsychiatric sequelae after COVID‐19 infection, yet in the midst of the biggest health threat of this generation there are relatively few long‐term studies which have endeavored to identify such complications, known to have a negative impact on quality of life. In this context, this study aims to identify cognitive impairment (CI) and depressive symptoms in severe COVID‐19 elderly survivors, 1‐year after hospital discharge and also to analyse the association between CI and depressive symptoms. Method This study is part of the longitudinal MAPA project still ongoing at a University Hospital in Porto, Portugal. Patients with >60 y.o., admitted into Intensive Care Medicine Department (ICMD), due to COVID‐19 (1st wave), were included. Exclusion criteria were: ICMD length of stay ≤24h, terminal illness, major auditory loss or inability to communicate at the follow‐up assessment. Participants were evaluated 1‐year after hospital discharge, with a research protocol, which includes Patient Health Questionnaire (PHQ‐9; depressive symptoms) and Six Item Cognitive Impairment Test (6CIT; CI). Result Thirty‐eight patients were included (median age = 71years). Mostly were male (66%), married (66%) and with low education (58% = 0‐4years). About 53% had previous psychiatric history (none had clinical registry of CI or dementia). Most patients (71%) needed deep sedation and invasive mechanical ventilation (71%). CI and depressive symptoms were observed in 18.4% of the sample, for both. Patients with depression had more CI (42.9%vs12.9%), however this difference was not statistically significant. Conclusion These findings showed that an important proportion of severe COVID‐19 elderly survivors suffers from depressive symptoms and CI, 1‐year post‐discharge, which are in line with other studies. These results underline the need to better clarify the long‐term relationship between depression and CI in severe COVID‐19 survivors.
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