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Rationale: Cognitive and psychiatric morbidity is common and potentially modifiable after acute lung injury (ALI). However, practical measures of neuropsychological function for use in multicenter trials are lacking. Objectives: To determine whether a validated telephone-based neuropsychological test battery is feasible in a multicenter trial. To determine the frequency and risk factors for long-term neuropsychological impairment. Methods: As an adjunct study to the Acute Respiratory Distress Syndrome Clinical Trials Network Fluid and Catheter Treatment Trial, we assessed neuropsychological function at 2 and 12 months post-hospital discharge. Measurements and Main Results: Of 406 eligible survivors, we approached 261 to participate and 213 consented. We tested 122 subjects at least once, including 102 subjects at 12 months. Memory, verbal fluency, and executive function were impaired in 13% (12 of 92), 16% (15 of 96), and 49% (37 of 76) of long-term survivors. Long-term cognitive impairment was present in 41 of the 75 (55%) survivors who completed cognitive testing. Depression, post-traumatic stress disorder, or anxiety was present in 36% (37 of 102), 39% (40 of 102), and 62% (63 of 102) of long-term survivors. Enrollment in a conservative fluid-management strategy (P ¼ 0.005) was associated with cognitive impairment and lower partial pressure of arterial oxygen during the trial was associated with cognitive (P ¼ 0.02) and psychiatric impairment (P ¼ 0.02).Conclusions: Neuropsychological function can be assessed by telephone in a multicenter trial. Long-term neuropsychological impairment is common in survivors of ALI. Hypoxemia is a risk factor for long-term neuropsychological impairment. Fluid management strategy is a potential risk factor for long-term cognitive impairment; however, given the select population studied and an unclear mechanism, this finding requires confirmation.Keywords: acute respiratory distress syndrome; acute lung injury; cognitive function; critical illnessIn the United States, approximately 200,000 patients develop acute lung injury (ALI) each year (1). Advances in ALI management have decreased mortality to 25-40% (1-4), resulting in an expanding population of survivors who have been ravaged by their acute illness. Survivorship, it has been put forth, will be the defining challenge of modern day critical care (5). Beyond the physical ailments that survivors endure, neuropsychological impairment is increasingly recognized as a prevalent, important, and potentially modifiable outcome among survivors of ALI (6-21) and critical illness in general (22-29). Traditionally, neuropsychological (cognitive and psychiatric) function is assessed in-person by an expert, a constraint that has limited the ability to study the frequency and determinants of neuropsychological impairment in critically ill populations and Correspondence and requests for reprints should be addressed to Mark E. Mikkelsen, M.D., M.S.C.E., Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University o...

In this preliminary report of a retrospective case series, persistent cognitive, vestibular, and oculomotor dysfunction, as well as sleep impairment and headaches, were observed among US government personnel in Havana, Cuba, associated with reports of directional audible and/or sensory phenomena of unclear origin. These individuals appeared to have sustained injury to widespread brain networks without an associated history of head trauma.

Significant cognitive abnormalities may be present in long-term ARDS survivors, particularly in memory and executive function. Impairments in cognition appear to be associated with significantly increased anxiety and worse quality of life.

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