Two-Year Cognitive, Emotional, and Quality-of-Life Outcomes in Acute Respiratory Distress Syndrome

Hopkins, Ramona O.; Weaver, Lindell K.; Collingridge, David; Parkinson, R. Bruce; Chan, Karen J.; Orme, James F.

doi:10.1164/rccm.200406-763oc

Cited by 680 publications

(518 citation statements)

References 59 publications

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“…Risk factors for depression at 1 year are alcohol dependence, female gender and younger age; risk factors for developing anxiety are lower Pa o 2 /Fi o 2 ratio and duration of mechanical ventilation 33. Cognitive impairment with reduced memory, attention and task execution is also common 34. Such morbidity has a significant economic burden and the development of physical and psychological rehabilitation strategies are important to improve outcome in ARDS/ALI survivors.…”

Section: Epidemiologymentioning

confidence: 99%

Acute respiratory distress syndrome and acute lung injury

Dushianthan

Grocott

Postle

et al. 2011

Postgraduate Medical Journal

262

187

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Acute respiratory distress syndrome (ARDS) is a life threatening respiratory failure due to lung injury from a variety of precipitants. Pathologically ARDS is characterised by diffuse alveolar damage, alveolar capillary leakage, and protein rich pulmonary oedema leading to the clinical manifestation of poor lung compliance, severe hypoxaemia, and bilateral infiltrates on chest radiograph. Several aetiological factors associated with the development of ARDS are identified with sepsis, pneumonia, and trauma with multiple transfusions accounting for most cases. Despite

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Section: Epidemiologymentioning

confidence: 99%

Acute respiratory distress syndrome and acute lung injury

Dushianthan

Grocott

Postle

et al. 2011

Postgraduate Medical Journal

262

187

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“…While low V T strategies have been embraced, recent work indicates that survival from ARDS may be complicated by neurocognitive decline correlated to hypoxaemic periods during mechanical ventilation [23,24]. Richard et al [25] advocate recruitment manoeuvres or increasing PEEP as alternative strategies to counteract low V T derecruitment.…”

Section: Discussionmentioning

confidence: 99%

Mathematical modelling to centre low tidal volumes following acute lung injury: A study with biologically variable ventilation

et al. 2005

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Background: With biologically variable ventilation [BVV -using a computer-controller to add breath-tobreath variability to respiratory frequency (f) and tidal volume (V T )] gas exchange and respiratory mechanics were compared using the ARDSNet low V T algorithm (Control) versus an approach using mathematical modelling to individually optimise V T at the point of maximal compliance change on the convex portion of the inspiratory pressure-volume (P-V) curve (Experimental).

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“…Studies of ARDS survivors suggest that a combination of acute hypoxia, hypoperfusion, and hyperglycemia plays an important role in the long-term cognitive sequelae of critical illness [3,58,59]. However, it has been difficult to demonstrate a clear relationship, given the lengthy interval between stimulus and effect and the great number of additional contributing variables that can obscure downstream effects.…”

Section: Occult Diffuse Brain Injurymentioning

confidence: 99%

“…However, it has been difficult to demonstrate a clear relationship, given the lengthy interval between stimulus and effect and the great number of additional contributing variables that can obscure downstream effects. Among ARDS survivors, Hopkins and colleagues showed that the degree of CD at 1 year is significantly correlated with the durations of hypoxia [58] and mean arterial blood pressure less than 50 mmHg during the ICU stay [3]. In animals, hyperglycemia markedly enhances hypoxic-ischemic brain damage due to increased brain edema and disrupted cerebral metabolism [60].…”

Section: Occult Diffuse Brain Injurymentioning

confidence: 99%

“…As greater numbers of patients survive intensive care, it is becoming increasingly evident that quality of life after critical illness is not always optimal. For instance, nearly half of ARDS survivors manifest neurocognitive sequelae 2 years after their illness, falling to below the 6th percentile of the normal distribution of cognitive function [3]. Considering that 89% of Americans would not wish to be kept alive if they had severe, irreversible neurologic damage [4], these findings are quite concerning.…”

Section: Introductionmentioning

confidence: 99%

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Milbrandt

Angus

2006

Crit Care

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Cognitive dysfunction is common in critically ill patients, not only during the acute illness but also long after its resolution. A large number of pathophysiologic mechanisms are thought to underlie critical illness-associated cognitive dysfunction, including neurotransmitter abnormalities and occult diffuse brain injury. Markers that could be used to evaluate the influence of specific mechanisms in individual patients include serum anticholinergic activity, certain brain proteins, and tissue sodium concentration determination via high-resolution three-dimensional magnetic resonance imaging. Although recent therapeutic advances in this area are exciting, they are still too immature to influence patient care. Additional research is needed if we are to understand better the relative contributions of specific mechanisms to the development of critical illnessassociated cognitive dysfunction and to determine whether these mechanisms might be amenable to treatment or prevention. IntroductionSince its advent more than 40 years ago, the specialty of critical care has made remarkable advances in the care of severely ill patients. Mortality rates for many commonly encountered critical illnesses such as severe sepsis [1] and acute respiratory distress syndrome (ARDS) [2] have declined sharply over the past 2 decades. As greater numbers of patients survive intensive care, it is becoming increasingly evident that quality of life after critical illness is not always optimal. For instance, nearly half of ARDS survivors manifest neurocognitive sequelae 2 years after their illness, falling to below the 6th percentile of the normal distribution of cognitive function [3]. Considering that 89% of Americans would not wish to be kept alive if they had severe, irreversible neurologic damage [4], these findings are quite concerning.Cognitive dysfunction (CD) is quite common in critically ill patients, not only during the acute illness but also long after the acute illness resolves [5]. Delirium, a form of acute CD that manifests as a fluctuating change in mental status, with inattention and altered level of consciousness, occurs in as many as 80% of mechanically ventilated intensive care unit (ICU) patients [6]. Most clinicians consider ICU delirium to be expected, iatrogenic, and without consequence. However, recent data associate delirium with increased duration of mechanical ventilation and ICU stay [7], worse 6-month mortality [8], and higher costs [9]. Chronically, critical illnessassociated CD manifests as difficulties with memory, attention, executive function, mental processing speed, spatial abilities, and general intelligence. Interestingly, patients who develop acute CD often go on to develop chronic CD after hospital discharge [10][11][12][13], suggesting that the two entities may share a common etiology.Although there are clearly defined risk factors for critical illness-associated CD, there is little understanding of the underlying pathophysiology. The precise mechanisms are unknown and there are likely to be mul...

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Two-Year Cognitive, Emotional, and Quality-of-Life Outcomes in Acute Respiratory Distress Syndrome

Cited by 680 publications

References 59 publications

Acute respiratory distress syndrome and acute lung injury

Acute respiratory distress syndrome and acute lung injury

Mathematical modelling to centre low tidal volumes following acute lung injury: A study with biologically variable ventilation

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