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Semin Respir Crit Care Med 2012; 33(04): 348-356
DOI: 10.1055/s-0032-1321984
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Medical and Economic Implications of Cognitive and Psychiatric Disability of Survivorship

Ramona O. Hopkins
1   Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah
2   Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah
,
Timothy D. Girard
3   Division of Allergy, Pulmonary, and Critical Care Medicine, Center for Health Services Research, and Center for Quality Aging in the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
4   Geriatric Research, Education, and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee
› Author Affiliations
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Publication History

Publication Date:
08 August 2012 (online)

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Abstract

Current research indicates that the majority of survivors of critical illness develop post–intensive care syndrome (PICS), which includes new or worsening cognitive or psychiatric disorders that persist for months to years after critical illness. These cognitive impairments and psychiatric disorders are profound and long-lasting, adversely affecting survivors' daily functioning, ability to return to work, and quality of life, as well as altering the lives of their family members. The medical effects of cognitive and psychiatric disability after critical illness translate directly into a large economic burden. A large and growing body of intensive care unit (ICU) survivors with cognitive and psychiatric morbidities presents challenges for research and identification of best practices and interventions, both during and after the ICU, including rehabilitation to prevent or remediate long-term neurological outcomes.

Keywords

critical care - cognitive impairments - depression - anxiety - posttraumatic stress disorder - ICU
 

  • References

  • 1 Iwashyna TJ. Survivorship will be the defining challenge of critical care in the 21st century. Ann Intern Med 2010; 153 (3) 204-205
    CrossrefPubMedGoogle Scholar
  • 2 Needham DM, Davidson J, Cohen H , et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med 2012; 40 (2) 502-509
    CrossrefPubMedGoogle Scholar
  • 3 Jackson JC, Hart RP, Gordon SM , et al. Six-month neuropsychological outcome of medical intensive care unit patients. Crit Care Med 2003; 31 (4) 1226-1234
    CrossrefPubMedGoogle Scholar
  • 4 Hopkins RO, Weaver LK, Collingridge D, Parkinson RB, Chan KJ, Orme Jr JF. Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med 2005; 171 (4) 340-347
    CrossrefPubMedGoogle Scholar
  • 5 Rothenhäusler HB, Ehrentraut S, Stoll C, Schelling G, Kapfhammer HP. The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: results of an exploratory study. Gen Hosp Psychiatry 2001; 23 (2) 90-96
    CrossrefPubMedGoogle Scholar
  • 6 Jackson JC, Girard TD, Gordon SM , et al. Long-term cognitive and psychological outcomes in the awakening and breathing controlled trial. Am J Respir Crit Care Med 2010; 182 (2) 183-191
    CrossrefPubMedGoogle Scholar
  • 7 Jackson JC, Obremskey W, Bauer R , et al. Long-term cognitive, emotional, and functional outcomes in trauma intensive care unit survivors without intracranial hemorrhage. J Trauma 2007; 62 (1) 80-88
    CrossrefPubMedGoogle Scholar
  • 8 Jackson JC, Archer KR, Bauer R , et al. A prospective investigation of long-term cognitive impairment and psychological distress in moderately versus severely injured trauma intensive care unit survivors without intracranial hemorrhage. J Trauma 2011; 71 (4) 860-866
    CrossrefPubMedGoogle Scholar
  • 9 Unroe M, Kahn JM, Carson SS , et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med 2010; 153 (3) 167-175
    CrossrefPubMedGoogle Scholar
  • 10 Hopkins RO, Jackson JC. Long-term neurocognitive function after critical illness. Chest 2006; 130 (3) 869-878
    CrossrefPubMedGoogle Scholar
  • 11 Adhikari NK, Tansey CM, McAndrews MP , et al. Self-reported depressive symptoms and memory complaints in survivors five years after ARDS. Chest 2011; 140 (6) 1484-1493
    CrossrefPubMedGoogle Scholar
  • 12 Ehlenbach WJ, Hough CL, Crane PK , et al. Association between acute care and critical illness hospitalization and cognitive function in older adults. JAMA 2010; 303 (8) 763-770
    CrossrefPubMedGoogle Scholar
  • 13 Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010; 304 (16) 1787-1794
    CrossrefPubMedGoogle Scholar
  • 14 Hopkins RO, Tate DF, Bigler ED. Anoxic versus traumatic brain injury: amount of tissue loss, not etiology, alters cognitive and emotional function. Neuropsychology 2005; 19 (2) 233-242
    CrossrefPubMedGoogle Scholar
  • 15 Bigler ED. Quantitative magnetic resonance imaging in traumatic brain injury. J Head Trauma Rehabil 2001; 16 (2) 117-134
    CrossrefPubMedGoogle Scholar
  • 16 Hopkins RO, Gale SD, Johnson SC , et al. Severe anoxia with and without concomitant brain atrophy and neuropsychological impairments. J Int Neuropsychol Soc 1995; 1 (5) 501-509
    CrossrefPubMedGoogle Scholar
  • 17 Johnson SC, Bigler ED, Burr RB, Blatter DD. White matter atrophy, ventricular dilation, and intellectual functioning following traumatic brain injury. Neuropsychology 1994; 8 (3) 307-315
    CrossrefPubMedGoogle Scholar
  • 18 Bigler ED. Neuroimaging correlates of functional outcome. In: Zasler ND, Katz DI, Zafonte RD, eds. Brain Injury and Medicine: Principles and Practice. New York: Demos; 2007: 201-224
    Google Scholar
  • 19 Hopkins RO, Gale SD, Weaver LK. Brain atrophy and cognitive impairment in survivors of Acute Respiratory Distress Syndrome. Brain Inj 2006; 20 (3) 263-271
    CrossrefPubMedGoogle Scholar
  • 20 Suchyta MR, Jephson A, Hopkins RO. Neurologic changes during critical illness: brain imaging findings and neurobehavioral outcomes. Brain Imaging Behav 2010; 4 (1) 22-34
    CrossrefPubMedGoogle Scholar
  • 21 Sharshar T, Carlier R, Bernard F , et al. Brain lesions in septic shock: a magnetic resonance imaging study. Intensive Care Med 2007; 33 (5) 798-806
    CrossrefPubMedGoogle Scholar
  • 22 Morandi A, Gunther ML, Vasilevskis EE , et al. Neuroimaging in delirious intensive care unit patients: a preliminary case series report. Psychiatry (Edgmont) 2010; 7 (9) 28-33
    PubMedGoogle Scholar
  • 23 Girard TD, Jackson JC, Pandharipande PP , et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 2010; 38 (7) 1513-1520
    CrossrefPubMedGoogle Scholar
  • 24 Hopkins RO, Suchyta MR, Snow GL, Jephson A, Weaver LK, Orme JF. Blood glucose dysregulation and cognitive outcome in ARDS survivors. Brain Inj 2010; 24 (12) 1478-1484
    CrossrefPubMedGoogle Scholar
  • 25 Duning T, van den Heuvel I, Dickmann A , et al. Hypoglycemia aggravates critical illness-induced neurocognitive dysfunction. Diabetes Care 2010; 33 (3) 639-644
    CrossrefPubMedGoogle Scholar
  • 26 Elenkov IJ, Iezzoni DG, Daly A, Harris AG, Chrousos GP. Cytokine dysregulation, inflammation and well-being. Neuroimmunomodulation 2005; 12 (5) 255-269
    CrossrefPubMedGoogle Scholar
  • 27 Capuron L, Lamarque D, Dantzer R, Goodall G. Attentional and mnemonic deficits associated with infectious disease in humans. Psychol Med 1999; 29 (2) 291-297
    CrossrefPubMedGoogle Scholar
  • 28 Reichenberg A, Yirmiya R, Schuld A , et al. Cytokine-associated emotional and cognitive disturbances in humans. Arch Gen Psychiatry 2001; 58 (5) 445-452
    CrossrefPubMedGoogle Scholar
  • 29 Rosene KA, Copass MK, Kastner LS, Nolan CM, Eschenbach DA. Persistent neuropsychological sequelae of toxic shock syndrome. Ann Intern Med 1982; 96 (6 Pt 2) 865-870
    CrossrefPubMedGoogle Scholar
  • 30 Angus DC, Musthafa AA, Clermont G , et al. Quality-adjusted survival in the first year after the acute respiratory distress syndrome. Am J Respir Crit Care Med 2001; 163 (6) 1389-1394
    CrossrefPubMedGoogle Scholar
  • 31 Herridge MS, Cheung AM, Tansey CM , et al; Canadian Critical Care Trials Group. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 2003; 348 (8) 683-693
    CrossrefPubMedGoogle Scholar
  • 32 Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson-LOHR V. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 1999; 160 (1) 50-56
    CrossrefPubMedGoogle Scholar
  • 33 Kapfhammer HP, Rothenhäusler HB, Krauseneck T, Stoll C, Schelling G. Posttraumatic stress disorder and health-related quality of life in long-term survivors of acute respiratory distress syndrome. Am J Psychiatry 2004; 161 (1) 45-52
    CrossrefPubMedGoogle Scholar
  • 34 Orme Jr JF, Romney JS, Hopkins RO , et al. Pulmonary function and health-related quality of life in survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med 2003; 167 (5) 690-694
    CrossrefPubMedGoogle Scholar
  • 35 Szokol JW, Vender JS. Anxiety, delirium, and pain in the intensive care unit. Crit Care Clin 2001; 17 (4) 821-842
    CrossrefPubMedGoogle Scholar
  • 36 Weinert CR, Gross CR, Kangas JR, Bury CL, Marinelli WA. Health-related quality of life after acute lung injury. Am J Respir Crit Care Med 1997; 156 (4 Pt 1) 1120-1128
    CrossrefPubMedGoogle Scholar
  • 37 Adhikari NK, McAndrews MP, Tansey CM , et al. Self-reported symptoms of depression and memory dysfunction in survivors of ARDS. Chest 2009; 135 (3) 678-687
    CrossrefPubMedGoogle Scholar
  • 38 McCartney JR, Boland RJ. Anxiety and delirium in the intensive care unit. Crit Care Clin 1994; 10 (4) 673-680
    PubMedGoogle Scholar
  • 39 Mikkelsen ME, Shull WH, Biester RC , et al. Cognitive, mood and quality of life impairments in a select population of ARDS survivors. Respirology 2009; 14 (1) 76-82
    CrossrefPubMedGoogle Scholar
  • 40 Davydow DS, Gifford JM, Desai SV, Bienvenu OJ, Needham DM. Depression in general intensive care unit survivors: a systematic review. Intensive Care Med 2009; 35 (5) 796-809
    CrossrefPubMedGoogle Scholar
  • 41 Schelling G, Stoll C, Haller M , et al. Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 1998; 26 (4) 651-659
    CrossrefPubMedGoogle Scholar
  • 42 Girard TD, Shintani AK, Jackson JC , et al. Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study. Crit Care 2007; 11 (1) R28
    CrossrefPubMedGoogle Scholar
  • 43 Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry 2008; 30 (5) 421-434
    CrossrefPubMedGoogle Scholar
  • 44 Granja C, Teixeira-Pinto A, Costa-Pereira A. Quality of life after intensive care—evaluation with EQ-5D questionnaire. Intensive Care Med 2002; 28 (7) 898-907
    CrossrefPubMedGoogle Scholar
  • 45 Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62 (6) 617-627 . Erratum in Arch Gen Psychiatry 2005;62(7):709 [Merikangas, Kathleen R added]
    Google Scholar
  • 46 Weinert C, Meller W. Epidemiology of depression and antidepressant therapy after acute respiratory failure. Psychosomatics 2006; 47 (5) 399-407
    CrossrefPubMedGoogle Scholar
  • 47 Jones C, Bäckman C, Capuzzo M, Flaatten H, Rylander C, Griffiths RD. Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Med 2007; 33 (6) 978-985
    CrossrefPubMedGoogle Scholar
  • 48 Samuelson KA, Lundberg D, Fridlund B. Stressful memories and psychological distress in adult mechanically ventilated intensive care patients: a 2-month follow-up study. Acta Anaesthesiol Scand 2007; 51 (6) 671-678
    CrossrefPubMedGoogle Scholar
  • 49 Hopkins RO, Key CW, Suchyta MR, Weaver LK, Orme Jr JF. Risk factors for depression and anxiety in survivors of acute respiratory distress syndrome. Gen Hosp Psychiatry 2010; 32 (2) 147-155
    CrossrefPubMedGoogle Scholar
  • 50 Rattray JE, Johnston M, Wildsmith JA. Predictors of emotional outcomes of intensive care. Anaesthesia 2005; 60 (11) 1085-1092
    CrossrefPubMedGoogle Scholar
  • 51 Dowdy DW, Dinglas V, Mendez-Tellez PA , et al. Intensive care unit hypoglycemia predicts depression during early recovery from acute lung injury. Crit Care Med 2008; 36 (10) 2726-2733
    CrossrefPubMedGoogle Scholar
  • 52 Dowdy DW, Bienvenu OJ, Dinglas VD , et al. Are intensive care factors associated with depressive symptoms 6 months after acute lung injury?. Crit Care Med 2009; 37 (5) 1702-1707
    CrossrefPubMedGoogle Scholar
  • 53 Myhren H, Ekeberg O, Tøien K, Karlsson S, Stokland O. Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care 2010; 14 (1) R14
    CrossrefPubMedGoogle Scholar
  • 54 Kiekkas P, Theodorakopoulou G, Spyratos F, Baltopoulos GI. Psychological distress and delusional memories after critical care: a literature review. Int Nurs Rev 2010; 57 (3) 288-296
    CrossrefPubMedGoogle Scholar
  • 55 Covinsky KE, Goldman L, Cook EF , et al; SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. The impact of serious illness on patients' families. JAMA 1994; 272 (23) 1839-1844
    CrossrefPubMedGoogle Scholar
  • 56 Strain LA, Blandford AA, Mitchell LA, Hawranik PG. Cognitively impaired older adults: risk profiles for institutionalization. Int Psychogeriatr 2003; 15 (4) 351-366
    CrossrefPubMedGoogle Scholar
  • 57 Rockwood K, Brown M, Merry H, Sketris I, Fisk J ; Vascular Cognitive Impairment Investigators of the Canadian Study of Health and Aging. Societal costs of vascular cognitive impairment in older adults. Stroke 2002; 33 (6) 1605-1609
    CrossrefPubMedGoogle Scholar
  • 58 Langa KM, Chernew ME, Kabeto MU , et al. National estimates of the quantity and cost of informal caregiving for the elderly with dementia. J Gen Intern Med 2001; 16 (11) 770-778
    CrossrefPubMedGoogle Scholar
  • 59 Needham DM, Feldman DR, Kho ME. The functional costs of ICU survivorship. Collaborating to improve post-ICU disability. Am J Respir Crit Care Med 2011; 183 (8) 962-964
    CrossrefPubMedGoogle Scholar
  • 60 Vasilevskis EE, Pandharipande PP, Girard TD, Ely EW. A screening, prevention, and restoration model for saving the injured brain in intensive care unit survivors. Crit Care Med 2010; 38 (10, Suppl) S683-S691
    CrossrefPubMedGoogle Scholar
  • 61 Bienvenu OJ, Neufeld KJ. Post-traumatic stress disorder in medical settings: focus on the critically ill. Curr Psychiatry Rep 2011; 13 (1) 3-9
    CrossrefPubMedGoogle Scholar
  • 62 Jones C, Bäckman C, Capuzzo M , et al; RACHEL group. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial. Crit Care 2010; 14 (5) R168
    CrossrefPubMedGoogle Scholar
  • 63 Jackson JC, Ely EW, Morey MC , et al. Cognitive and physical rehabilitation of intensive care unit survivors: Results of the RETURN randomized controlled pilot investigation. Crit Care Med 2012; 40 (4) 1088-1097
    CrossrefPubMedGoogle Scholar