Cognitive Impairment in ICU Survivors: A Systematic Review of Risk Factors and Long-Term Sequelae
CCCF ePoster library. Lalli R. Nov 9, 2018; 233433
Raj Lalli
Raj Lalli
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Abstract
Rate & Comment (0)

Introduction

Cognitive impairment is prevalent in ICU survivors (1). Developing preventative and rehabilitative strategies requires an understanding of the risk factors for and consequences of cognitive impairment in ICU survivors.

 

Objectives

The purpose of this systematic review was two-fold: (1) to create a comprehensive compendium of all pre-morbid, illness- and ICU-acquired risk factors associated with cognitive impairment in ICU survivors and (2) to identify associated sequelae of cognitive impairment in ICU survivors.

 

Methods

A clinical librarian conducted a systematic search of OVID Medline, EMBASE and PsycINFO for potentially relevant, English-language articles. Two reviewers screened titles and abstracts independently and reviewed full-text to identify original articles that reported at least one potential risk factor and/or consequence of cognitive impairment in adult ICU survivors. We excluded studies that exclusively assessed cognition in cardiac arrest or acute neurological injury survivors.

 

Results

We screened 3351 titles and abstracts and identified 62 relevant studies. Forty studies reported risk factors of cognitive dysfunction, 12 reported long-term consequences, and 10 reported both.

 

A compendium of all risk factors and consequences identified and their frequencies was developed (Figure 1). Fourteen of 18 studies reported that age was not associated with cognitive dysfunction. Sex showed no association with cognitive dysfunction. There was conflicting data on whether a lower level of education or greater medical comorbidities increased the risk of cognitive dysfunction. Nine of 13 studies found that ICU delirium was associated with cognitive impairment.

 

Amongst illness-related risk factors, the majority of studies reported that illness severity and ICU or hospital length-of-stay were not associated with cognitive impairment. Among ICU-acquired risk factors, pharmacological agents explored included use of sedatives, benzodiazepines, propofol, opioids and steroids. Among these, only benzodiazepine dose was found to be a risk factor. Mechanical ventilation was not associated with cognitive dysfunction.

 

Studies where the consequences of post-ICU cognitive dysfunction were explored revealed conflicting results. Six of 10 studies reported an association with long-term depressive symptoms, 4 of 6 studies reported an association with long-term anxiety, and 4 of 5 studies reported an association with worse mental health-related quality of life.

 

Conclusion

This review provides a systematic summary of all premorbid, illness-related, and ICU-acquired factors associated with cognitive dysfunction in ICU survivors. Establishing an inventory of the risk factors and consequences of ICU-related cognitive dysfunction empowers clinicians to identify at-risk patients and establish appropriate preventative and rehabilitative interventions.

 


    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.


Save Settings