Medical and Economic Implications of Cognitive and Psychiatric Disability of Survivorship

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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 10 Hopkins RO, Jackson JC. Long-term neurocognitive function after critical illness. Chest 2006; 130 (3) 869-878
• 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
• 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
• 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
• 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
• 15 Bigler ED. Quantitative magnetic resonance imaging in traumatic brain injury. J Head Trauma Rehabil 2001; 16 (2) 117-134
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 26 Elenkov IJ, Iezzoni DG, Daly A, Harris AG, Chrousos GP. Cytokine dysregulation, inflammation and well-being. Neuroimmunomodulation 2005; 12 (5) 255-269
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 35 Szokol JW, Vender JS. Anxiety, delirium, and pain in the intensive care unit. Crit Care Clin 2001; 17 (4) 821-842
• 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
• 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
• 38 McCartney JR, Boland RJ. Anxiety and delirium in the intensive care unit. Crit Care Clin 1994; 10 (4) 673-680
• 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
• 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
• 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
• 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
• 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
• 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
• 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]
• 46 Weinert C, Meller W. Epidemiology of depression and antidepressant therapy after acute respiratory failure. Psychosomatics 2006; 47 (5) 399-407
• 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
• 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
• 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
• 50 Rattray JE, Johnston M, Wildsmith JA. Predictors of emotional outcomes of intensive care. Anaesthesia 2005; 60 (11) 1085-1092
• 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
• 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
• 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
• 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
• 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
• 56 Strain LA, Blandford AA, Mitchell LA, Hawranik PG. Cognitively impaired older adults: risk profiles for institutionalization. Int Psychogeriatr 2003; 15 (4) 351-366
• 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
• 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
• 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
• 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
• 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
• 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
• 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