Neurocognitive Impairment in Survivors of ARDS

  • R. O. Hopkins


Critically ill, mechanically ventilated patients in the intensive care unit (ICU) consume a considerable proportion of medical resources [1]. As intensive care treatment has improved due to advances in medical technology and knowledge, more critically ill patients are surviving. Most outcome studies following intensive care treatment have focused on survival as the major ICU outcome variable. During the past two decades, other outcome variables have emerged as important measures of recovery including physical recovery, respiratory symptoms, pulmonary function, health-related quality of life (HRQL), neurocognitive function, and affect. Recent studies indicate that critically ill patients experience impaired HRQL and psychosocial impairments following treatment in the ICU [1–3]. Reports also indicate that mechanically ventilated patients reported anxiety [4] and painful or unpleasant experiences due to respiratory treatment [5]. Forty percent of ICU survivors were unable to return to work due to physical and/or psychosocial problems [6]. One limitation of most outcome research on ICU survivors is the heterogeneity of the patient groups, so outcome data for specific ICU patient populations, such as survivors of acute respiratory distress syndrome (ARDS), is limited.


Obstructive Sleep Apnea Acute Respiratory Distress Syndrome Chronic Fatigue Syndrome Obstructive Sleep Apnea Syndrome Posttraumatic Stress Disorder 
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  1. 1.
    Spicher E, White DP (1987) Outcome and function following prolonged mechanical ventilation. Arch Intern Med 147: 421–425PubMedCrossRefGoogle Scholar
  2. 2.
    Konopad E, Noseworth TW, Johnston R, Shustack A, Grace M (1995) Quality of life measures before and one year after admission to an intensive care unit. Grit Care Med 23: 1653–1659CrossRefGoogle Scholar
  3. 3.
    Tian ZM, Miranda DR (1995) Quality of life after intensive care with the sickness impact profile. Intensive Care Med 21: 422–428PubMedCrossRefGoogle Scholar
  4. 4.
    McCartney JR, Boland RJ (1994) Anxiety and delirium in the intensive care unit. Crit Care Clin 19: 673–680Google Scholar
  5. 5.
    Bergbom-Engberg I, Haljamae H (1989) Assessment of patients’ experience of discomforts during respirator therapy. Crit Care Med 17: 1068–1072PubMedCrossRefGoogle Scholar
  6. 6.
    Goldstein RL, Campion EW, Thibault GE, Mulley AG, Skinner E (1989) Functional outcomes following medical intensive care. Crit Care Med 14: 783–788CrossRefGoogle Scholar
  7. 7.
    Bernard GR, Artigas A, Brigham KL, et al (1994) The American-European consensus conference on ARDS: Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149: 818–824Google Scholar
  8. 8.
    Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138: 720–723PubMedCrossRefGoogle Scholar
  9. 9.
    Suchyta M, Clemmer T, Elliott CG, Orme JJ, Weaver L (1993) The adult respiratory distress syndrome. A report of survival and modifying factors. Chest 104: 647–648Google Scholar
  10. 10.
    Hudson LD, Milberg JA, Anardi D, Maunder RJ (1995) Clinical risks for development of acute respiratory distress syndrome. Am J Respir Crit Care Med 151: 293–301PubMedCrossRefGoogle Scholar
  11. 11.
    Thomsen GE, Morris AH (1995) Incidence of the adult respiratory distress syndrome in the state of Utah. Am J Respir Crit Care Med 152: 965–971PubMedCrossRefGoogle Scholar
  12. 12.
    Montgomery AB, Stager MA, Carrico CJ, Hudson LD (1985) Causes of mortality in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 132: 485–489PubMedGoogle Scholar
  13. 13.
    Petty TL, Ashbaugh DG (1971) The adult respiratory distress syndrome: Clinical features factors influencing prognosis, and principles of management. Chest 60: 233–239Google Scholar
  14. 14.
    Fein AM, Lippman M, Holzman H, Eliraz A, Goldberg SK (1983) The risk factors, incidence, and prognosis of the adult respiratory distress syndrome following septicemia. Chest 83: 40–42PubMedCrossRefGoogle Scholar
  15. 15.
    Milberg JA, Davis DR, Steinberg KP, Hudson LD (1995) Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983–1993. JAMA 273: 306–309PubMedCrossRefGoogle Scholar
  16. 16.
    Lee J, Turner S, Morgan CJ, Keogh BF, Evans TW (1994) Adult respiratory distress syndrome: has there been a change in outcome predictive measures? Thorax 49: 596–597PubMedCrossRefGoogle Scholar
  17. 17.
    Gondos T, Szabo K, Jokkel G, Penzes I (1991) Outcome prediction in adult respiratory distress syndrome using discriminant analysis of cardiorespiratory data. Acta Med Hug 48: 51–60Google Scholar
  18. 18.
    Moss M, Bucher B, Moore FA, Moore EE, Parsons PE (1996) The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults. JAMA 275: 50–54PubMedCrossRefGoogle Scholar
  19. 19.
    Halvey A, Sirik Z, Adam YG, Leewinsohn G (1984) Long-term evaluation of patients following the Adult Respiratory Distress Syndrome. Respir Care 29: 132–137Google Scholar
  20. 20.
    Elliott CG, Rassmusson BY, Crapo RO, Morris AH, Jensen RL (1987) Prediction of pulmonary function abnormalities after adult respiratory distress syndrome ( ARDS ). Am Rev Respir Dis 135: 634–638Google Scholar
  21. 21.
    Peters JI, Bell RC, Prihoda TJ, Harris G, Andrews C, Johansen WG (1989) Clinical determinants of abnormalities in pulmonary function in survivors of the adult respiratory distress syndrome. Am Rev Respir Dis 139: 1163–1168PubMedCrossRefGoogle Scholar
  22. 22.
    Hudson LD (1994) What happens to survivors of the adult respiratory distress syndrome? Chest 105: 26S (Abst)Google Scholar
  23. 23.
    Hopkins RO, Weaver LK, Pope D, Orme JF Jr, Bigler ED, Larson-Lohr V (1999) Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 160: 50–56PubMedCrossRefGoogle Scholar
  24. 24.
    McHugh LG, Milberg JA, Whitcomb ME, Schoene RB, Maunder RJ, Hudson LD (1994) Recovery of function in survivors of the acute respiratory distress syndrome. Am J Respir Crit Care Med 150: 90–4PubMedCrossRefGoogle Scholar
  25. 25.
    Schelling G, Stoll C, Haller M, et al (1998) Health-related quality of life and post-traumatic stress disorder in survivors of the acute respiratory distress syndrome ( ARDS ). Crit Care Med 25: 651–659Google Scholar
  26. 26.
    Wienert CR, Gross C, Kangas JR, Bury CR, Marinelli WA (1997) Health-related quality of life after acute lung injury. Am J Respir Crit Care Med 156: 1120–1128CrossRefGoogle Scholar
  27. 27.
    Davidson TA, Caldwell ES, Curtis JR, Hudson LD, Steinberg KP (1999) Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA 281: 354–360PubMedCrossRefGoogle Scholar
  28. 28.
    Hopkins RO, Larson-Lohr V, Weaver LK, Bigler ED (1998) Neuropsychological impairments following hantavirus pulmonary syndrome. J Int Neuropsychological Soc 4: 190–196CrossRefGoogle Scholar
  29. 29.
    Marquis KA, Curtis JR, Caldwell ES, et al (2000) Neuropsychologic sequelae in survivors of ARDS compared with critically ill control patients. Am J Respir Crit Care Med 16: A383 (Abst)Google Scholar
  30. 30.
    Rothenhausler HB, Ehrentraut S, Stoll C, Schelling G, Kapfhammer HP (2001) 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 23: 90–96PubMedCrossRefGoogle Scholar
  31. 31.
    Popkin MK, Andrews JE (1997) Mood disorders secondary to systemic medical conditions. Semin Clin Neuropsychiatry 2: 296–306PubMedGoogle Scholar
  32. 32.
    Jackson R, Baldwin B (1993) Detecting depression in elderly medically ill patients: the use of the Geriatric Depression Scale compared with medical and nursing observations. Age Ageing 22: 349–353PubMedCrossRefGoogle Scholar
  33. 33.
    Reynolds CF, Kupfer DJ, McEachran AB, Taska LS, Sewitch DE, Coble PA (1984) Depressive psychopathology in male sleep apneics. J Clin Psychiatry 45: 287–290PubMedGoogle Scholar
  34. 34.
    Krass I, Dyksterhuis JE, Rubin H, Patel K (1975) Correlation of psycholophysiologic variables with vocational rehabilitation outcome in patients with chronic obstructive pulmonary disease. Chest 67: 433–440CrossRefGoogle Scholar
  35. 35.
    Prigatano GP, Parsons O, Levin DC, Wright E, Hawryluk G (1983) Neuropsychological test performance in mildly hypoxemic patients with chronic obstructive pulmonary disease. J Consult Clin Psychology 51: 108–116CrossRefGoogle Scholar
  36. 36.
    Heaton RK, Grant I, McSweeny AJ, Adams KM, Petty TL (1983) Psychologic effects of continuous and nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med 143: 1941–1947PubMedCrossRefGoogle Scholar
  37. 37.
    Prigatano G, Wright D, Levin D (1984) Quality of life and its predictors in patients with mild hypoxemia and chronic obstructive pulmonary disease. Arch Intern Med 144: 16131619Google Scholar
  38. 38.
    Beutler LE, Ware JC, Karacan I, Thornby JI (1981) Differentiating psychological characteristics of patients with sleep apnea and narcolepsy. Sleep 4: 39–47PubMedGoogle Scholar
  39. 39.
    Klonoff H, Fleetham J, Raylor R, Clark C (1987) Treatment outcome of obstructive sleep apnea. J Nervous Mental Dis 175: 208–212CrossRefGoogle Scholar
  40. 40.
    Stoll C, Kapfhammer HP, Rothenhausler HB, et al (1999) Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive Care Med 25: 697–704PubMedCrossRefGoogle Scholar
  41. 41.
    Grant I, Heaton R, McSweeny A, Adams K, Timms R (1982) Neuropsychological findings in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med 142: 1470–1476PubMedCrossRefGoogle Scholar
  42. 42.
    Hopkins RO, Kesner RP, Goldstein M (1995) Memory for novel and familiar spatial and linguistic temporal distance information in hypoxic subjects. J Int Neuropsychological Soc 1: 454–468CrossRefGoogle Scholar
  43. 43.
    Kesner RP, Hopkins RO (2001) Short-term memory for duration and distance in humans: Role of the hippocampus. Neuropsychology 15: 58–68Google Scholar
  44. 44.
    Press GA, Amaral DG, Squire LR (1986) Hippocampal abnormalities in amnesic patients revealed by high-resolution magnetic resonance imaging. Nature 341: 54–57CrossRefGoogle Scholar
  45. 45.
    Findley LJ, Barth JT, Powers DC, Wilhor SC, Boyd DG, Suratt PS (1986) Cognitive impairments in patients with obstructive sleep apnea and associated hypoxemia. Chest 90: 686690Google Scholar
  46. 46.
    Bedard M, Montplaisir J, Richer F, Roulea I, Malo J (1991) Obstructive sleep apnea syndrome: Pathogenesis of neuropsychological deficits. J Clin Exp Neuropsychiatry 13: 950–964Google Scholar
  47. 47.
    Hopkins RO, Gale SD, Johnson SC, Anderson CV, Bigler ED, Blatter DD (1995) Severe anoxia with and without concomitant brain atrophy and neuropsychological impairments. J Int Neuropsychology Soc 1: 501–509CrossRefGoogle Scholar
  48. 48.
    Bone RC, Grodzin CJ, Balk RA (1997) Sepsis: a new hypothesis for pathogenesis of the disease process. Chest 112: 235–243PubMedCrossRefGoogle Scholar
  49. 49.
    Capuron L, Lamarque D, Dantzer R, Goodall G (1999) Attentional and mnemonic deficit associated with infectious disease in humans Psychol Med 29: 291–297Google Scholar
  50. 50.
    Bernard GR, Vincent JL, Laterre PF, et al (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344: 699–709PubMedCrossRefGoogle Scholar
  51. 51.
    Esmon CT (1992) The protein C anticoagulant pathway. Arterioscler Thromb 12: 135–145PubMedCrossRefGoogle Scholar
  52. 52.
    Reichenberg A, Yirmiya R, Schuld A, et al (2001) Cytokine-associated emotional and cognitive disturbances in humans. Arch Gen Psychiatry 58: 445–452PubMedCrossRefGoogle Scholar
  53. 53.
    Patarca-Montero R, Antoni M, Fletcher MA, Klimas NG (2001) Cytokine and other immunologic markers in chronic fatigue syndrome and their relation to neuropsychological factors. Appl Neuropsychol 8: 51–64PubMedCrossRefGoogle Scholar
  54. 54.
    Sieser A, Schwarx S, Brainin M (1992) Critical illness polyneuropathy: clinical aspects and long-term outcome. Wien Klin Wochenschr 104: 294–300Google Scholar
  55. 55.
    McGeer PL, Akiyama H, Itagaki S, McGeer EG (1989) Immune system response in Alzheimer’s disease. Can J Neurol Sci 16: 516–527PubMedGoogle Scholar
  56. 56.
    Hauss-Wegrzyniak B, Dobrzanski P, Stoehr JD, Wenk GL (1998) Chronic neuroinflammation in rats reproduces components of the neurobiology of Alzheimer’s disease. Brain Res 780: 294–303PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2002

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  • R. O. Hopkins

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