Law, ethics, and psychiatryThe relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: results of an exploratory study☆
Introduction
During the past 30 years, intensive care treatment of critically ill patients has tremendously improved associated with significant advances in modern technology. Apparently, these exciting medical achievements have fundamental implications for modern consultation-liaison psychiatry, as they have an important impact on the survivors’ psychosocial outcome [9]. Hence, the success of intensive care management of severe diseases such as acute respiratory distress syndrome (ARDS) is no longer judged solely by its effects on survival but by its influence on patients’ psychosocial well-being [6].
Outcome studies of ARDS survivors mainly focus on survival rates and pulmonary function outcomes (e.g. [27]), whereas studies on health-related quality of life in these patients are rare [20], [23]. Moreover, only one study has investigated cognitive and psychological outcomes in ARDS survivors [14]. This prospective 1-yr outcome study has shown that 100% of these patients experienced cognitive impairments at hospital discharge, and 30% of them still exhibited generalized cognitive decline at 1 year-follow-up. The pathogenesis of these cognitive problems was not clear. The authors found that the studied ARDS survivors suffered prolonged hypoxemia while on ICU that could lead to brain injury. Alternately, it was discussed whether sepsis that represents a principal reason for the development of ARDS might result in cognitive decline due to its brain-injuring toxic effects.
To our knowledge, no study has examined cognitive performance and its influence on employment status and health-related quality of life in long-term survivors of ARDS. As ARDS survivors are more concerned about quality of life than longevity [23], comprehensive measurements targeting psychosocial adaptation after recovery from ARDS in the long-term course are of paramount importance. C/L-psychiatrists and other health-care providers thus will be able to enhance appropriate counseling of ARDS survivors and their relatives.
The main purpose of this exploratory study was to assess cognitive performance in long-term ARDS survivors admitted to a 20-bed multidisciplinary ICU of a tertiary care university hospital, and to investigate how cognitive functioning is related to employment status and health-related quality of life.
Section snippets
Subjects
Of 192 ARDS patients consecutively admitted to the Department of Anaesthesiology at the Klinikum Grosshadern (Ludwigs-Maximilians University, Munich, Germany), a major referral and tertiary care center, 119 patients survived and were discharged between January 1985 and January 1995. On retrospective analyses, all patients met the ARDS criteria of the American-European Consensus Conference for ARDS founded in 1994 [4].
In 1998, this C/L–psychiatric exploratory study was conducted to assess
Cognitive outcome
Based on thorough history taking of the patients’ educational and vocational levels, two different levels of premorbid intelligence could be determined in the entire sample: 37 of 46 ARDS survivors (80.4%) were assigned an IQ from 90 to 110, 9 of them (19.6%) were given an IQ over 110. Considering these retrospectively assessed levels of premorbid intelligence and taking into account the four age groups (aged from 18 to 44; 45 to 54; 55 to 64; and older than 65 years of age; see Table 1), we
Discussion
To summarize, first, we found that over three-fourths of patients in our sample of ARDS survivors did not display signs of cognitive impairments at median time of 6.0 years after ICU discharge. This was a main finding in terms of the natural history of cognitive performance following ARDS. As we know from the only study published in the literature targeting cognitive sequelae after ARDS as the primary outcome variable, the prevalence rate of cognitive impairments was 100% at the time of
Acknowledgements
The authors wish to thank Hartmut Lehfeld, Ph.D., for providing age-related reference scores from the SKT data bank available at GEROMED GmbH, Erlangen, Germany.
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This study was supported by grants from the Eli-Lilly Foundation, Bad Homburg, Germany.