Critically ill patients who survive a stay in an intensive-care unit, where they are often heavily sedated and ventilated, can find themselves mentally impaired long after release. A new study says the problem is far more common and lasting than previously believed

Updated October 2, 2013, 5:40 p.m. ET

Intensive-Care Units Pose Long-Term Brain Risk, Study Finds

LAURA LANDRO

Critically ill patients who survive a stay in an intensive-care unit, where they are often heavily sedated and ventilated, can find themselves mentally impaired long after release. A new study says the problem is far more common and lasting than previously believed. Nearly 80% of patients with prolonged ICU stays showed cognitive problems a year or more later, and more than half exhibited effects similar to Alzheimer’s disease and traumatic brain injury, according to a report Wednesday in the New England Journal of Medicine.The researchers, at Vanderbilt University in Nashville, Tenn., and the Tennessee Valley Veterans Affairs Geriatric Research Education and Clinical Center, said the findings highlight the need to modify ICU practices that put patients at risk of cognitive problems, and to offer rehabilitation programs to restore concentration, thinking and memory function after patients leave the hospital.

Intensive-care units traditionally keep patients heavily sedated, immobilized and on mechanical ventilation to keep them free of pain, anxiety and agitation as they heal or undergo invasive procedures. But prolonged sedation can trigger or exacerbate delirium, a temporary state of acute brain injury that can also be caused by conditions such as septic shock, an infection that spreads through the body and is a common reason for being admitted to an ICU.

Delirium, long linked to higher rates of death, is also associated with long-term mental impairment in ICU survivors, the study found. E. Wesley Ely, senior author of the study and founder of Vanderbilt’s ICU Delirium and Cognitive Impairment Study Group, said some ICU-related brain injury could be prevented if the duration of delirium in the ICU is shortened. A new protocol Vanderbilt and others are following includes weaning patients from sedatives carefully, waking them regularly to see if they can breathe on their own sooner, and getting them out of bed and moving as soon as possible.

The study included 821 patients with respiratory failure or septic shock who had a median ICU stay of 5 days. Their ages ranged from 18 to 99. Only 6% had pre-existing cognitive impairment, and 75% developed delirium during their hospital stay. Assessed for cognitive function at one year after discharge, 34% still had scores similar to moderate traumatic brain injury, and 24% had scores similar to patients with mild Alzheimer’s disease. In total, nearly 80% scored lower than predicted by age and education.

“Whether you are young or old and even if you are previously healthy, if you go into an ICU with significant breathing problems, are on a breathing machine or in shock, you may not be coming out with an intact brain,” said Dr. Ely. And after discharge, he adds, “so many people are living in their own private hell of mental fog and no one around them knows about it, tells them it is going to happen, or tries to prevent or treat it.”

Joan Healy, a 48-year-old who lives in Huntington, N.Y., spent a week in an ICU three years ago suffering from septic shock due to an infection. For two months after discharge, she said all she could do was sleep, and for the first year after recovery she would experience what she described as “brownouts,” where she could do little more than nod and smile during conversations without grasping what was being said.

Her family was just happy she was alive, making every effort to help, but “they can’t fathom that I can’t follow directions, that a simple recipe to cook for dinner is torture,” Ms. Healy said. “It’s like being in a dim room at sunset, you can navigate but you don’t feel you have a grasp on everything going on around you.”

Ms. Healy, who does administrative work for her husband’s orthopedics practice, reached out to experts at Vanderbilt, who referred her to a computer-based program for attention and memory problems, which she said has been helpful. “I am not the person I was, but from last year to now, I am doing better, and I am still working hard at it,” she said.

Malaz Boustani, chief operating officer of the Indiana University Center for Innovation and Implementation Science, who wasn’t involved in the study, said its findings add to the evidence about brain-health concerns for ICU survivors and highlight the need for recovery programs that “coordinate the complex cognitive, functional and psychological recovery needs of Americans who survived a critical illness.”

About bambooinnovator
Kee Koon Boon (“KB”) is the co-founder and director of HERO Investment Management which provides specialized fund management and investment advisory services to the ARCHEA Asia HERO Innovators Fund (www.heroinnovator.com), the only Asian SMID-cap tech-focused fund in the industry. KB is an internationally featured investor rooted in the principles of value investing for over a decade as a fund manager and analyst in the Asian capital markets who started his career at a boutique hedge fund in Singapore where he was with the firm since 2002 and was also part of the core investment committee in significantly outperforming the index in the 10-year-plus-old flagship Asian fund. He was also the portfolio manager for Asia-Pacific equities at Korea’s largest mutual fund company. Prior to setting up the H.E.R.O. Innovators Fund, KB was the Chief Investment Officer & CEO of a Singapore Registered Fund Management Company (RFMC) where he is responsible for listed Asian equity investments. KB had taught accounting at the Singapore Management University (SMU) as a faculty member and also pioneered the 15-week course on Accounting Fraud in Asia as an official module at SMU. KB remains grateful and honored to be invited by Singapore’s financial regulator Monetary Authority of Singapore (MAS) to present to their top management team about implementing a world’s first fact-based forward-looking fraud detection framework to bring about benefits for the capital markets in Singapore and for the public and investment community. KB also served the community in sharing his insights in writing articles about value investing and corporate governance in the media that include Business Times, Straits Times, Jakarta Post, Manual of Ideas, Investopedia, TedXWallStreet. He had also presented in top investment, banking and finance conferences in America, Italy, Sydney, Cape Town, HK, China. He has trained CEOs, entrepreneurs, CFOs, management executives in business strategy & business model innovation in Singapore, HK and China.

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