From U Pennsylvania: Long-Term Neuropsychological Function in Acute Lung Injury Survivors

http://www.ncbi.nlm.nih.gov/pubmed/22492988

Am J Respir Crit Care Med. 2012 Apr 6. [Epub ahead of print]

The ARDS Cognitive Outcomes Study (ACOS): Long-Term Neuropsychological Function in Acute Lung Injury Survivors.

Mikkelsen ME, Christie JD, Lanken PN, Biester RC, Thompson BT, Bellamy SL, Localio AR, Demissie E, Hopkins RO, Angus DC.

Source

Pulmonary, Allergy, and Critical Care Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States.

Abstract

RATIONALE:

Cognitive and psychiatric morbidity is common and potentially modifiable following acute lung injury (ALI). However, practical measures of neuropsychological function for use in multi-center trials are lacking.

OBJECTIVES:

To determine whether a validated telephone-based neuropsychological test battery is feasible in a multi-center trial. To determine the frequency and risk factors for long-term neuropsychological impairment.

METHODS:

As an adjunct study to the ARDSNet Fluid and Catheter Treatment Trial, we assessed neuropsychological function at 2 and 12 months post-hospital discharge.

MEASUREMENTS AND MAIN RESULTS:

Of 406 eligible survivors, we approached 261 to participate and 213 consented. We tested 122 subjects at least once, including 102 subjects at 12 months. Memory, verbal fluency and executive function were impaired in 13% (12/92), 16% (15/96), and 49% (37/76) of long-term survivors. Long-term cognitive impairment was present in 41 of the 75 (55%) survivors who completed cognitive testing. Depression, post-traumatic stress disorder, or anxiety was present in 36% (37/102), 39% (40/102), and 62% (63/102) of long-term survivors. Enrollment in a conservative fluid-management strategy (p=0.005) was associated with cognitive impairment and lower partial pressure of arterial oxygen during the trial was associated with cognitive (p=0.02) and psychiatric impairment (p=0.02).

CONCLUSIONS:

Neuropsychological function can be assessed by telephone in a multi-center trial. Long-term neuropsychological impairment is common in ALI survivors. Hypoxemia is a risk factor for long-term neuropsychological impairment. Fluid management strategy is a potential risk factor for long-term cognitive impairment; however, given the select population studied and an unclear mechanism, this finding requires confirmation.