Journal Article

Long-term Cognitive and Psychological Outcomes in the Awakening and Breathing Controlled Trial

Ely, E. Wesley, Pun, Brenda T., Dittus, Robert S., Bernard, Gordon R., Shintani, Ayumi K., Thomason, Jason W. W., Jackson, James C., Thompson, Jennifer L., Dunn, Janet G., Canonico, Angelo E., Gordon, Sharon M., Girard, Timothy D.

2010

Overview

Abstract Rationale Studies have shown that reducing sedation of critically ill patients shortens time on the ventilator and in the intensive care unit (ICU). Little is known, however, of how such strategies affect long-term cognitive, psychological, and functional outcomes. Objectives To determine the long-term effects of a wake up and breathe protocol that interrupts and reduces sedative exposure in the ICU. Methods In this a priori planned substudy conducted at one tertiary care hospital during the Awakening and Breathing Controlled Trial, a multicenter randomized controlled trial, we assessed cognitive, psychological, and functional/quality-of-life outcomes 3 and 12 months postdischarge among 180 medical ICU patients randomized to paired daily spontaneous awakening trials with spontaneous breathing trials (SBTs) or to sedation per usual care plus daily SBTs. Measurements and Main Results Cognitive impairment was less common in the intervention group at 3-month follow-up (absolute risk reduction, 20.2%; 95% confidence interval, 1.5–36.1%; P = 0.03) but not at 12-month follow-up (absolute risk reduction, −1.9%; 95% CI, −21.3 to 27.1%; P = 0.89). Composite cognitive scores, alternatively, were similar in the two groups at 3-month and 12-month follow-up (P = 0.80 and 0.61, respectively), as were symptoms of depression (P = 0.59 and 0.82) and posttraumatic stress disorder (P = 0.59 and 0.97). Activities of daily living, functional status, and mental and physical quality of life were similar between groups throughout follow-up. Conclusions In this trial, management of mechanically ventilated medical ICU patients with a wake up and breathe protocol resulted in similar cognitive, psychological, and functional outcomes among patients tested 3 and 12 months post-ICU. The proven benefits of this protocol, including improved 1-year survival, were not offset by adverse long-term outcomes. Clinical trial registered with www.clinicaltrials.gov (NCT00097630).

• Publisher: Oxford University Press,American Thoracic Society
• Subject: Aged / Anesthesia / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Biological and medical sciences / C. Critical Care / Clinical Protocols / Clinical trials / Cognition Disorders - epidemiology / Cognitive ability / Cognitive impairment / Conscious Sedation / Critical Care - methods / Depression - epidemiology / Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care / Enrollments / Female / Follow-Up Studies / Humans / Intensive care / Intensive care medicine / Intensive Care Units / Male / Medical sciences / Middle Aged / Neuropsychological Tests / Patient Discharge / Patient safety / Post traumatic stress disorder / Quality of Life / Respiration, Artificial / Stress Disorders, Post-Traumatic - epidemiology / Ventilator Weaning / Ventilators