The Adult Respiratory Distress Syndrome Cognitive Outcomes Study: Long-Term Neuropsychological Function in Survivors of Acute Lung Injury

Am J Respir Crit Care Med. 2012 Jun 15;185(12):1307-15. doi: 10.1164/rccm.201111-2025OC. Epub 2012 Apr 6.

Abstract

Rationale: Cognitive and psychiatric morbidity is common and potentially modifiable after acute lung injury (ALI). However, practical measures of neuropsychological function for use in multicenter trials are lacking.

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

Methods: As an adjunct study to the Acute Respiratory Distress Syndrome Clinical Trials Network 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 of 92), 16% (15 of 96), and 49% (37 of 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 of 102), 39% (40 of 102), and 62% (63 of 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 multicenter trial. Long-term neuropsychological impairment is common in survivors of ALI. 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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Lung Injury / complications*
  • Acute Lung Injury / mortality
  • Acute Lung Injury / psychology
  • Acute Lung Injury / therapy
  • Adult
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / etiology
  • Anxiety Disorders / physiopathology
  • Cognition Disorders / epidemiology
  • Cognition Disorders / etiology*
  • Cognition Disorders / physiopathology
  • Critical Illness
  • Depression / epidemiology
  • Depression / etiology
  • Depression / physiopathology
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neuropsychological Tests*
  • Prospective Studies
  • Respiratory Distress Syndrome, Adult / complications*
  • Respiratory Distress Syndrome, Adult / mortality
  • Respiratory Distress Syndrome, Adult / psychology
  • Respiratory Distress Syndrome, Adult / therapy
  • Risk Assessment
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / etiology
  • Stress Disorders, Post-Traumatic / physiopathology
  • Survivors
  • Time Factors