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The Adult Respiratory Distress Syndrome Cognitive Outcomes Study: Long-Term Neuropsychological Function in Survivors of Acute Lung Injury
Open accessAbstract
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.
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“Moreover, one-year post-discharge, ARDS survivors show high rates of anxiety, depression, executive dysfunction and post-traumatic stress disorder [121, 122].”
From Cognitive decline following acute viral infections: literature review and projections for post-COVID-19 (2022) · cites this paper as [121]
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Metadata
- Authors
- Mikkelsen, M. E., Christie, J. D., Lanken, P. N., Biester, R. C., Thompson, B. T., Bellamy, S. L., Localio, A. R., Demissie, E., Hopkins, R. O., & Angus, D. C.
- Affiliations
- University of Pennsylvania (US)
- Pulmonary, Allergy, and Critical Care Division, Department of Medicine
- Philadelphia VA Medical Center (US)
- Massachusetts General Hospital (US)
- Center for Clinical Epidemiology and Biostatistics, and
- Intermountain Medical Center (US)
- Brigham Young University (US)
- Corresponding author
- Mikkelsen, Mark E.
- ORCID
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-06
- Volume
- 185
- Issue
- 12
- Pages
- 1307-1315
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- PMC
- PMC3381234
- OpenAlex
- W2101436344
- Cited by
- 615
- References
- 68
- Citations by year
- 2026: 21 · 2025: 42 · 2024: 41 · 2023: 43 · 2022: 55 · 2021: 81 · 2020: 59 · 2019: 43 · 2018: 40 · 2017: 40 · 2016: 44 · 2015: 32 · 2014: 35 · 2013: 28 · 2012: 11
- FWCI
- 28.32
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Thoracic Society
- University of Pittsburgh
- National Institutes of Health (n01hr016146-000, n01hr046058-006)
- National Heart, Lung, and Blood Institute (T32HL07891, N01-HR46046-64, N01-HR-16146-54, N01 HR016146, N01 HR046058, N01 HR46058, T32HL007891)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Keywords
- acute lung injury, neuropsychological deficits, cognitive impairment, executive function, memory, verbal fluency, depression, post-traumatic stress disorder, anxiety, fluid management, conservative fluid management, hypoxemia, risk factors, ARDS survivors
- MeSH terms
- Adult, Anxiety Disorders, Cognition Disorders, Depression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neuropsychological Tests, Prospective Studies, Respiratory Distress Syndrome, Stress Disorders, Post-Traumatic, Time Factors, Incidence, Multivariate Analysis, Logistic Models, Critical Illness, Survivors, Risk Assessment, Acute Lung Injury
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