Recovering from serious ailments has substantially improved. All thanks to the developments in intensive care medicine. Even though the patients appear to have recovered physically, there is growing evidence suggesting that most of the patients experience long-term cognitive and psychological impairment. The most important part of Post-Intensive Care Syndrome (PICS) is memory loss, diminished attention, and weak executive function, these have been tracked and documented months to years following ICU discharge.
The most common cause of this is ICU delirium, which is found to affect a large population of critically sick and mechanically ventilated patients and is strongly linked to long-term cognitive impairment. Recurrent ICU practices further pose a risk of delirium and may turn out to be a leading cause of long-lasting brain damage include deep or extended sedation, sleep disturbance, continuous noise and polypharmacy.
From the medication point of view, sedatives such as opioids, benzodiazepines, and anticholinergics have been associated with reduced cognitive function and higher chances of delirium. On the contrary, techniques that have been proven to be successful in reducing the burden of delirium comprise of milder sedation, daily sedation interruption and pharmacist-led drug optimization.
As the rate of ICU mortality has reduced, survival alone can’t be used to draw a conclusion whether it’s an adequate indicator of success or not. In the current critical care practices, it is important to pay more attention to cognitive functions, gentle sedation practices and long-term quality of life.
If ICU care contributes to long-term cognitive harm, should cognitive recovery be considered a core outcome of critical care alongside survival and length of stay?