The Adult Respiratory Distress Syndrome Cognitive Outcomes Study Long-Term Neuropsychological Function in Survivors of Acute Lung Injury
The Adult Respiratory Distress Syndrome Cognitive Outcomes Study Long-Term Neuropsychological Function in Survivors of Acute Lung Injury
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DOI：
10.1164/rccm.201111-2025oc
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发表时间：
2012-06-15
影响因子：
24.7
通讯作者：
Angus, Derek C.
中科院分区：
文献类型：
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作者：
Mikkelsen, Mark E.;Christie, Jason D.;Angus, Derek C.
原理：认知和精神疾病的发病率是常见的，并可能在急性肺损伤（ALI）后改变。然而，在多中心trials.Objectives使用的神经心理学功能的实际措施是缺乏的：以确定一个有效的电话为基础的神经心理学测试电池是否是可行的多中心试验。为了确定长期neuropsychological impairment.Methods的频率和危险因素：作为一项辅助研究，急性呼吸窘迫综合征临床试验网络液体和导管治疗试验，我们评估了神经心理功能在2个月和12个月后出院。测量和主要结果：406名合格的幸存者，我们接近261参加，213同意。我们对122名受试者进行了至少一次测试，其中102名受试者在12个月时接受了测试。13%（12/92）、16%（15/96）和49%（37/76）的长期存活者的记忆、语言流畅性和执行功能受损。在完成认知测试的75名幸存者中，有41人（55%）存在长期认知障碍。抑郁、创伤后应激障碍或焦虑分别出现在36%（37/102）、39%（40/102）和62%（63/102）的长期幸存者中。在保守的液体管理策略（P = 0.005）与认知功能障碍和较低的动脉血氧分压在试验过程中与认知（P = 0.02）和精神损害（P = 0.02）。结论：神经心理功能可以通过电话进行评估，在多中心试验。长期的神经心理损害在ALI幸存者中很常见。低氧血症是长期神经心理损害的危险因素。液体管理策略是长期认知功能障碍的潜在风险因素;然而，考虑到研究的选定人群和不清楚的机制，这一发现需要确认。
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.