Acute and long-term cognitive consequences of treatment on intensive care units

• Published in: Nervenarzt 2016-03, Vol.87 (3), p.246-252
• Main Authors: Kratz, T, Diefenbacher, A
• Format: Article
• Language: ger
• Subjects: Acute Disease; Chronic Disease; Cognition Disorders - diagnosis; Cognition Disorders - psychology; Cognition Disorders - therapy; Critical Care - methods; Critical Illness - psychology; Critical Illness - therapy; Delirium - diagnosis; Delirium - psychology; Delirium - therapy; Humans; Intensive Care Units; Postoperative Complications - diagnosis; Postoperative Complications - psychology; Postoperative Complications - therapy; Treatment Outcome
• ISSN: 1433-0407
• DOI: 10.1007/s00115-016-0078-0

Following treatment on the intensive care unit (ICU) patients often suffer from acute and long-term cognitive deficits. This is true for patients of all age groups but especially for elderly patients who have undergone surgery and develop postoperative delirium (POD) or postoperative cognitive decline (POCD). Both are associated with severe limitations in the quality of life and long-term outcome. Which acute and long-term cognitive effects develop in ICU survivors and how do they influence the outcome? How can POD and POCD be differentiated? A selective literature search was carried out. Following surgery POCD can develop within days to weeks, may persist for weeks or months and can lead to problems in attentiveness even under conditions of inconspicuous consciousness. Remission is possible but may take up to more than 12 months. The POD is a phenomenon characterized by disturbances of consciousness and problems in attention, beginning acutely hours and days postoperatively, can persist for days to weeks and remission can be expected within a few days. While POD often has an organic cause, such as an infection, the pathogenesis of POCD has not been sufficiently elucidated. Both POD and particularly POCD can lead to a deterioration of cognition following ICU treatment. As efficient treatment still has to be developed preventive methods, such as preoperative screening for risk factors, thorough planning of operative and anesthetic techniques and compensation of risk factors as well as providing assistance to patients, e. g. by a trained nurse should be implemented in the clinical routine more often than is presently the case.