Critical Illness
Conditions
Brief summary
As survival rates from critical illness improve, strategies to return patients to their baseline cognitive and functional status are important research priorities. Up to 100% of ICU survivors will suffer some degree of cognitive impairment at hospital discharge and approximately 50% will have decrements that persist for years. While the mechanisms for this newly acquired brain injury are poorly understood, several risk factors have been identified. Unfortunately, it is unclear how to accurately predict long-term cognitive impairment. Immediate opportunities to improve cognitive outcomes through risk reduction exist. The investigators propose to comprehensively study the prevalence of sleep abnormalities and their association with cognitive impairment, as it may yield potential targets for effective therapy. Moreover, the investigators will examine for gene x environment associations \[APOE ε4\] that may allow for genetic risk stratification of individuals at greatest risk of cognitive impairment. The investigators hypothesize that EEG \[a sensitive longitudinal marker of brain dysfunction\] is a novel and independent predictor of long-term cognitive impairment, and possibly a candidate intermediate end point for future clinical trials. This study has the potential to identify novel biomarkers and risk factors for post-critical illness cognitive impairment, and may lay the foundation for rational interventions to mitigate risk in high-risk individuals.
Interventions
None listed
Sponsors
The Physicians' Services Incorporated Foundation
University of Toronto
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ≥16 years of age * Admission to study ICU for invasive mechanical ventilation \[minimum of 72 hours\]
Exclusion criteria
* Advanced cognitive impairment or unable to follow simple commands before their acute illness \[e.g. end-stage Alzheimer's disease\] * Primary neurological injury \[e.g. anoxic brain injury, stroke or traumatic brain injury\] * Anticipated death within 3 months of discharge \[e.g. palliative\] * Uncontrolled psychiatric illness at hospital admission * Not fluent in English * Unlikely to adhere with follow-up \[e.g. no fixed address\] * Residence greater than 300 kms from referral centre
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change in cognitive performance from day 7 after ICU discharge as measured by the Repeatable Battery for the Assessment of Neuropsychological Status [RBANS] and Trail Making Tests A and B | 7 days, 6-months and 12-months after ICU discharge |
Secondary
| Measure | Time frame |
|---|---|
| Medical Outcomes Study Short Form -36 Questionnaire (SF-36) | 7 days, 6- and 12-months after ICU discharge |
| Beck Depression Inventory-II (BDI-II) | 7 days, 6- and 12-months after ICU discharge |
| Richard Campbell Sleep Questionnaire | 7 days, 6- and 12-months after ICU discharge |
| Pittsburgh Sleep Quality Index | 7 days, 6- and 12-months after ICU discharge |
Countries
Canada
Contacts
Primary ContactM. Elizabeth Wilcox, MD, MPH
Outcome results
None listed