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Cognitive sequelae in acute respiratory distress syndrome patients with and without recall of the intensive care unit

  • MICHAEL J. LARSON (a1) (a2), LINDELL K. WEAVER (a3) (a4) and RAMONA O. HOPKINS (a1) (a3) (a5)


Some critically ill patients have dramatic recollections of the intensive care unit (ICU), whereas 23–50% have little or no recollection of their ICU stay. In addition, cognitive impairments are common following critical illness and ICU treatment. Little is known regarding the relationship between cognitive sequelae and ICU recall. We assessed recall of the ICU and its relationship to cognitive functioning at hospital discharge and 1 and 2 years after discharge in 70 consecutive acute respiratory distress syndrome (ARDS) patients. Seventeen patients (24%) had no recall of the ICU. Patients without ICU recall had increased rates of cognitive sequelae at hospital discharge and 1-year follow-up compared with the ICU recall group. Patients without ICU recall had a greater magnitude of cognitive impairments at hospital discharge, but not at 1- or 2-year follow-up. Profile analysis showed significant group differences in general intellectual functioning, executive function, processing speed, and spatial skills at hospital discharge, but not at 1- or 2-year follow-up. Estimated premorbid intelligence scores were inversely related to the magnitude of cognitive sequelae, suggesting greater “cognitive reserve” in patients with fewer cognitive decrements. (JINS, 2007, 13, 595–605.)


Corresponding author

Correspondence and reprint requests to: Ramona O. Hopkins, Ph.D., Division of Critical Care Medicine, LDS Hospital, 8th Avenue and C Street, Salt Lake City, UT 84143, USA. E-mail:


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Alexander, G.E., Furey, M.L., Grady, C.L., Pietrini, P., Brady, D.R., Mentis, M.J., & Schapiro, M.B. (1997). Association of premorbid intellectual function with cerebral metabolism in Alzheimer's disease: Implications for the cognitive reserve hypothesis. American Journal of Psychiatry, 154, 165172.
Al-Saidi, F., McAndrews, M.P., Cheunt, A.M., Tansey, C.M., Matte-Martyn, A., Diaz-Granadoes, N., & Herridge, M.S. (2003). Neuropsychological sequelae in ARDS survivors. American Journal of Respiratory and Critical Care Medicine, 167, A737.
Angus, D.C., Musthafa, A.A., Clermont, G., Griffin, M.F., Linde-Zwirble, W.T., Dremisizov, T., & Pinsky, M.R. (2001). Quality-adjusted survival in the first year after the acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 163, 13891394.
Ashbaugh, D.G., Bigelow, D.B., Petty, T.L., & Levine, B.E. (1967). Acute respiratory distress in adults. Lancet, 2, 319323.
Beck, A.T. (1987). Beck Depression Inventory Manual. San Antonio, TX: Psychology Corporation.
Beck, A.T. & Steer, R.A. (1993). Beck Anxiety Inventory Manual. San Antonio, TX: Psychology Corporation.
Bergbom-Engberg, I. & Haljamea, H. (1989a). Assessment of patients' experience of discomforts during respirator therapy. Critical Care Medicine, 17, 10681072.
Bergbom-Engberg, I. & Haljamea, H. (1989b). Patient experiences during respirator treatment—reason for positive-pressure ventilation treatment and patient awareness in the intensive care unit. Critical Care Medicine, 17, 2225.
Capuzzo, M., Pinamonti, A., Cingolani, E., Grassi, L., Bianconni, M., Contu, P., Gritti, G., & Alvisi, R. (2001). Analgesia, sedation, and memory of intensive care. Journal of Critical Care, 16, 8389.
Daffurn, K., Bishop, G.F., Hillman, K.M., & Bauman, A. (1994). Problems following discharge after intensive care. Intensive Critical Care Nursing, 10, 244251.
Gale, S.D. & Hopkins, R.O. (2004). Effects of hypoxia on the brain: Neuroimaging and neuropsychological findings following carbon monoxide poisoning and obstructive sleep apnea. Journal of the International Neuropsychological Society, 10, 6071.
Gale, S.D., Hopkins, R.O., Weaver, L.K., Walker, J.M., Bigler, E.D., & Cloward, T.V. (2000). Hippocampal atrophy following sleep apnea and carbon monoxide poisoning: Similarities and differences. Journal of the International Neuropsychological Society, 10, 6071.
Geffen, G., Moar, K.J., O'Hanlon, A.P., Clark, C.R., & Geffen, L.B. (1990). Performance measures of 16- to 86-year old males and females on the Auditory Verbal Learning Test. Clinical Neuropsychologist, 4, 4563.
Goldman, L.S. & Kimball, C.P. (1987). Depression in intensive care units. International Journal of Psychiatry and Medicine, 17, 201212.
Gordon, S.M., Jackson, J.C., Ely, E.W., Burger, C., & Hopkins, R.O. (2004). Clinical identification of cognitive impairment in ICU survivors: Insights for intensivists. Intensive Care Medicine, 30, 19972008.
Granberg, A., Bergbom-Engberg, I., & Lunberg, D. (1998). Patients' experience of being critically ill or severely injured and cared for in an intensive care unit in relation to the ICU syndrome: Part I. Intensive Critical Care Nursing, 14, 294307.
Granja, C., Lopes, A., Moreira, S., Dias, C., Costa-Pereira, A., Carneiro, A., & JMIP Study Group. (2005). Patients' recollections of experiences in the intensive care unit may affect their quality of life. Critical Care, 9, 96109.
Green, A. (1996). An exploratory study of patients' memory recall of their stay in an adult intensive therapy unit. Intensive and Critical Care Nursing, 12, 131137.
Hall-Lord, M., Larsson, G., & Bostrom, I. (1994). Elderly patients' experiences of pain and distress in intensive care: A grounded theory study. Intensive Critical Care Nursing, 10, 133141.
Heaton, R.K., Grant, I., & Matthews, C.G. (1991). Comprehensive Norms for an Expanded Halstead-Reitan Battery: Demographic Corrections, Research Findings, and Clinical Applications. Odessa, TX: Psychological Assessment Resources.
Holland, C., Cason, C.L., & Prater, L.R. (1997). Patient's recollection in critical care. Dimensions in Critical Care Nursing, 16, 132141.
Hopkins, R.O. & Brett, S. (2005). Chronic neurocognitive effects of critical illness. Current Opinions in Critical Care, 11, 369375.
Hopkins, R.O. & Jackson, J.C. (2006). Long-term neurocognitive function after critical illness. Chest, 130, 869878.
Hopkins, R.O., Weaver, L.K., Collingridge, D., Parkinson, R.B., Chan, K.J., & Orme, J.F. (2005). Two year cognitive, emotional, and quality of life outcomes in acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 171, 340347.
Hopkins, R.O., Weaver, L.K., Pope, D., Orme, J.F., Bigler, E.D., & Larson-Lohr, V. (1999). Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. American Journal of Respiratory Critical Care Medicine, 160, 5056.
Jackson, J.C., Gordon, S.M., Hart, R.P., Hopkins, R.O., & Ely, E.W. (2004). The association between delirium and cognitive decline: A review of the empirical literature. Neuropsychology Review, 14, 8798.
Jackson, J.C., Hart, R.P., Gordon, S.M., Shintani, A., Truman, B., May, L., & Ely, E.W. (2003). Six-month neuropsychological outcome of medical intensive care unit patients. Critical Care Medicine, 31, 12261234.
Jones, C., Griffiths, R.D., & Humphris, G. (2000). Disturbed memory and amnesia related to intensive care. Memory, 8, 7994.
Jones, C., Griffiths, R.D., Humphris, G., & Skirrow, P.M. (2001). Memory, delusions, and the development of posttraumatic stress disorder-related symptoms after intensive care. Critical Care Medicine, 29, 573580.
Jones, C., Griffiths, R.D., Macmillan, R., & Palmer, T.E.A. (1994). Psychological problems occurring after intensive care. British Journal of Intensive Care, 2, 4653.
Knaus, W.A., Draper, E.A., Wagner, D.P., & Zimmerman, J.E. (1985). APACHE II: A severity of disease classification system. Critical Care Medicine, 13, 818829.
Leur, J.P., Zwaveling, J.H., Loef, B.G., & Schans, C.P. (2003). Patient recollection of airway suctioning in the ICU: Routine versus minimally invasive procedure. Intensive Care Medicine, 29, 433436.
Lof, L., Berggren, L., & Ahlstrom, G. (2006). Severely ill ICU patients recall of factual events and unreal experiences of hospital admission and ICU stay–3 and 12 months after discharge. Intensive Critical Care Nursing, 22, 154166.
Magarey, J.M. & McCutcheon, H.H. (2005). ‘Fishing with the dead’–Recall of memories from the ICU. Intensive and Critical Care Nursing, 21, 344354.
McCartney, J.R. & Boland, R.J. (1994). Anxiety and delirium in the intensive care unit. Critical Care Clinics, 10, 673680.
McKegney, F.P. (1966). The intensive care syndrome. Connecticut Medicine, 30, 633636.
Meyers, J.E. & Meyers, K.R. (1995). Rey Complex Figure Test and Recognition Trial. Lutz, FL: PAR Inc.
Mittenberg, W., Burton, D.B., Darrow, E., & Thompson, G.B. (1992). Normative data for the Wechsler Memory Scale-Revised. Psychological Assessment, 4, 363368.
Orme, J.F., Romney, J.S., Hopkins, R.O., Pope, D., Chan, K.J., Thomsen, G., Crapo, R.O., & Weaver, L.K. (2003). Pulmonary function and health-related quality of life in survivors of acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 167, 690694.
Rothenhausler, H.B., Ehrentraut, S., Stoll, C., Schelling, G., & Kapfhammer, H.P. (2001). The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: Results of an exploratory study. General Hospital Psychiatry, 23, 9096.
Rundshagen, I., Schnabel, K., & Wegner, S.A.E. (2002). Incidence of recall, nightmare, and hallucination during analgosedation in intensive care. Intensive Care Medicine, 28, 3843.
Satz, P. (1993). Brain reserve capacity on symptom onset after brain injury: A formulation and review of evidence for threshold theory. Neuropsychology, 7, 273295.
Schelling, G., Stoll, C., Haller, M., Briegle, J., Manert, W., Hummel, T., Lenhart, A., Heyduck, M., Polasek, J., Meier, M., Perub, U., Bullinger, M., Schuffel, W., & Klaus, P. (1998). Health-related quality of life and post-traumatic stress disorder in survivors of the acute respiratory distress syndrome. Critical Care Medicine, 26, 651659.
Schelling, G., Stoll, C., Vogelmeier, C., Himmel, T., Behr, J., Kapfhammer, H.P., Rothenhausler, H.B., Haller, M., Durst, K., Drausneck, T., & Briegel, J. (2000). Pulmonary function and health related quality of life in a sample of long-term survivors of the acute respiratory distress syndrome. Intensive Care Medicine, 26, 13041311.
Schmand, B., Smit, J.H., Geerlings, M.I., & Lindeboom, J. (1997). The effects of intelligence and education on the development of dementia. A test of the brain reserve hypothesis. Psychological Medicine, 27, 13371344.
Schmitz, R., Lantin, M., & White, A. (1998). Future needs in pulmonary and critical care medicine. Cambridge: ABT.
Scott, J.G., Krull, K.R., Williamson, D.J.G., Adams, R.L., & Iverson, G.L. (1997). Oklahoma premorbid intelligence estimation (OPIE): Utilization in clinical samples. Clinical Neuropsycholgy, 11, 146154.
Simini, B. (1999). Patients' perceptions of intensive care. Lancet, 9178, 571572.
Skodol, A.E. (1999). Anxiety in the medically ill: Nosology and principles of differential diagnosis. Seminars in Clinical Neuropsychiatry, 4, 6471.
Stern, Y., Albert, S., Tang, M., & Tsai, W. (1999). Rate of memory decline in AD is related to education and occupation: Cognitive reserve? Neurology, 53, 19421947.
Stern, Y., Alexander, G.E., Prohovnik, I., Stricks, L., Link, B., Lennon, M.C., & Mayeux, R. (1995). Relationships between lifetime occupation and parietal flow: Implications for a reserve against Alzheimer's disease pathology. Neurology, 45, 5560.
Stevens, J. (1996). Applied multivariate statistics for the social sciences (3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.
Sukantarat, K.T., Burgess, P.W., Williamson, R.C.N., & Brett, S. (2005). Prolonged cognitive dysfunction after critical illness. Anaesthesia, 60, 847853.
Swaiss, I.G. & Badran, I. (2004). Discomfort, awareness and recall in the intensive care-still a problem? Middle Eastern Journal of Anesthesiology, 17, 951958.
Tabachnik, B.G. & Fidell, L.S. (2001). Using multivariate statistics (4th ed.). Needham Heights, MA: Allyn and Bacon.
The Acute Respiratory Distress Syndrome Network. (2000). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. New England Journal of Medicine, 342, 13011308.
Turner, J.S., Briggs, S.J., Springhorn, H.E., & Potgieter, P.D. (1990). Patients' recollection of intensive care unit experience. Critical Care Medicine, 18, 966968.
Weaver, L.K., Hopkins, R.O., Chan, K.J., Churchill, S., Elliott, C.G., Clemmer, T., Orme, J.F., Thomas, F.O, & Morris, A.H. (2002). Hyperbaric oxygen for acute carbon monoxide poisoning. New England Journal of Medicine, 347, 10571067.
Wechsler, D. (1987). Wechsler Memory Scale-Revised. San Antonio, TX: The Psychological Corporation.
White, J., Hopkins, R.O., Glissmeyer, E.W., Kitterman, N., & Elliott, C.G. (2006). Cognitive, emotional, and quality of life outcomes in patients with pulmonary arterial hypertension. Respiratory Research, 7, 55.



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