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In this episode, survivors tell us what “cognitive deficits” really look like and the impact they have on their function and lives.
Episode Transcription
Kali Dayton
Today, I want to talk about cognitive deficits. Dr. Ely gave us insight into the brain injury that happens as a result of ICU delirium. For a while, I had heard the term cognitive deficits. And statistics such as 33% of survivors have cognitive deficits, but in reality that held very little meaning to me- until I started listening to ICU survivors.
On these Facebook pages, they were asking each other, hey, do you forget everything too? And I love reading books. And now I can barely follow sentence is anyone having the same problems? And even questions like, Will I ever be functional again, this is when it started to become real to me, just like any of you. My brain is my life, my passions, my independence, and my pursuits are so much of my identity, fulfillment and joy. I use my cognitive function to work in the ICU. Take care of two kids two and under play the piano, do this podcast cook everything. I have gotten inexpressibly frustrated with moments of pregnancy brain. So what would my life be like if I was victim of prolonged sedation are survivors again opened up to tell us how their lives were impacted?
Survivor 1
My name is Jim, I was just calling to tell you about the cognitive crap. I love telling jokes. I have done some stand up comedy. And now I’m finding I have trouble putting the words in the right orders to make them make sense. In what I’m, you know, funny thing I’m trying to say, and I love to laugh. I think if I don’t laugh every day, and when I lost my ability to walk, you know, I still had my mind. And I lost the ability to use my hands. And I still had my mind. And those things have come back. But when this happens, I lose who I am. And that’s what, that’s the worst of all things. Thanks for asking. Bye.
Survivor 2
Hi, this is Jerry sharp, and I’m calling to leave feedback on what I experienced after I was out of the ICU. First of all, I had flashbacks and nightmares that went on for quite a while. I had anger issues at being restrained for 13 days and unable to communicate. I’ve had concentration issues, such as reading aloud, going to the grocery store being overwhelming, too many choices. Simple math problems, I just can’t I can’t even do math anymore. following directions, losing things, pairing meals and just following a recipe. I have brain fog. And I have a hard time focusing on things. I get very emotional over the least little thing. I have extreme fatigue, problems with insomnia. Another page here. Problems with depression, sometimes for no reason at all. There’s also a sense of loneliness because I can’t seem to keep up with my friends and their activities. I also have problems with feeling guilt. I feel like I’m a burden to family because of the limitations I have. The problem that thinks about me the most is just I feel like my brain shuts down. I can’t process anything. When I get overly tired. I just like my brain just shut down. I can’t concentrate any more than four years and I’m still dealing with a lot of this. It’s really difficult because friends don’t understand it. Family members are beginning to understand it. But it’s it’s just very frustrating to have to go through this and I think there needs to really be an awareness as to what we patients experienced after going through the trauma that we did in the ICU, the mental trauma that is I hope this helps. Thanks bye bye.
Survivor 3
The short term memory and cognitive problems soon became apparent when I arrived back home after three months in hospital issues like walking into a room and forgetting what I went in therefore, losing my train of thought during conversation. Momentary confusion when performing the simplest of tasks like making a cup of tea. After struggling for several weeks, I was referred to neurology by my family doctor. My initial appointment was with The consultant neurologist, who after arranging and receiving the results of an MRI scan of my head and spine, passed me on to the brain injury team. They performed a memory evaluation where I had to repeat strings of numbers or words, look at a picture, then draw it from memory, then go back and repeat an earlier test and so on. When the doctor went through the results with me, it became clear how badly I had performed. I knew I had some memory issues, but not to that extent. And the realization of it came as a huge psychological blow for me at the time. I remained in urology for around 18 months, where I was taught coping strategies, some of which I still use today. nearly 10 years later, I had worked in defense and intelligence for close to 30 years. But along with my physical issues, the memory and cognitive problems contributed to me having to take medical retirement on the advice of the work doctor. After they had kept my job open for over 20 months, my physical and psychological recovery had become too slow and was stalling.
Kali Dayton
I recently had a patient that was admitted for her fourth suicide attempt in six months. She had a long history of PTSD from intense traumatic events in her past and had had pseudo seizures since she was 16. I went to tell her that her EEG did not show seizure activity, and she began to ask, but will my brain ever be the same again, I asked her what she meant. She then told me that despite her PTSD, depression, and pseudo seizures, she was living a full life as special needs teacher driving, working and was fully functional and independent.
When she moved to the States seven months ago from Puerto Rico to be with her son. She had a pseudo seizure a month later and was taken to the hospital. She was intubated and sedated, and for reasons unclear to me. She was in a medically induced coma for 12 days. She said they never found any real seizure activity either. She said during that time, she vividly relived all the trauma of her life, kidnapping, rape, Hurricane Maria car accidents. And when she woke up, she couldn’t move. She had to relearn how to walk. But for her that came back, what didn’t come back, she said, was her brain. She said she can’t function thinks through things. And the PTSD she always kept at bay, was now unmanageable.
She had no idea why she was like this, and figured that if this was going to be her functional level and her life, then she would rather die. We took away her brain coping mechanisms and slammed her PTSD her face and permanently altered her life. Think of your own life. What is it like right now? What role does your cognitive capacity play in your daily and minute to minute life?
If you were to have severe pneumonia tomorrow required mechanical ventilation, then were in a medically induced coma and developed ICU delirium? How would that impact your life, your family? Your career, studies have shown that the less patients recall their ICU experience, the greater risk they are of having cognitive deficits and the worst their cognitive deficits are, the more patients can remember what they experienced during the ICU stay, the better their cognitive outcomes are before giving medications we evaluate the potential effects on the kidneys, liver or other parts of the body before giving sedatives, opioids, benzodiazepines, etc.
Let’s take the brain into consideration. Let’s step back and look at the big picture and strive to protect their future function by the choices we make. In that moment. Ask the questions. Is it necessary? Is it worth it? Can we try to allow this patient to wake up after intubation and see if they have pain and anxiety? Can we treat their pain and anxiety without making them comatose and mobile and inducing delirium? May we take brains, lives and souls into consideration as we evaluate our sedation practices.
Transcribed by https://otter.ai
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