Carlson Catherine Gogela, Huang David T
Crit Care. 2013 May 24;17(3):317. doi: 10.1186/cc12709.
Mikkelsen ME, Christie JD, Lanken PN, Biester RC, Thompson BT, Bellamy SL, Localio AR, Demissie E, Hopkins RO, Angus DC: The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med 2012, 185:1307-1315.
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.
The objectives were to determine whether a validated telephone-based neuropsychological test battery is feasible in a multicenter trial and to determine the frequency and risk factors for long-term neuro psychological impairment.
A prospective, multicenter cohort study of a subset of survivors from the Fluid and Catheter Treatment Trial (FACTT) was conducted.
The FACTT enrolled patients from 38 North American hospitals between June 2000 and October 2005.
To be eligible for the ALI Cognitive Outcomes Study (ACOS), subjects had to be enrolled in the FACTT and the EA-PAC (Economic Assessment of the Pulmonary Artery Catheter) trial. The FACTT enrolled mechanically ventilated adults who met the American-European Consensus Conference criteria for ALI.
In an adjunct study to the Acute Respiratory Distress Syndrome Clinical Trials Network Fluid and Catheter Treatment Trial, neuropsychological function at 2 and 12 months after hospital discharge was assessed.
e primary outcome was the result of a validated telephone battery of standardized neuropsychological tests administered to consenting, English-speak-ing subjects at 2 and 12 months after hospital discharge.
Of 406 eligible survivors, 261 patients were approached to participate and 213 consented. One hundred twenty-two subjects, including 102 subjects at 12 months, were tested at least once. 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, respectively. Long-term cognitive impairment was present in 41 (55%) of the 75 survivors who completed cognitive testing. Depression, post-traumatic stress disorder, and anxiety were present in 36% (37 of 102), 39% (40 of 102), and 62% (63 of 102) of long-term survivors, respectively. 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 (P<0.02) impairment.
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. A 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.
米克尔森ME、克里斯蒂JD、兰肯PN、比斯特RC、汤普森BT、贝拉米SL、洛卡利奥AR、德米西E、霍普金斯RO、安格斯DC：成人呼吸窘迫综合征认知结果研究：急性肺损伤幸存者的长期神经心理功能。《美国呼吸与危重症医学杂志》2012年，185:1307 - 1315。
急性肺损伤（ALI）后认知和精神疾病发病率常见且可能可改变。然而，缺乏用于多中心试验的神经心理功能实用测量方法。
目的是确定经过验证的基于电话的神经心理测试组合在多中心试验中是否可行，并确定长期神经心理损害的频率和危险因素。
对液体与导管治疗试验（FACTT）的一部分幸存者进行了一项前瞻性、多中心队列研究。
FACTT在2000年6月至2005年10月期间从38家北美医院招募患者。
要符合ALI认知结果研究（ACOS）的条件，研究对象必须参加FACTT和EA - PAC（肺动脉导管经济评估）试验。FACTT招募了符合美国 - 欧洲共识会议ALI标准的机械通气成人。
在急性呼吸窘迫综合征临床试验网络液体与导管治疗试验的一项辅助研究中，评估了出院后2个月和12个月时的神经心理功能。
主要结果是对出院后2个月和12个月时同意参与且讲英语的受试者进行的经过验证的标准化神经心理测试电话组合的结果。
在406名符合条件的幸存者中，261名患者被邀请参与，213名同意。122名受试者，包括12个月时的102名受试者，至少接受了一次测试。长期幸存者中，记忆、语言流畅性和执行功能受损的比例分别为13%（92名中的12名）、16%（96名中的15名）和49%（76名中的37名）。在完成认知测试的75名幸存者中，41名（55%）存在长期认知损害。长期幸存者中分别有36%（102名中的37名）、39%（102名中的40名）和62%（102名中的63名）存在抑郁、创伤后应激障碍和焦虑。采用保守液体管理策略（P<0.005）与认知损害相关，试验期间较低的动脉血氧分压与认知（P<0.02）和精神（P<0.02）损害相关。
在多中心试验中可通过电话评估神经心理功能。长期神经心理损害在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损害的潜在危险因素；然而，鉴于所研究的特定人群以及机制不明，这一发现需要证实。
