The Neuropsychological Consequences of Intensive Care

Abstract

Understanding the complex series of factors that contribute to a patient’s recovery from an episode of critical illness is not simple. Defining ‘recovery’ implies that we understand what the patient regards as an acceptable outcome, and of course patients may have very different expectations. For example an elderly patient having surgery for aortic valve disease may be satisfied with relief of dyspnea and chest pain, whereas a young person recovering from severe trauma wishes to return to the same functional status that he or she had prior to their accident. In addition, the patient may wish to return to a physically and mentally active occupation to provide for their family; any deficit perceived in one area is likely to have a negative impact on another. Thus from the patient’s perspective there may be a number of possible definitions of ‘recover’. The sorts of factors that may impair an individual’s recovery are outhned in the Venn diagram in Figure 1 The zones do not overlap because the relative importance and interaction of these zones is highly individual. The complexity of these interactions is exemplified by cardiac surgical patients, many of whom have cognitive deficits measurable during recovery, but whose quality of life is increased because the overwhelming factor is an improvement in physical symptoms after surgery [1 2]. Because intensive care follow-up is a relatively novel phenomenon, this area has been inadequately studied, but some important research is now underway and some published studies are beginning to alert people to these problems. The purpose of this review is to define the current status of this research and place this in the context of ‘recovery’ in its broadest sense.