ABSTRACT
INTRODUCTION: Patients with post-intensive care syndrome (PICS) suffer from a constellation of cognitive, mental, and physical effects. Previous studies have demonstrated increased antidepressant prescribing in patients with PICS. The purpose of this study was to examine the rates of antidepressant and antipsychotic use in patients with PICS following critical illness due to COVID-19. METHOD(S): This was a retrospective chart review of adult patients (>18 years old) with PICS following critical illness due to COVID-19 who had at least 1 visit to the ICU survivor clinic at IU Health between September 2020 and July 2022. Patients were excluded if they were never admitted to the ICU, were admitted to a non IU Health ICU, or if they had incomplete medical records. The primary endpoint was the rate of combined antidepressant and antipsychotic use before ICU admission compared to their last clinic visit. The chi-square test was used to compare nominal data. RESULT(S): A total of 117 patients presented to the survivor clinic during the study time period. 35 patients were included in the analysis. Patients had a mean (+/- SD) age 53 (+/- 17) years and tended to be Caucasian 23 (66%) with low rates of having a college degree 6 (17%). During their ICU stays patients there were high rates of mechanical ventilation 24 (69%). While use of ECMO 9 (26%) and documented delirium 10 (28%) were less frequent. Underlying conditions identified at the initial clinic visit included cognitive impairment 20 (57%), depression 11 (31%), anxiety 8 (23%), and PTSD 4 (11%). Antidepressant and antipsychotic use was higher at the last clinic visit when compared to prior to ICU admission [16 (46%) vs. 5 (14%);p=0.0041]. At the time of the last clinic visit none of the 16 patients were receiving an antipsychotic while all were receiving an antidepressant. CONCLUSION(S): Patients with PICS following critical illness due to COVID-19 have an increased rate of antidepressant prescribing use compared to pre-illness. Further research is needed regarding the management and outcomes of these patients following critical illness due to COVID-19.
ABSTRACT
INTRODUCTION: Post-Intensive care syndrome (PICS) is the culmination of cognitive, psychological and physical issues critical illness survivors encounter. More than half of critically ill patients may experience cognitive impairment after hospital discharge. There is limited information on cognitive impairment surrounding PICS in COVID-19 survivors. This study aims to evaluate the impact anticholinergic cognitive burden has on cognitive function in the COVID-19 survivor patient population. METHODS: This retrospective, observational cohort study included patients from the post-intensive care survivor clinic at Indiana University Health that were discharged from April 2020 to March 2021. Patients were excluded if they did not have an admitting diagnosis of respiratory failure secondary to COVID-19 or did not have discharge documentation. Cognitive impairment was evaluated using the Montreal Cognitive Assessment (MoCA). Demographics and anticholinergic cognitive burden (ACB) scores were compared between patients with cognitive impairment (MoCA < 26) versus those without cognitive impairment (MoCA > 26). RESULTS: Twenty-six patients were included in this evaluation. Twelve patients had cognitive impairment and fourteen patients did not have cognitive impairment. ACB score at discharge for those with and without cognitive impairment had a median (IQR) score of 2.5 (0.75-4.25) and 1 (0.25-2), respectively (p=0.208). The patients with cognitive impairment had a median (IQR) ACB score at the start and end of the initial appointment of 1.5 (0.75-2.5) and 1.5 (0.75-2.25), respectively. The median (IQR) ACB score at the start and end of the initial appointment for patients without cognitive impairment was 1 (0-1.75). Delirium was reported 7 patients (58%) with cognitive impairment compared to 5 patients (36%) without cognitive impairment (p=0.431). The Charlston comorbidity score was higher in those with cognitive impairment, with a median (IQR) score of 3.5 (2.75-5) compared to 0 (0-2) for those without cognitive impairment (p=0.002). CONCLUSIONS: The difference in ACB scores at discharge was not statistically different between patients with and without cognitive impairment. Patients with cognitive impairment post ICU discharge tended to have a higher Charlston comorbidity score.