Mechanisms of Neurologic Failure in Critical Illness
Section snippets
Neurobehavioral changes in critical illness
Clinical evidence of global disturbances in brain function is frequent in the ICU and includes anxiety, confusion, agitation, stupor, and coma. Terms that have been used to denote these changes include “ICU syndrome,” ICU psychosis,” “organic brain syndrome,” “acute confusional state,” “delirium,” “cerebral insufficiency,” “brain failure,” and “encephalopathy.” In recent years, there has been an effort to rationalize and simplify this terminology, with a special emphasis on the syndrome of
Long-term cognitive dysfunction
Available evidence suggests that 30% to 80% of critical illness survivors suffer from long-term cognitive dysfunction (LTCD), which may include, but is not limited to, significant deficits in memory, attention, and executive function [104], [105], [106], [107], [108]. Together with psychiatric disorders (eg, depression, anxiety, and posttraumatic stress disorder) and neuromuscular sequelae, it is believed that LTCD contributes significantly to the reduced quality of life and functional
Critical illness neuromuscular abnormalities
In addition to NCCI, a subset of critically ill patients acquire a syndrome of neuromuscular dysfunction characterized by generalized weakness, decreased or absent deep tendon reflexes, and an inability to wean from mechanical ventilation [149]. Weakness in this setting is associated with a spectrum of disorders including ICU-acquired polyneuropathy, several subtypes of myopathy, and coexisting polyneuropathy and myopathy, collectively termed CINMA [3], [150]. In a recent systematic review of
Summary
Neurologic failure is frequent in critically ill patients and represents a key facet of multiple organ dysfunction. Types of NCCI such as delirium and coma reflect the brain's response to a diverse array of insults, including perturbations in systemic physiology, metabolism, inflammation, and iatrogenic factors such as neuroactive drug administration. NCCI is associated with profound derangements in brain electrophysiology, structure, metabolism, inflammatory state, and neurotransmitter
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