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Critical illness is a situation of severe and prolonged stress for patients with mechanical ventilation (MV). Between 40-80% of these patients present the Post-ICU syndrome, a set of physical, cognitive, psychological alterations at hospital discharge. In more than a third of the ICU survivors, these sequelae become chronic being observed months and even years after ICU stay.
The characteristics of the Post-ICU syndrome have been related to different risk factors associated with the critical illness and its management. However, the impact of accumulated physiological stress is still unknown. The physiological response to prolonged stress generates high levels of cortisol that have been related to the loss of muscle tissue, cognitive and psychological alterations in both clinical populations and healthy subjects. The concentration of cortisol in plasma is not a measure of adequate physiological stress due to the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis during critical illness. Therefore, the objective of this study is to assess the levels of accumulated cortisol in human hair (CHH) during the different stages of the critical illness and its recovery, as well as to explore its relationship with the functional and neuropsychological sequelae observed in the ICU survivors.
A prospective pilot study has been proposed in 50 critical patients with> 24 hours of mechanical ventilation. CHH levels will be recorded at admission, 1 month and 1 year after ICU discharge. In all survivors, the presence of delirium will be assessed during the ICU stay and the functional, cognitive and psychological status will be assessed at short (1 month after ICU discharge) and long term (1 year after ICU discharge).
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| Measure | Description | Time Frame |
|---|---|---|
| Accumulated physiological stress | Levels of Cortisol in Human Hair (CHH) | At admission |
| Accumulated physiological stress | Levels of Cortisol in Human Hair (CHH) | 1 month after discharge |
| Accumulated physiological stress | Levels of Cortisol in Human Hair (CHH) | 1 year after discharge |
| Measure | Description | Time Frame |
|---|---|---|
| Delirium | Confusion Assessment Method for ICU(CAM-ICU) | From date of ICU admission until the date of ICU discharge or date of death from any cause, whichever came first, assessed up to 3 months |
| Comorbidity index |
| Measure | Description | Time Frame |
|---|---|---|
| Illness severity | Acute Physiology and Chronic Health Evaluation (APACHE II) | At ICU admission |
| Days of MV | Time with mechanical ventilation |
Inclusion Criteria:
Exclusion Criteria:
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Critically ill patients undergoing mechanical ventilation
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| Name | Affiliation | Role |
|---|---|---|
| LluÃs Blanch, PhD | I3PT-Fundació Parc Taulà | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fundacio Parc Taulà | Sabadell | Barcelona | 08208 | Spain |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25409903 | Background | Berghe GV. Novel insights in the HPA-axis during critical illness. Acta Clin Belg. 2014 Dec;69(6):397-406. doi: 10.1179/2295333714Y.0000000093. | |
| 22975887 | Background | Cuesta JM, Singer M. The stress response and critical illness: a review. Crit Care Med. 2012 Dec;40(12):3283-9. doi: 10.1097/CCM.0b013e31826567eb. |
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| ID | Term |
|---|---|
| D016638 | Critical Illness |
| D060825 | Cognitive Dysfunction |
| D001008 | Anxiety Disorders |
| D003863 | Depression |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D003072 | Cognition Disorders |
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Charlson comorbidity index
| At ICU admission |
| Frailty index | Clinical frailty scale of Rockwood (Range 1 to 9 from 'Very fit patient' to ' Terminally ill patient' | At ICU admission |
| Post-ICU syndrome physical sequelae | Functional score (Muscle weakness - Grip strength) | 1 month after discharge |
| Post-ICU syndrome physical sequelae | Functional score (Muscle weakness - Grip strength) | 1 year after discharge |
| Post-ICU syndrome functional sequelae | Functional score (Functional Morbidity - Time Up&Go) | 1 month after discharge |
| Post-ICU syndrome functional sequelae | Functional score (Functional Morbidity - Time Up&Go) | 1 year after discharge |
| Post-ICU syndrome cognitive sequelae | Neurocognitive score (Neurocognitive Indexes based in the neuropsychological tests) | 1 month after discharge |
| Post-ICU syndrome cognitive sequelae | Neurocognitive score (Neurocognitive Indexes based in the neuropsychological tests) | 1 year after discharge |
| Post-ICU syndrome psychological sequelae | Psicological status (Anxiety & Depression score) | 1 month after discharge |
| Post-ICU syndrome psychological sequelae | Psicological status (Anxiety & Depression score) | 1year after discharge |
| From date of intubation in ICU until the date of extubation in ICU or date of death from any cause, whichever came first, assessed up to 3 months |
| ICU stay | Days in ICU | From date of ICU admission until the date of ICU discharge or date of death from any cause, whichever came first, assessed up to 24 months |
| Hospital stay | Days in hospital after ICU discharge | From date of ICU discharge until the date of hospital discharge or date of death from any cause, whichever came first, assessed up to 24 months |
| Level of f alertness or agitation | Richmond Agitation-Sedation Scale (RASS) | From date of ICU admission until the date of ICU discharge or date of death from any cause, whichever came first, assessed up to 3 months |
| Dosis of sedatives and opioids | Daily accumulated dosis of sedatives and opioids | From date of ICU admission until the date of ICU discharge or date of death from any cause, whichever came first, assessed up to 3 months |
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| 24088092 | Background | Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes CG, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese SK, Canonico A, Hopkins RO, Bernard GR, Dittus RS, Ely EW; BRAIN-ICU Study Investigators. Long-term cognitive impairment after critical illness. N Engl J Med. 2013 Oct 3;369(14):1306-16. doi: 10.1056/NEJMoa1301372. |
| 23384320 | Background | Hopkins RO. The brain after critical illness: effect of illness and aging on cognitive function. Crit Care. 2013 Feb 6;17(1):116. doi: 10.1186/cc11913. |
| 12682497 | Background | Jackson JC, Hart RP, Gordon SM, Shintani A, Truman B, May L, Ely EW. Six-month neuropsychological outcome of medical intensive care unit patients. Crit Care Med. 2003 Apr;31(4):1226-34. doi: 10.1097/01.CCM.0000059996.30263.94. |
| 27334119 | Background | Reser JE. Chronic stress, cortical plasticity and neuroecology. Behav Processes. 2016 Aug;129:105-115. doi: 10.1016/j.beproc.2016.06.010. Epub 2016 Jun 19. |
| 16870732 | Background | Liston C, Miller MM, Goldwater DS, Radley JJ, Rocher AB, Hof PR, Morrison JH, McEwen BS. Stress-induced alterations in prefrontal cortical dendritic morphology predict selective impairments in perceptual attentional set-shifting. J Neurosci. 2006 Jul 26;26(30):7870-4. doi: 10.1523/JNEUROSCI.1184-06.2006. |
| 27986469 | Background | Allen AP, Curran EA, Duggan A, Cryan JF, Chorcorain AN, Dinan TG, Molloy DW, Kearney PM, Clarke G. A systematic review of the psychobiological burden of informal caregiving for patients with dementia: Focus on cognitive and biological markers of chronic stress. Neurosci Biobehav Rev. 2017 Feb;73:123-164. doi: 10.1016/j.neubiorev.2016.12.006. Epub 2016 Dec 13. |
| 19040777 | Background | Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G. Clinical review: Critical illness polyneuropathy and myopathy. Crit Care. 2008;12(6):238. doi: 10.1186/cc7100. Epub 2008 Nov 25. |
| 23506003 | Background | Boonen E, Vervenne H, Meersseman P, Andrew R, Mortier L, Declercq PE, Vanwijngaerden YM, Spriet I, Wouters PJ, Vander Perre S, Langouche L, Vanhorebeek I, Walker BR, Van den Berghe G. Reduced cortisol metabolism during critical illness. N Engl J Med. 2013 Apr 18;368(16):1477-88. doi: 10.1056/NEJMoa1214969. Epub 2013 Mar 19. |
| 22366690 | Background | Stalder T, Kirschbaum C. Analysis of cortisol in hair--state of the art and future directions. Brain Behav Immun. 2012 Oct;26(7):1019-29. doi: 10.1016/j.bbi.2012.02.002. Epub 2012 Feb 15. |
| 26881835 | Background | McLennan SN, Ihle A, Steudte-Schmiedgen S, Kirschbaum C, Kliegel M. Hair cortisol and cognitive performance in working age adults. Psychoneuroendocrinology. 2016 May;67:100-3. doi: 10.1016/j.psyneuen.2016.01.029. Epub 2016 Feb 1. |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |