tailieunhanh - Báo cáo y học: "Cognitive dysfunction after critical illness: measurement, rehabilitation, and disclosure"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Cognitive dysfunction after critical illness: measurement, rehabilitation, and disclosure. | Available online http content 13 4 312 Viewpoint Cognitive dysfunction after critical illness measurement rehabilitation and disclosure Cheryl Misak Simcoe Hall King s College Circle University of Toronto Toronto Ontario Canada M5S 1A1 Corresponding author Cheryl Misak Published 26 August 2009 This article is online at http content 13 4 312 2009 BioMed Central Ltd Critical Care 2009 13 312 doi cc7962 Abstract A growing consensus seems to be emerging that neurocognitive outcomes are poor for patients who have been critically ill with acute respiratory distress syndrome and multiple organ failure. However intensive care unit delirium post-traumatic stress disorder and other outcomes must be considered as potentially confounding factors. Once the uncertainty around the causes of postmorbid cognitive functioning is acknowledged there are practical implications for appropriate rehabilitative interventions and there are ethical implications for the kinds of appropriate disclosure to patients. Introduction Intensivists are now examining cognitive outcomes after prolonged critical illness and advanced life support. The results are gripping - Hopkins and Brett 1 suggest that the neurocognitive impairments in ARDS acute respiratory distress syndrome survivors are long lasting and likely permanent . I shall argue that it is difficult to pull apart the diverse factors that might prevent a patient s return to clear thinking. I shall also argue that disclosure of information about cognitive function around which there is genuine uncertainty may have a negative or self-fulfilling effect on patients subsequent progress. Thus important questions are raised about both the issue of disclosure of uncertain prognostic information and about just what interventions might be appropriate for those patients who are experiencing cognitive difficulties after being gravelly ill. In 1998 I spent weeks in an intensive care unit ICU with an