Cognitive Impairment in Patients Requiring Mechanical Ventilation and Sedation Due to Critical Illness: A Prospective Observational Study
Bibliographic record
Abstract
Cognitive impairment is a significant and often under-recognized consequence among critically ill patients who undergo mechanical ventilation and sedation. The depth and duration of sedation are increasingly implicated in long-term neurocognitive deficits, necessitating careful evaluation of sedation practices in intensive care units (ICUs). Objective: To assess the prevalence and progression of cognitive impairment in critically ill patients undergoing mechanical ventilation with sedation and to determine the association between sedation type, duration, and cognitive outcomes. Methods: A prospective observational study was conducted from April to September 2024 in the medical, surgical, and cardiac ICUs of a tertiary care hospital. A total of 150 adult patients (aged ≥18 years) requiring mechanical ventilation for ≥48 hours and sedated with midazolam, propofol, or dexmedetomidine were enrolled. Exclusion criteria included pre-existing cognitive or neurologic disorders. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) at ICU discharge, and again at 3- and 6-month follow-up. Sedation parameters, comorbidities, and demographic data were also collected. Statistical analysis was performed using SPSS v25.0. Results: The mean patient age was 58 ± 12 years; 43.3% were male. Cognitive impairment was identified in 28% of patients at ICU discharge, declining to 20% at 3 months and 12% at 6 months. Midazolam was used in 40% of patients, propofol in 35%, and dexmedetomidine in 25%. MoCA scores were highest among patients receiving dexmedetomidine (mean: 26.5 ± 1.8), followed by propofol (24.3 ± 2.1), and lowest with midazolam (22.1 ± 2.5). A significant negative correlation was observed between sedation duration and MoCA score (r = -0.45, p < 0.001), indicating that longer sedation durations were associated with greater cognitive decline. Conclusion: Cognitive impairment is a prevalent and clinically significant complication in critically ill patients receiving sedation and mechanical ventilation. The type and duration of sedation play crucial roles in influencing cognitive outcomes. Dexmedetomidine appears to be associated with better cognitive recovery, while midazolam is linked to poorer outcomes. Strategies aimed at minimizing sedation duration and prioritizing agents with a favorable cognitive profile should be integrated into ICU sedation protocols to enhance long-term patient recovery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".