# Feasibility of Early Assessment of Cognitive Deficits in Patients With Ventilation Sepsis: A Cross-Sectional Study

## TL;DR

This study shows that cognitive impairments are common in sepsis patients, but early computer-based assessments are limited and should be done later in recovery.

## Contribution

The study demonstrates the feasibility and timing of cognitive assessments in sepsis patients using a specific sedation scale.

## Key findings

- Cognitive testing was only feasible when patients had a RASS score of 0 and had regained orientation.
- Tonic and phasic alertness scores were significantly worse in sepsis patients compared to norms.
- Cognitive impairments correlated with sepsis severity markers like ventilation duration and noradrenaline use.

## Abstract

•Sepsis impairs cognitive function, particularly alertness.•Prolonged drowsiness negatively affects cognitive outcome.•Future approaches should commence testing not too early.

Sepsis impairs cognitive function, particularly alertness.

Prolonged drowsiness negatively affects cognitive outcome.

Future approaches should commence testing not too early.

To evaluate the feasibility of early computer-based assessment, quantify cognitive impairments and identify factors influencing cognition.

Prospective, cross-sectional study.

Data were collected on a surgical intensive care unit. All patients underwent cognitive assessment once they reached a Richmond Agitation-Sedation Scale (RASS) score of −1 or higher.

During data collection, 60 patients (N=60) met the inclusion criteria: sepsis and 24 hours of ventilation. Patients with prior cognitive impairment, or neurologic or psychiatric diagnoses, were excluded. Therefore, a total of 28 patients were included in the study.

Not applicable.

Primary outcome variables were tonic alertness, the general level of attention and phasic alertness, the temporarily increased attentiveness after a stimulus. They were normalized for age and sex. The hypothesis proposed was that testing would be feasible starting from a RASS score of −1.

Testing was only possible when patients had a RASS of 0 and had regained orientation. On average, a successful test could be performed 6.6 (mean) days from RASS≥−1 or 4.7 (mean) days after the end of ventilation. On average, the results of tonic alertness were 3 standard deviations (95% CI, −3.8 to −2.2) worse. For phasic alertness, the mean score was −2.3 standard deviations (95% CI, −3.1 to −1.5).

There are significant typical markers for sepsis severity with moderate correlations between an increasing number of ventilation days [r=−0.38, 95% CI: −0.66 to −0.01], number of days required between the cessation of ventilation and testing [r=−0.40, 95% CI: −0.68 to −0.04], days with noradrenaline [r=−0.48, 95% CI: −0.73 to −0.13], and days from awakening to the day of testing [r=−0.5, 95% CI: −0.74 to −0.15] and worsened tonic cognition.

Early cognitive impairments are common in sepsis patients. Although early rehabilitation might be beneficial within this early stage, the utilization of computer-based assessments, appear to be limited. Detailed analysis of cognition should be considered later in recovery process. Further approaches could use demonstrated times at which assessment is likely to be successful.