Aaron E. Bunnell

Advancements in critical care medicine have improved survival rates for patients experiencing critical illness in intensive care units (ICUs). Although mortality has declined, more than half of ICU survivors experience functional impairments that persist beyond discharge. Of particular concern is ICU‐related cognitive impairment, which can extend across the care continuum, ranging from acute and transient presentations in the ICU (eg, delirium) to long‐term impairments years after discharge. ICU‐related cognitive impairment has received increased attention in the literature, particularly as it relates to ICU survivors who have received and survived critical care in the context of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic and are now experiencing postacute sequelae of SARS‐CoV‐2 infection. The medical complexity and heterogeneity of ICU survivors, coupled with the multifactorial etiology of ICU‐related cognitive impairments, lead to challenges in how to optimize care for ICU survivors at various stages of recovery. This review aims to provide an overview of cognitive outcomes associated with critical illness by integrating recent literature focused on etiology, assessment, and interventions in the context of ICU‐related cognitive impairments. The narrative review employs a biopsychosocial framework to comprehensively evaluate the multifactorial nature of ICU‐related cognitive outcomes. Authors also highlight that multidisciplinary teams composed of key rehabilitation providers are likely best suited for optimizing recovery trajectories of ICU survivors.

Patients with severe cases of coronavirus disease 2019 (COVID‐19) often become critically ill requiring intensive care unit (ICU) management. These individuals are at risk for developing ICU‐acquired weakness (ICUAW), a multifactorial condition in which polyneuropathy, myopathy, and/or disuse muscle atrophy result in motor weakness. This weakness is thought to contribute to the long‐term functional disability frequently observed in survivors of critical illness. This review discusses the current evidence regarding the epidemiology, pathophysiology, evaluation, risk factors, and rehabilitation‐specific management of ICUAW in patients with COVID‐19. Because of the novelty of COVID‐19, the exact prevalence of ICUAW is not well delineated among COVID‐19 patients. However, ICUAW has been reported in this population with retrospective studies showing weakness occurring in up to 45.5% of patients with severe COVID‐19. There are multiple risk factors for developing ICUAW among COVID‐19 patients, including premorbid health status, sepsis, multiple organ failure, mechanical ventilation, immobilization, neuromuscular blockade, corticosteroid use, and glycemic control. ICUAW is more likely to occur after prolonged mechanical ventilation and long hospital stays and can be diagnosed with manual muscle and electrodiagnostic testing. Although the long‐term sequela of COVID‐19 after ICU stays is not fully studied, increasing evidence indicates significant risk for this population developing long‐term functional impairments. Establishing postacute rehabilitation programs for COVID‐19 survivors will be important for recovery of endurance, mobility, and function.