The use of a concept analysis method to clarify the meaning of cognitive impairment in patients’ intensive care unit trajectory

BACKGROUND
• Intensive care unit (ICU) survivorship has increased, leading to greater focus on the consequences of an ICU admission.
• Cognitive impairment is a frequent but highly under-recognised complication for critically ill patients.
• It is crucial to clarify the meaning of cognitive impairment in critically ill patients throughout the trajectory of their rehabilitation during and after and ICU admission
METHODS
• A concept analysis based on Rodgers’ evolutionary method.
• Systematic search: CINAHL, PubMed, and PsycINFO.
• Overall search terms: “patients with cognitive impairments” AND “intensive care unit”.
• Inclusion: Literature published between 2008 and 2022; screened by title and abstract.
• Descriptive analysis; focused on surrogate terms/related concepts, attributes, and context
RESULTS
• 30 studies were included, representing variability in study design and country of origin.
• The analysis uncovered descriptions of the general terminology and the temporal trajectory of the concept, spanning from the acute phase to a long-term perspective.
• Attributes of the concept were described as delirium and domains of cognition.
• Antecedents were juxtaposed to risk factors, which were multifactorial.
• Consequences of cognitive impairment related to patients’ quality of life
CONCLUSION
• The concept analysis provided a systematic method to understand cognitive impairment in the critical care pathway in depth.
• Cognitive impairment is a complex concept with many surrogate and related terms and is intertwined with the concepts of delirium and post-intensive care syndrome.
• It is necessary to distinguish between acute and long-term cognitive impairment