11 June 2021
Cognitive assessment of COVID-19 patients following mechanical ventilation
Jamileth More recently spoke to us about the impact that receiving one of the three 2021 CANTAB Research Grant prizes will have on her research into monitoring protocol of COVID-19 patients survivors of mechanical ventilation.
Let us know a little about yourself and your research organisation?
I am from Venezuela, Biologist of the Universidad Central de Venezuela (UCV). In 2012 I traveled to Santiago, Chile to do my postgraduate studies at the Universidad de Chile. I recently started my postdoctoral research (“Electroencephalographic Biomarkers for the Detection of Major Depressive Disorder as a Prodromal Stage of Alzheimer Disease" FONDECYT Postdoctoral 2021). During these years, I’ve had a great interest in investigating the changes that underlie cognitive decline during neurodegenerative diseases and health impairment.
Currently, I am on a multidisciplinary team at the Centro de Investigación Clinica Avanzada (CICA) at the Hospital Clínico Universidad de Chile, Santiago, Chile. The CICA is compromised with translational research and is integrated by healthcare and basic research professionals. This center is directed by Maria Isabel Behrens, MD Neurologist/Ph.D., coordinated by Daniela Ponce, Eng., who direct young researchers such as: Rodrigo Gutierrez, MD Anesthetist /Ph.D.; Verónica Rojas, Nurse/MSc and myself, Jamileth More MSc/Ph.D.
Provide us with some background to the study, the methods you plan to use, and why?
Previous studies have reported that the time spent on mechanical ventilation and the high levels of sedative drugs used during Intensive Care Unit (ICU) stay increases the risk of potential secondary effects, such as delirium and long-term cognitive impairment. The current COVID-19 pandemic has increased the number of patients requiring hospital care and mechanical ventilation in ICU. The most common intervention practices for COVID-19 patients use unusually high levels of sedative drugs and a combination of multiple sedative agents that increase the risks of potential secondary effects. Therefore, greater precision in the monitoring of the depth of sedation, for example by electroencephalographic (EEG) monitoring, is required.
Previously our team won a grant to investigate an "Electroencephalographic monitoring protocol to guide sedation in patients with COVID-19" (PI Rodrigo Gutierrez, Grant of ANID, Chile 2020). This protocol has shown a lower consumption of anesthetic (propofol) maintaining a clinically adequate level of sedation in mechanically ventilated patients compared with deep sedation guided under another frequently used protocol (sedation-agitation scale (SAS) protocol). In addition, recent reports indicate neurological alterations in COVID-19 patients after mechanical ventilation, but it is still controversial as to whether the neurological alterations are caused by long-term sedation, a direct effect of the virus, or due to pro-inflammatory mediators. Thus, a comprehensive neurological evaluation is necessary in patients with COVID-19 survivors of respiratory failure and mechanical ventilation. The CANTAB Research Grant funding will enable us to perform a cognitive assessment of COVID-19 patients survivors of mechanical ventilation.
To help us understand this, we propose using the CANTAB battery in our cohort of patients with COVID-19 who survived mechanical ventilation and received a light sedation protocol with monitoring of sedation levels contrasting them with patients with the conventional intervention.
After working with the Science team at Cambridge Cognition, and taking into consideration post intensive care syndrome and some of the neurological alterations described in COVID-19 patients surviving mechanical ventilation (impaired consciousness, agitation, confusion, cognitive impairment, impairment of working memory, impairment of processing speed and impairments in executive memory and attention), we plan to use the following CANTAB battery:
- Spatial Working Memory (SWM) - Working memory and strategy
- Paired Associates Learning (PAL) - Visual episodic memory
- Delayed Matching to Sample (DMS) - Attention and short-term visual memory
- Rapid Visual Information Processing (RVP) - Sustained attention
- Emotion Recognition Task (ERT) - Emotion recognition
- One Touch Stockings of Cambridge (OTS) - Executive function and planning
The CANTAB tests have been chosen due to their demonstrated sensitivity to both cognitive decline and cognitive enhancement and are precise and validated tools.
What impact will winning the CANTAB Research Grant have on your research?
I would like to thank the team at Cambridge Cognition for awarding me one of the 2021 CANTAB Research Grant Secondary Awards! I am very happy and excited to be provided with the opportunity to use CANTAB in our research. This grant will support my professional career and help extend my expertise in the study of learning and memory. Also, it will allow us to support our research on cognitive impairment of COVID-19 patients survivors of mechanical ventilation.
What future areas of investigation could follow your research?
The results obtained with the CANTAB battery will allow us to characterize the cognitive performance and identify the cognitive alterations in survivors of mechanical ventilation that could trigger long-term cognitive alterations. Therefore, it is relevant to follow this line of study, also addressing the underlying cellular mechanisms.
Jamileth More - Hospital Clínico Universidad de Chile