Changes in cognitive function after pediatric intensive care unit rounds: A prospective study

Mental fatigue is impaired cognitive function induced by engaging in cognitively demanding activities. Pediatric intensive care unit (PICU) rounds are demanding and may be a cause of impaired cognitive functioning. The purpose of this study is to evaluate if PICU rounds induce poorer performance on cognitive tasks after rounds compared to before rounds and assess the feasibility of cognitive testing in the PICU. This was a prospective study of residents in the PICU. Participants were evaluated before and after rounds on a single day, consisting of two tests of cognitive function that are sensitive to mental fatigue, the cognitive estimation test (CET) and the repeatable episodic memory test (REMT). Thirty residents participated. The mean length of rounds was 191 min (SD 33.8 min), the mean number of patients rounded on by the team was 14.9 (SD 2.3) and the median patients presented by the participant was two (range 0-6). The average number of words recalled on the REMT was significantly lower after rounds compared to before (29.6 vs. 31.2, p < 0.05). There were significantly more falsely recalled words after rounds (1.3 vs. 0.7, p=0.02). There was a correlation between worsening performance and later time of testing in the 4-week PICU rotation (r=0.42, p < 0.02). There were no differences in performance on the CET. PICU rounds induced impairments on cognitive testing but the effect size is small and not consistent across tests. There is an increased susceptibility to impaired cognition induced by rounds over the course of a rotation, this finding merits further investigation.