Trajectories of emotional and physical distress during ICU stay and their association with clinical factors and cognitive status at discharge

Emotional distress, including anxiety and sadness, is common among patients in the intensive care unit (ICU). It may be influenced by clinical factors but also by physical distress symptoms such as dyspnea and pain; however, trajectories of emotional and physical distress and interactions throughout the ICU stay, and their potential impact after discharge, remain relatively unexplored. The main objective of the study was to investigate the trajectory and interplay of anxiety, sadness, dyspnea, and pain during the ICU stay, and also their associations with clinical and demographic factors and with cognitive status at discharge. Observational, longitudinal study in non-delirious adult ICU patients in whom emotional state (anxiety and sadness) and physical discomfort (dyspnea and pain) were assessed daily using a visual analog scale, once an adequate level of consciousness (RASS between - 1 and + 1) had been achieved. A new variable was created to compare the evolution of distress in the different phases of admission. Mixed-effects models were used to explore associations with the phase of ICU stay, invasive mechanical ventilation (IMV), and other clinical variables. Cognitive status was assessed at ICU discharge with the MoCA test. In 62 ICU patients, levels of sadness consistently exceeded anxiety during ICU stay, although both remained stable and declined only in the final phase. IMV was associated with higher levels of sadness (β = 2.45, p < 0.001) and dyspnea (β = 1.24, p = 0.003). Male patients reported lower anxiety levels (β = - 1.34, p = 0.039). Pain correlated with sadness early in the ICU period (r = 0.44, p = 0.016), and with dyspnea during the second (r = 0.54, p = 0.001) and late phases (r = 0.34, p = 0.004). At ICU discharge, 70.9% of patients showed cognitive impairment unrelated to distress, clinical or demographic variables. Sadness was identified as a more prominent component of emotional distress than anxiety during the ICU stay. The findings underscore the impact of IMV on both sadness and dyspnea, highlighting the value of a multidimensional psychological assessment in critically ill patients. The lack of association between cognitive impairment at discharge and in-ICU emotional/physical distress trajectories suggests that cognitive and emotional sequelae may arise from distinct underlying mechanisms. Trial registration: ClinicalTrials.gov (NCT07153380).