Objectives: Despite decreasing mortality rates in acute lung injury, studies of long-term physical function in acute lung injury survivors have consistently reported poorer quality of life persisting years into recovery for reasons that are not completely understood. We sought to determine if pulmonary dysfunction is independently associated with functional impairment among acute lung injury survivors and to determine if high-resolution computed tomography could be used to predict its development.
Design: Secondary analysis of data from a randomized controlled trial in acute lung injury.
Setting: ICUs at three academic medical centers.
Patients: Patients diagnosed with acute lung injury who had high-resolution computed tomography scans performed at 14 and/or 180 days after diagnosis.
Measurements and Main Results: An objective radiologic scoring system was used to quantify patterns present on chest high-resolution computed tomography obtained at 14 and 180 days in patients with acute lung injury. These scores were correlated in univariable and multivariable analyses with pulmonary function testing and quality of life survey data obtained at 180 days. Eighty-nine patients had evaluable data at day 14, and 47 at 180 days. At 180 days, increased radiologic scores for reticulation were associated with a decreased total lung capacity, forced vital capacity, and diffusing capacity for carbon monoxide (p values all < 0.002). Decrements in quality of life attributable to pulmonary dysfunction were most strongly associated with higher radiologic scores. Additionally, radiologic scores at 14 days independently predicted poorer quality of life at 180 days, accounting for age, severity of illness, pneumonia as the acute lung injury risk factor, and length of time on mechanical ventilation.
Conclusions: Among survivors of acute lung injury, increasing chest high-resolution computed tomography involvement correlated with restrictive physiology and poorer health-related quality of life, implicating pulmonary dysfunction as a potential contributor to activity limitation in these patients.
1 Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Denver, CO.
2 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI.
3 Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City, UT.
4 Department of Radiology, University of Michigan School of Medicine, Ann Arbor, MI.
5 Department of Radiology, National Jewish Health, Denver, CO.
6 Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, Denver, CO.
*See also p. 668.
This work was performed at the University of Michigan School of Medicine, Emory University School of Medicine, and the University of Colorado School of Medicine.
Supported, in part, by research grant P50 HL074024.
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Dr. Burnham has received grant support from the National Institutes of Health (NIH). Dr. Paine III received the study drug for the parent GM-CSF trial without charge from Berlex, Bayer AG, and Genzyme. Dr. Quint has received funding from the NIH. Dr. Lynch has consulted for IntermunegLead, Perceptive Imagery, Novartis, Actelim, and Centocor. He has also received grant support from Siemens. Dr. Standiford has received funding from the NIH. The remaining authors have not disclosed any potential conflicts of interest.
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