Institutional members access full text with Ovid®

Physical Complications in Acute Lung Injury Survivors: A Two-Year Longitudinal Prospective Study

Fan, Eddy MD, PhD1,2; Dowdy, David W. MD, PhD2,3; Colantuoni, Elizabeth PhD2,4; Mendez-Tellez, Pedro A. MD2,5; Sevransky, Jonathan E. MD, MHS6; Shanholtz, Carl MD7; Dennison Himmelfarb, Cheryl R. RN, PhD8; Desai, Sanjay V. MD2,9; Ciesla, Nancy DPT2; Herridge, Margaret S. MD, MPH1; Pronovost, Peter J. MD, PhD2,5,8,10; Needham, Dale M. MD, PhD2,9,11

doi: 10.1097/CCM.0000000000000040
Clinical Investigations

Objective: Survivors of severe critical illness frequently develop substantial and persistent physical complications, including muscle weakness, impaired physical function, and decreased health-related quality of life. Our objective was to determine the longitudinal epidemiology of muscle weakness, physical function, and health-related quality of life and their associations with critical illness and ICU exposures.

Design: A multisite prospective study with longitudinal follow-up at 3, 6, 12, and 24 months after acute lung injury.

Setting: Thirteen ICUs from four academic teaching hospitals.

Patients: Two hundred twenty-two survivors of acute lung injury.

Interventions: None.

Measurements and Main Results: At each time point, patients underwent standardized clinical evaluations of extremity, hand grip, and respiratory muscle strength; anthropometrics (height, weight, mid-arm circumference, and triceps skin fold thickness); 6-minute walk distance, and the Medical Outcomes Short-Form 36 health-related quality of life survey. During their hospitalization, survivors also had detailed daily evaluation of critical illness and related treatment variables. Over one third of survivors had objective evidence of muscle weakness at hospital discharge, with most improving within 12 months. This weakness was associated with substantial impairments in physical function and health-related quality of life that persisted at 24 months. The duration of bed rest during critical illness was consistently associated with weakness throughout 24-month follow-up. The cumulative dose of systematic corticosteroids and use of neuromuscular blockers in the ICU were not associated with weakness.

Conclusions: Muscle weakness is common after acute lung injury, usually recovering within 12 months. This weakness is associated with substantial impairments in physical function and health-related quality of life that continue beyond 24 months. These results provide valuable prognostic information regarding physical recovery after acute lung injury. Evidence-based methods to reduce the duration of bed rest during critical illness may be important for improving these long-term impairments.

1Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.

2Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD.

3Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.

4Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.

5Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

6Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, GA.

7Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD.

8Johns Hopkins University School of Nursing, Baltimore, MD.

9Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

10Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.

11Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.

Drs. Fan, Pronovost, and Needham participated in the conception of the study. Drs. Fan, Dowdy, Colantuoni, Pronovost, and Needham participated in study design. Drs. Mendez-Tellez, Sevransky, Shanholtz, Dennison Himmelfarb, Desai, Ciesla, and Needham recruited patients and collected data. Drs. Fan, Dowdy, Colantuoni, and Needham analyzed the data. All authors participated in the interpretation of the results. Dr. Fan drafted the article, and all authors contributed to critical review and revision of the article. All authors have seen and approved the final version of the article. The funding bodies had no role in the study design, data collection, analysis, interpretation, writing, or decision to submit the article for publication.

Supported, in part, by the National Institutes of Health (Acute Lung Injury SCCOR Grant #P050 HL73994).

Dr. Fan was supported by a Detweiler Traveling Award from the Royal College of Physicians and Surgeons of Canada and a Fellowship Award from the Canadian Institutes of Health Research. Drs. Fan, Shanholtz, and Needham received support for article research from the National Institutes of Health (NIH). Dr. Sevransky’s institution received grant support from Abbott laboratory. Dr. Shanholtz and his institution received grant support from the NIH. Dr. Dennison-Himmelfarb’s institution received grant support from the NIH. Drs. Dennison-Himmelfarb and Pronovost are employed by Johns Hopkins University. Dr. Ciesla’s institution received grant support from the NIH (study funded through the NIH grant). Dr. Ciesla is employed by Johns Hopkins University (research physical therapist and research assistant). Dr. Ciesla received support for article research from the NIH (to principal investigator). Dr. Ciesla received support for travel from Johns Hopkins University (ATS meeting). Dr. Pronovost was supported by a Mid-Career Investigator Award in Patient-Oriented Research (K24 HL88551). Dr. Pronovost’s institution received grant support from the Society of Cardiovascular Anesthesiologists Foundation, Commonwealth Fund, RAND, and NIH (NIH grant for acute lung in injury study). Dr. Pronovost is a board member with the Cantel Medical Group. Dr. Pronovost and his institution lectured for Lehigh Bureau (various hospitals and Health Care organizations). Dr. Pronovost receives royalties from the Penguin Group (published book). Dr. Needham was supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: efan@mtsinai.on.ca

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins