Journal
INTENSIVE CARE MEDICINE
Volume 42, Issue 10, Pages 1557-1566Publisher
SPRINGER
DOI: 10.1007/s00134-016-4530-1
Keywords
Acute respiratory distress syndrome; Intensive care unit; Recovery of function; Physical function
Categories
Funding
- National Institutes of Health [P050HL73994, R01HL088045, K24HL088551]
- Johns Hopkins Institute for Clinical and Translational Research (ICTR) [UL1 TR 000424-06]
- Institutional National Research Service Award [T32HP10025B0]
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Survivors of acute respiratory distress syndrome (ARDS) are at high risk for new or ongoing physical declines after hospital discharge. The objective of our study was to evaluate the epidemiology of physical declines over 5-year follow-up and identify patients at risk for decline. This multi-site prospective cohort study evaluated ARDS survivors who completed a physical status assessment at 3 or 6 months post-discharge. Three measures were evaluated: muscle strength (Medical Resource Council sumscore); exercise capacity [6-min walk test (6MWT)]; physical functioning [36-Item Short Form Health Survey (SF-36 survey)]. Patients were defined as declined if a comparison of their current and prior score showed a decrease that was greater than the Reliable Change Index-or if the patient died. Risk factors [pre-ARDS baseline status, intensive care unit (ICU) illness severity, and other intensive care variables] were evaluated using longitudinal, generalized linear regression models for each measure. During the follow-up of 193 ARDS survivors (55 % male; median age 49 years), 166 (86 %) experienced decline in aeyen1 physical measure (including death) and 133 (69 %) experienced a physical decline (excluding death). For all measures, age was a significant risk factor [odds ratios (OR) 1.34-1.69 per decade; p < 0.001]. Pre-ARDS comorbidity (Charlson Index) was independently associated with declines in strength and exercise capacity (OR 1.10 and 1.18, respectively; p < 0.02), and organ failure [maximum daily Sequential Organ Failure Assessment (SOFA) score in ICU] was associated with declines in strength (OR 1.06 per 1 point of SOFA score; p = 0.02). Over the follow-up period, the majority of ARDS survivors experienced a physical decline, with older age and pre-ICU comorbidity being important risk factors for this decline.
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