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 (HRQOL). Our objective was to determine the longitudinal epidemiology of muscle weakness, physical function, and HRQOL, and their associations with critical illness and intensive care unit exposures. Design A multi-site prospective study with longitudinal follow-up at 3, 6, 12, and 24 months after acute lung injury. Setting 13 intensive care units from 4 academic teaching hospitals. Patients 222 survivors of acute lung injury. 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 (SF-36) HRQOL 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 HRQOL 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 intensive care unit were not associated with weakness. Conclusions Muscle weakness is common after ALI, usually recovering within 12 months. This weakness is associated with substantial impairments in physical function and HRQOL that continue beyond 24 months. These results provide valuable prognostic information regarding physical recovery after ALI. Evidence-based methods to reduce the duration of bed rest during critical illness may be important for improving these long-term impairments.

Purpose To compare neuromuscular electrical stimulation (NMES) versus sham on leg strength at hospital discharge in mechanically ventilated patients. Materials and Methods We conducted a randomized pilot study of NMES versus sham applied to 3 bilateral lower extremity muscle groups for 60 minutes daily in ICU. Between 6/2008 and 3/2013, we enrolled adults who were receiving mechanical ventilation within the first week of ICU stay, and who could transfer independently from bed to chair before hospital admission. The primary outcome was lower extremity muscle strength at hospital discharge using Medical Research Council score (maximum = 30). Secondary outcomes at hospital discharge included walking distance and change in lower extremity strength from ICU awakening. Clinicaltrials.gov:NCT00709124. Results We stopped enrollment early after 36 patients due to slow patient accrual and the end of research funding. For NMES versus sham, mean (SD) lower extremity strength was 28(2) versus 27(3), p=0.072. Among secondary outcomes, NMES versus sham patients had a greater mean (SD) walking distance (514(389) vs. 251(210) feet, p=0.050) and increase in muscle strength (5.7(5.1) vs. 1.8(2.7), p=0.019). Conclusions In this pilot randomized trial, NMES did not significantly improve leg strength at hospital discharge. Significant improvements in secondary outcomes require investigation in future research.

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.

Objective To longitudinally evaluate the association of post-ICU muscle weakness and associated trajectories of weakness over time with 5-year survival. Design Longitudinal prospective cohort study over 5 years of follow-up Patients 156 acute respiratory distress syndrome (ARDS) survivors Setting 13 ICUs in 4 hospitals in Baltimore, MD Interventions None Measurements and Main Results Strength was evaluated with standardized manual muscle testing using the Medical Research Council sumscore (range: 0–60, higher is better), with post-ICU weakness defined as sumscore <48. Muscle strength was assessed at hospital discharge and at 3, 6, 12, 24, 36, and 48 months after ARDS. At discharge, 38% of patients had muscle weakness. Every 1 point increase in sumscore at discharge was associated with improved survival (hazard ratio (95% confidence interval) 0.96 (0.94–0.98)), with similar findings longitudinally (0.95, 0.93–0.98). Having weakness at discharge was associated with worse 5-year survival (1.75, 1.01–3.03); but the association was attenuated (1.54, 0.82–2.89) when evaluated longitudinally over follow-up. Occurring in 50% of patients during follow-up, persisting and resolving trajectories of muscle weakness were associated with worse survival (3.01, 1.12–8.04; and 3.14, 1.40–7.03, respectively) compared to a trajectory of maintaining no muscle weakness. Conclusions At hospital discharge, >1/3 of ARDS survivors had muscle weakness. Greater strength at discharge and throughout follow-up was associated with improved 5-year survival. In patients with post-ICU weakness, both persisting and resolving trajectories, were commonly experienced and associated with worse survival during follow-up.