Fatigue Symptoms During the First Year Following ARDS

Abstract

BACKGROUND: Fatigue is commonly reported by ARDS survivors, but empirical data are scarce. RESEARCH QUESTION: This study evaluated fatigue prevalence and associated variables in a prospective study of ARDS survivors. STUDY DESIGN AND METHODS: This analysis is part of the ARDSNet Long-Term Outcomes Study (ALTOS) conducted at 38 US hospitals. Using age-and sex-adjusted, time-averaged random effects regression models, we evaluated associations between the validated Functional Assessment of Chronic Illness Therapy-Fatigue Scale with patient and critical illness variables, and with physical, cognitive, and mental health status at 6 and 12 months following ARDS. RESULTS: Among ARDS survivors, 501 of 711 (70%) and 436 of 659 (66%) reported clinically significant symptoms of fatigue at 6 and 12 months, respectively, with 41% and 28% reporting clinically important improvement and worsening (n ¼ 638). At 6 months, the prevalence of fatigue (70%) was greater than that of impaired physical functioning (50%), anxiety (42%), and depression (36%); 46% reported both impaired physical function and fatigue, and 27% reported co-existing anxiety, depression, and fatigue. Fatigue was less severe in men and in those employed prior to ARDS. Critical illness variables (eg, illness severity, length of stay) had little association with fatigue symptoms. Worse physical, cognitive, and mental health symptoms were associated with greater fatigue at both the 6-and 12-month follow-up. INTERPRETATION: During the first year following ARDS, more than two-thirds of survivors reported clinically significant fatigue symptoms. Due to frequent co-occurrence, clinicians should evaluate and manage survivors' physical, cognitive, and mental health status when fatigue is endorsed.

Fatigue of ICU Survivors, No Longer to Be Neglected

“…9 The mean transformed FACIT-F score AE SD that we found in the patients was 66 AE 12, which is quite similar to the 62 AE 18 found by Neufeld et al 8 This finding may be surprising considering that the patients we presented were less critically ill than those of Neufeld et al 8 (mean ICU length of stay, 10 AE 11 and 14 AE 11 days, respectively). Considering that the transformed FACIT-F score for the normal US population is 74.7 AE 15, 7 both studies 8,9 suggest that, generally, ICU survivors at 1 year suffer from symptoms of fatigue, especially younger patients with ARDS (mean age, 49 AE 15 years 8 and 68 AE 11 years, respectively). 9 Furthermore, the authors pointed out that the prevalence of fatigue at 6 months was greater than impaired physical function, impaired cognition, anxiety, or depression.…”

“…In this field, the use of tools assessing patient-reported outcomes is widespread, and as far as fatigue is concerned, a dedicated tool to appraise the perceived fatigue in detail has been developed. 7 In this issue of CHEST, Neufeld et al 8 investigated the occurrence of fatigue assessed by the Functional Assessment of Chronic Illness Therapy (FACIT-F), after 6 and 12 months, in ARDS survivors. Interestingly, 70% and 66% of former patients with ARDS reported clinically significant symptoms of fatigue at 6 and 12 months, respectively.…”

“…Indeed, social integration affected HRQoL to a larger extent than age, sex, and the ICUrelated factors examined, but to a lower extent than the preexisting diseases. 10 The strengths of the study of Neufeld et al 8 include the multicenter longitudinal prospective design, the followup at 6 and 12 months after discharge, the high rate of responders, and the use of comprehensive measures of neurocognitive outcome in a well-defined ARDS population. Nevertheless, the high number of hospitals involved in the study (n ¼ 38) and the long period taken to enroll patients (7 years) may reflect a selection bias, possibly testified by the quite young mean age of participants (49 years of age) and the high percentage of those living independently prior to admission in the ICU (91%).…”

Survivorship after COVID-19 ICU stay

“…The interplay of physical, cognitive and mental health impairments can lead to important functional problems, such as persistent fatigue, chronic pain and sleep dysfunction, and reduced health-related quality of life 8 . Moreover, globally, at 1-year follow-up, one-third of previously employed survivors of ICU stay are jobless 9 .…”

COVID-19 and pulmonary rehabilitation: preparing for phase three

“…It has been found that cognitive impairment in ARDS survivors ranges from 70% to 100% at hospital discharge and 20% at 5 years, while mood deterioration including depression and post-traumatic stress disorder were also present [ 6 ]. Patients with COVID-19 seem to be prone to movement-related fatigue, similar to ARDS patients [ 7 ], even in those subjects not developing a critical illness. Therefore, the rehabilitation community is calling for action preparing for post-intensive care syndrome (PICS) in COVID-19 patients [ 8 – 10 ].…”