Physical Complications in Acute Lung Injury Survivors

Abstract

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.

Post-intensive care syndrome: An overview

“…[14][15][16] Physical: ICU-acquired neuromuscular weakness is the most common form of physical impairment occurring more than 25% of ICU survivors (poor mobility, recurrent falls, or quadri or tetra paresis). [17][18][19] Conditions strongly associated with the development of ICU-acquired weakness include prolonged mechanical ventilation (> 7 days), sepsis, multisystem organ failure, as well as prolonged duration of the bed-restore deep sedation. [20][21][22] …”

Sindrom postintenzivne skrbi Post-intensive care syndrome

“…development Smanjenje fizičke kondicije i razvoj slabosti tijekom liječe-nja u JIL-u povezuju se s produženom uporabom mehaničke ventilacije (>7 dana), sepsom, multi-organskim zatajenjem organa [engl. multiorganic system failure] i produljenim trajanjem u horizontalnom položaju [16,17]. Rezultati recentnih studija, iznalaze da je stečena slabost JIL povezana s ARDS-om, sindromom sistemskog upalnog odgovora, nereguliranim vrijednostima GUK-a, starijom životnom dobi te kroničnom uporabom vazoaktivnih lijekova i kortikosteroida [18,19].…”

The Hidden Consequences of Ventilator Management Decisions

“…The clinical trial, which suggested efficacy, arbitrarily set the duration of neuromuscular blockade to 48 h. Better data on the optimum timeframe of this intervention would be helpful, because prolonged use of paralytics is associated with muscle wasting, tends to be applied in conjunction with deep sedation, and therefore delays any chance for early physical rehabilitation and risks late neuropsychiatric complications. [14][15][16] …”