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Dellinger RP, Trzeciak SW, Criner GJ, Zimmerman JL, Taylor RW, Usansky H, Young J, Goldstein B. Association between inhaled nitric oxide treatment and long-term pulmonary function in survivors of acute respiratory distress syndrome. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R36. [PMID: 22386043 PMCID: PMC3681348 DOI: 10.1186/cc11215] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 10/04/2011] [Accepted: 03/02/2012] [Indexed: 01/11/2023]
Abstract
Introduction Assessment of treatments for acute respiratory distress syndrome (ARDS) has focused on short-term outcomes (for example, mortality); little information exists regarding long-term effects of ARDS treatment. Survivors of ARDS episodes may have long-term obstructive/restrictive pulmonary abnormalities and pulmonary gas exchange impairment. A 2004 prospective randomized placebo-controlled trial assessed the efficacy and safety of inhaled nitric oxide (iNO) in patients with non-septic ARDS; the primary endpoint was days alive and off assisted breathing. This analysis examined potential effects of iNO or placebo on pulmonary function six months post-treatment in ARDS survivors from that original study. Methods ARDS survivors (N = 92) from a large-scale randomized, placebo-controlled study evaluating mortality after either 5 ppm iNO or placebo for up to 28 days were assessed six months post-treatment. Pulmonary function testing across seven parameters was conducted. Results At 6 months post-treatment, results indicated significantly better absolute values for iNO versus placebo for mean ± SD total lung capacity (TLC, 5.54 ± 1.42 vs. 4.81 ± 1.00; P = 0.026). There were also significantly better values for mean ± SD percent predicted values for a) forced expiratory volume in 1 second (FEV1, 80.23 ± 21.21 vs. 69.51 ± 28.97; P = 0.042), b) forced vital capacity (FVC, 83.78 ± 19.37 vs. 69.84 ± 27.40; P = 0.019), c) FEV1/FVC (96.14 ± 13.79 vs. 87.92 ± 19.77; P = 0.033), and d) TLC (93.33 ± 18.21 vs. 76.10 ± 21.84; P < 0.001). Nonsignificant differences were found in absolute FEV1, FEV1/FVC, FVC, forced expiratory flow from 25% to 75% of FVC, functional residual capacity, and CO diffusion. Conclusions ARDS patients surviving after treatment with low-dose iNO had significantly better values for select pulmonary function tests at six months post-treatment than placebo-treated patients. Further trials are warranted to determine the effects of iNO on chronic lung function in ARDS survivors, a factor in long-term morbidity and quality of life in this population. Trial Registration A Double-blind, Randomized, Placebo-controlled, Dose-response Study of Inhaled Nitric Oxide in the Treatment of Acute Respiratory Distress Syndrome. NCT number: ISRCTN53268296
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Affiliation(s)
- R Phillip Dellinger
- Division of Critical Care Medicine, Department of Medicine, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103, USA.
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Hodgson CL, Hayes K, Everard T, Nichol A, Davies AR, Bailey MJ, Tuxen DV, Cooper DJ, Pellegrino V. Long-term quality of life in patients with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation for refractory hypoxaemia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R202. [PMID: 23082772 PMCID: PMC3682304 DOI: 10.1186/cc11811] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 09/28/2012] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The purpose of the study was to assess the long term outcome and quality of life of patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) for refractory hypoxemia. METHODS A retrospective observational study with prospective health related quality of life (HRQoL) assessment was conducted in ARDS patients who had ECMO as a rescue therapy for reversible refractory hypoxemia from January 2009 until April 2011 in a tertiary Australian centre. Survival and long-term quality of life assessment, using the Short-Form 36 (SF-36) and the EuroQol health related quality of life questionnaire (EQ5D) were assessed and compared to international data from other research groups. RESULTS Twenty-one patients (mean age 36.3 years) with ARDS receiving ECMO for refractory hypoxemia were studied. Eighteen (86%) patients were retrieved from external intensive care units (ICUs) by a dedicated ECMO retrieval team. Eleven (55%) had H1N1 influenza A-associated pneumonitis. Eighteen (86%) patients survived to hospital discharge. Of the 18 survivors, ten (56%) were discharged to other hospitals and 8 (44%) were discharged directly home. Sequelae and health related quality of life were evaluated for 15 of the 18 (71%) long-term survivors (assessment at median 8 months). Mean SF-36 scores were significantly lower across all domains compared to age and sex matched Australian norms. Mean SF-36 scores were lower (minimum important difference at least 5 points) than previously described ARDS survivors in the domains of general health, mental health, vitality and social function. One patient had long-term disability as a result of ICU acquired weakness. Only 26% of survivors had returned to previous work levels at the time of follow-up. CONCLUSIONS This ARDS cohort had a high survival rate (86%) after use of ECMO support for reversible refractory hypoxemia. Long term survivors had similar physical health but decreased mental health, general health, vitality and social function compared to other ARDS survivors and an unexpectedly poor return to work.
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Wehler M. [Long-term outcome of elderly patients after intensive care treatment]. Med Klin Intensivmed Notfmed 2012; 106:29-33. [PMID: 21975839 DOI: 10.1007/s00063-011-0021-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In general, elderly patients have poorer outcomes than younger patients after intensive care treatment. Diagnosis at admission and high age mainly influence short-term mortality within the first few months after intensive care, while comorbitities and functional status are more pivotal regarding long-term mortality. Furthermore, the main reasons for reduced physical fitness and neurocognitive consequences that often last for many months after intensive care treatment of older patients are described. Many outcome studies show that physical und mental sequelae after intensive care treatment are not only substantial but also unpredictable. Due to the constant improvement of intensive care treatment during recent decades, increasingly more patients survive their acute critical disease. Now it is time to focus on translational research to discover causal relationships between intensive care treatment and morbidity during follow-up to improve the quality of survival.
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Affiliation(s)
- M Wehler
- Zentrale Notaufnahme, Klinikum Augsburg, Augsburg, Deutschland.
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Finigan JH, Mishra R, Vasu VT, Silveira LJ, Nethery DE, Standiford TJ, Burnham EL, Moss M, Kern JA. Bronchoalveolar lavage neuregulin-1 is elevated in acute lung injury and correlates with inflammation. Eur Respir J 2012; 41:396-401. [PMID: 22599357 DOI: 10.1183/09031936.00004912] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Shedding of neuregulin (NRG)-1 from the pulmonary epithelium leads to activation of the epithelial human epidermal growth factor receptor (HER)2 receptor, increased pulmonary epithelial permeability and acute lung injury (ALI). We sought to determine whether NRG-1 was detectable and elevated in bronchoalveolar lavage (BAL) and plasma from patients with ALI compared with controls and to determine whether a correlation exists between NRG-1 and inflammation and outcome in ALI. Matched BAL and plasma samples were obtained from 23 ALI patients requiring intubation and mechanical ventilation. Control patients (n=5) included healthy volunteers. NRG-1 and indices of inflammation were measured in BAL and plasma via ELISA. The mean±sd BAL NRG-1 concentration in ALI patients was 187.0±21.35 pg·mL(-1) compared with 85.50±9.2 pg·mL(-1) in controls (p=0.001). Increased BAL NRG-1 was associated with markers of inflammation, and inversely correlated with ventilator-free days (VFDs; r= -0.51, p=0.015). Plasma NRG-1 was elevated in ALI patients compared with controls (611.7±354.2 versus 25.17±19.33 pg·mL(-1), p<0.001) and inversely correlated with VFDs (r= -0.51, p=0.04). These results confirm shedding of NRG-1 in ALI and suggest that the NRG-1-HER2 pathway is active in patients with ALI.
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Affiliation(s)
- James H Finigan
- Dept. of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
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A randomized trial of recombinant human granulocyte-macrophage colony stimulating factor for patients with acute lung injury. Crit Care Med 2012; 40:90-7. [PMID: 21926600 DOI: 10.1097/ccm.0b013e31822d7bf0] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
RATIONALE Despite recent advances in critical care and ventilator management, acute lung injury and acute respiratory distress syndrome continue to cause significant morbidity and mortality. Granulocyte-macrophage colony stimulating factor may be beneficial for patients with acute respiratory distress syndrome. OBJECTIVES To determine whether intravenous infusion of granulocyte-macrophage colony stimulating factor would improve clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome. DESIGN A randomized, double-blind, placebo-controlled clinical trial of human recombinant granulocyte-macrophage colony stimulating factor vs. placebo. The primary outcome was days alive and breathing without mechanical ventilatory support within the first 28 days after randomization. Secondary outcomes included mortality and organ failure-free days. SETTING Medical and surgical intensive care units at three academic medical centers. PATIENTS One hundred thirty individuals with acute lung injury of at least 3 days duration were enrolled, out of a planned cohort of 200 subjects. INTERVENTIONS Patients were randomized to receive human recombinant granulocyte-macrophage colony stimulating factor (64 subjects, 250 μg/M) or placebo (66 subjects) by intravenous infusion daily for 14 days. Patients received mechanical ventilation using a lung-protective protocol. MEASUREMENTS AND MAIN RESULTS There was no difference in ventilator-free days between groups (10.7 ± 10.3 days placebo vs. 10.8 ± 10.5 days granulocyte-macrophage colony stimulating factor, p = .82). Differences in 28-day mortality (23% in placebo vs. 17% in patients receiving granulocyte-macrophage colony stimulating factor (p = .31) and organ failure-free days (12.8 ± 11.3 days placebo vs. 15.7 ± 11.9 days granulocyte-macrophage colony stimulating factor, p = .16) were not statistically significant. There were similar numbers of serious adverse events in each group. CONCLUSIONS In a randomized phase II trial, granulocyte-macrophage colony stimulating factor treatment did not increase the number of ventilator-free days in patients with acute lung injury/acute respiratory distress syndrome. A larger trial would be required to determine whether treatment with granulocyte-macrophage colony stimulating factor might alter important clinical outcomes, such as mortality or multiorgan failure. (ClinicalTrials.gov number, NCT00201409 [ClinicalTrials.gov]).
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Chiumello D, Taccone P, Berto V, Marino A, Migliara G, Lazzerini M, Gattinoni L. Long-term outcomes in survivors of acute respiratory distress syndrome ventilated in supine or prone position. Intensive Care Med 2011; 38:221-9. [PMID: 22187085 DOI: 10.1007/s00134-011-2445-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 10/25/2011] [Indexed: 12/29/2022]
Abstract
PURPOSE The aim of this study is to examine long-term pulmonary function and quality of life in survivors of acute respiratory distress syndrome (ARDS) previously enrolled in a randomized multicenter trial testing prone compared with supine positioning (PSII study) at five Italian centers. DESIGN Observational prospective study. SUBJECTS AND MEASUREMENTS Pulmonary function [spirometric test, gas exchange, carbon monoxide diffusion capacity (DLCO)], high-resolution computed tomography (CT) scan, and health-related quality of life [Short Form-36 (SF-36) and St. George's Respiratory Questionnaire] were evaluated at 12 months. RESULTS Twenty-six patients (13 in each group, mean age 54.1 ± 2.8 years, body mass index 24.5 ± 1.4 kg/m(2), PaO(2)/FiO(2) 117 ± 49 mmHg) were evaluated. There were no significant differences in demographic data, illness severity, or outcome between the prone and supine groups. The overall survival rate was 40%. Pulmonary function was in the normal range without any differences between the two groups. Quantitative lung CT scan analysis showed similar amounts for not aerated (8.1 ± 3.2% versus 7.3 ± 3.4%), poorly aerated (15.3 ± 3.6% versus 17.1 ± 4.9%), and well-aerated (64.0% ± 8.4 versus 70.2 ± 8.4%) lung regions, while overaerated lung region was slightly higher in the prone compared with the supine group (12.5 ± 6.5% versus 5.3 ± 5.5%). Health-related quality of life was similar to in healthy population. However, these patients showed reduction in daily activity specifically due to pulmonary disease as measured by the St. George's Respiratory Questionnaire. CONCLUSIONS No differences in pulmonary function or quality of life were observed in this small group of ARDS survivor patients treated in prone versus supine position.
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Affiliation(s)
- D Chiumello
- Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy.
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Abstract
Interest in longer-term outcomes after acute respiratory distress syndrome (ARDS) and the understanding of patterns of recovery have increased enormously over the past 10 years. This article highlights important advances in outcomes after ARDS and describes pulmonary outcomes, the most recent data on functional and neuropsychological disability in patients, health care cost, family caregivers, and early models of rehabilitation and intervention.
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Affiliation(s)
- Margaret S Herridge
- Division of Respiratory and Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, 11C-1180 585 University Avenue, Toronto, Ontario M5G 2C4, Canada.
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Quispe-Laime AM, Fiore C, González-Ros MN, Bettini JE, Rolfo VE, Campagne CG, Barberio PA. [Lung diffusion capacity and quality of life 6 months after discharge from the ICU among survivors of acute respiratory distress syndrome due to influenza A H1N1]. Med Intensiva 2011; 36:15-23. [PMID: 22118978 DOI: 10.1016/j.medin.2011.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 09/03/2011] [Accepted: 09/08/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE An evaluation is made of lung function and quality of life 6 months after discharge from the Intensive Care Unit (ICU) among survivors of acute respiratory distress syndrome (ARDS) due to pandemic 2009 influenza A H1N1, based on studies of lung function and the EQ-5D health questionnaire. DESIGN Case series. SETTING The ICU of Dr. Leónidas Lucero Acute Cases Municipal Hospital, Bahía Blanca, Argentina. PATIENTS PATIENTS discharged from the ICU who had been admitted with ARDS in 2009 due to influenza A H1N1. RESULTS Eleven patients were studied. Seven were positive for influenza H1N1 and four were negative. The mean age was 37±9.5 years, and 73% were males. Quality of life, as measured by the EQ-5D, showed changes in the 5 components in all patients, particularly in the pain/discomfort dimension 1.55±0.52; health status (EQ%health) was 70%±24. The indices adjusted for Argentina were Time Trade Off (TTO) 0.903±0.085 and Visual Analog Scale (VAS) 0.827±0.153. In all patients, spirometry and the study of pulmonary diffusion (DLCO) showed values of >80%. There was no correlation between lung diffusion and quality of life (%DLCO and EQ%health). A correlation was observed between quality of life and TTO (EQ%health and TTO), and between quality of life and the VAS score (EQ%health and VAS). CONCLUSION Although the sample is small, our results suggest that patients with ARDS due to influenza A H1N1 evaluated 6 months after discharge from the ICU show no deterioration of lung function, and the impact on quality of life is moderate-in contrast to the situation found in patients with ARDS of other etiologies.
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Affiliation(s)
- A M Quispe-Laime
- Unidad de Cuidados Intensivos, Hospital Municipal de Agudos Dr. Leónidas Lucero, Bahía Blanca, Argentina. ,
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Wilcox ME, Herridge MS. Lung function and quality of life in survivors of the acute respiratory distress syndrome (ARDS). Presse Med 2011; 40:e595-603. [PMID: 22078086 DOI: 10.1016/j.lpm.2011.04.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 04/29/2011] [Indexed: 11/26/2022] Open
Abstract
Recent studies have begun to describe the long-term outcomes of acute respiratory distress syndrome (ARDS) survivors. These patients experience a number of physical, mental and psychological morbidities that significantly impair their health-related quality of life (HRQL). The trajectory of pulmonary recovery in survivors of ARDS, as it relates to lung function, structure and health-related quality of life (HRQL), is predictable and often persists years after hospital discharge. True pulmonary parenchymal morbidity is uncommon and when present, persistent restrictive disease is likely related to diaphragmatic weakness with a mild reduction in diffusion capacity (DLCO). Future research should focus on identifying patients at risk for long-term functional limitations and the design of rehabilitation interventions tailored to individual patient needs.
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Affiliation(s)
- M Elizabeth Wilcox
- University of Toronto, Toronto Western Hospital, Division of Pulmonary and Critical Care Medicine, Toronto, Ontario, Canada.
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Adhikari NKJ, Tansey CM, McAndrews MP, Matté A, Pinto R, Cheung AM, Diaz-Granados N, Herridge MS. Self-reported depressive symptoms and memory complaints in survivors five years after ARDS. Chest 2011; 140:1484-1493. [PMID: 21998261 DOI: 10.1378/chest.11-1667] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Survivors of ARDS report depressive symptoms and memory complaints, the prevalence of which after 5 years is unknown. METHODS We administered instruments assessing symptoms of depression (Beck Depression Inventory II [BDI-II]) and memory complaints (Memory Assessment Clinics Self-Rating Scale [MAC-S]) to 64 survivors of ARDS from four university-affiliated ICUs 5 years after ICU discharge. We compared BDI-II scores to quality of life (Medical Outcomes Study 36-Item Short Form [SF-36]) mental health domains (role emotional, mental health, mental component summary), compared BDI-II and MAC-S scores to earlier scores (median, 22 months postdischarge), and examined return to work. RESULTS Forty-three (67.2%), 46 (71.9%), and 38 (59.4%) patients fully completed the BDI-II, MAC-S ability subscale, and MAC-S frequency of occurrence subscale, respectively. Responders were young (median, 48 years; first-third quartile [Q1-Q3], 39-61 years) with high illness severity. The median BDI-II score was 10 (Q1-Q3, 3-18); eight of 43 (18.6%) had moderate to severe depressive symptoms compared with 14 of 43 (32.6%) earlier (P = .15, n = 38 with paired data). Median MAC-S ability and MAC-S frequency scores were 81 (Q1-Q3, 57-92) and 91.5 (Q1-Q3, 76-105), respectively, similar to earlier scores (P = .67 and P = .64, respectively); 0% to 4.3% scored > 2 SDs below population norms. Higher BDI-II score was predicted by higher earlier BDI-II score, slower recovery of organ function, and longer duration of mechanical ventilation and ICU stay. Higher MAC-S score was predicted by higher earlier MAC-S score. SF-36 mental health domain scores were very stable (P = .57-.83). BDI-II and SF-36 mental health domains were negatively correlated (Spearman coefficient, -0.50 to -0.82). Most patients returned to work regardless of depressive symptoms (minimal to mild, 31 of 35 [88.6%]; moderate to severe, five of eight [62.5%]; P = .12). CONCLUSIONS Compared with ∼ 2 years postdischarge from the ICU, depressive symptoms and memory complaints were similar at 5 years. Mental health domains of the SF-36 may not be sensitive to small changes in mood symptoms.
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Affiliation(s)
- Neill K J Adhikari
- Interdepartmental Division of Critical Care, University of Toronto, Toronto; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto.
| | | | | | - Andrea Matté
- Department of Medicine, University Health Network, Toronto
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto
| | - Angela M Cheung
- Department of Medicine, University Health Network, Toronto; Women's Health Program, University Health Network, Toronto; Department of Medicine, University of Toronto, Toronto; Department of Health Policy, Management and Evaluation and the Dalla Lana School of Public Health, University of Toronto, Toronto
| | - Natalia Diaz-Granados
- Women's Health Program, University Health Network, Toronto; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care, University of Toronto, Toronto; Department of Medicine, University Health Network, Toronto; Department of Medicine, University of Toronto, Toronto
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Benington S, McWilliams D, Eddleston J, Atkinson D. Exercise testing in survivors of intensive care--is there a role for cardiopulmonary exercise testing? J Crit Care 2011; 27:89-94. [PMID: 21958985 PMCID: PMC7125548 DOI: 10.1016/j.jcrc.2011.07.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 06/28/2011] [Accepted: 07/17/2011] [Indexed: 01/22/2023]
Abstract
Purpose The aims of this study were to assess the feasibility of cardiopulmonary exercise testing (CPET) for the early assessment of cardiorespiratory fitness in general adult intensive care unit (ICU) survivors and to characterize the pathophysiology of exercise limitation in this population. Methods Fifty general ICU survivors (ventilated for ≥5 days) performed a maximal cycle ergometer CPET within 6 weeks of hospital discharge. Health-related quality of life was measured by the Medical Outcome Study Short Form 36 version 2.0 questionnaire. Results Fifty patients (median age, 57 years; median Acute Physiology And Chronic Health Evaluation II score, 16) completed a CPET 24 ± 14 days after hospital discharge with no adverse events. Significant exercise limitation was present with peak Vo2 56% ± 16% predicted and anaerobic threshold (AT) 41% ± 13% of peak predicted Vo2. Prospectively stratified subgroup comparison showed that patients ventilated for 14 days or more had a significantly lower AT and peak Vo2 than those ventilated for 5 to 14 days (AT: 9.6 vs 11.7 mL/kg per minute O2, P = .009; peak Vo2: 12.9 vs 15.3 mL/kg per minute O2, P = .022). At peak exercise, heart rate reserve was 25% ± 14%, breathing reserve was 47% ± 19%, and the respiratory exchange ratio was 0.96 ± 0.11. Ventilatory equivalents for CO2 (Eqco2) were 39 ± 9. Conclusions Significant exercise limitation is evident in patients who have had critical illness. Etiology of exercise limitation appears multifactorial, with general deconditioning and muscle weakness as major contributory factors. Early CPET appears a practical method of assessing exercise capacity in ICU survivors. Cardiopulmonary exercise testing could be used to select patients who may benefit most from a targeted physical rehabilitation program, aid in exercise prescription, and help assess the response to intervention.
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Ishizaki T, Miyasita K. [Acute lung injury/acute respiratory distress syndrome: progress in diagnosis and treatment topics: IV. Recent topics; 2. Long-term prognosis of acute lung injury]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2011; 100:1607-1612. [PMID: 21770286 DOI: 10.2169/naika.100.1607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Takeshi Ishizaki
- Division of Respiratory Medicine, University of Fukui Hospital and Department of Nursing, Faculty of Medicine, University of Fukui, Japan
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Masclans JR, Roca O, Muñoz X, Pallisa E, Torres F, Rello J, Morell F. Quality of life, pulmonary function, and tomographic scan abnormalities after ARDS. Chest 2011; 139:1340-1346. [PMID: 21330382 DOI: 10.1378/chest.10-2438] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND ARDS can produce a loss of lung function with persistent sequelae. This study aimed to evaluate health-related quality of life (HRQL) in survivors of ARDS compared with a healthy reference population and to determine the middle/long-term radiographic abnormalities and functional status, as well as their relation to observed HRQL, in these patients. METHODS This was a prospective study carried out in three ICUs. HRQL in patients was determined with the Nottingham Health Profile immediately after ARDS diagnosis and 6 months after diagnosis. Patients underwent complete respiratory function testing, chest CT scan study, and the 6-min walk test. RESULTS Follow-up was conducted in 38 patients with ARDS. Survivors of ARDS presented a poorer overall HRQL vs the general population, mainly because of lower scores in the dimensions related to mobility, energy, and social isolation. Limitations in daily life activities were documented in 40%. Respiratory function was altered in 67%, with a restrictive respiratory pattern in 58%. Radiologic study disclosed alterations in 76% (mainly reticular pattern). Patients were able to cover only 366 m (318-411 m) in the 6-min walk test and had a minimum pulse oximetry of 93% (90%-94%). A significant correlation was documented between the overall quality of life at first and at 6 months (r = 0.68, P < .01). CONCLUSIONS Survivors of ARDS after 6 months had a poorer HRQL than the healthy population and showed mild radiographic and functional involvement. Early HRQL study in these patients enabled early detection of those who would present more long-term HRQL morbidity.
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Affiliation(s)
- Joan R Masclans
- Department of Critical Care Medicine, Hospital Universitari Vall d'Hebron-Vall d'Hebron Research Institute-Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Oriol Roca
- Department of Critical Care Medicine, Hospital Universitari Vall d'Hebron-Vall d'Hebron Research Institute-Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; CIBERES, Instituto Salut Carlos III, Ministerio de Sanidad de España, IDIBAPS, Barcelona, Spain
| | - Xavier Muñoz
- Department of Respiratory Medicine, Hospital Universitari Vall d'Hebron-Vall d'Hebron Research Institute-Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; CIBERES, Instituto Salut Carlos III, Ministerio de Sanidad de España, IDIBAPS, Barcelona, Spain
| | - Esther Pallisa
- Department of Radiology, Hospital Universitari Vall d'Hebron-Vall d'Hebron Research Institute-Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ferran Torres
- Laboratory of Biostatistics & Epidemiology (UAB), Statistics & Methodology Support Unit (USEM), IDIBAPS, Barcelona, Spain
| | - Jordi Rello
- Department of Critical Care Medicine, Hospital Universitari Vall d'Hebron-Vall d'Hebron Research Institute-Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; CIBERES, Instituto Salut Carlos III, Ministerio de Sanidad de España, IDIBAPS, Barcelona, Spain
| | - Ferran Morell
- Department of Respiratory Medicine, Hospital Universitari Vall d'Hebron-Vall d'Hebron Research Institute-Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; CIBERES, Instituto Salut Carlos III, Ministerio de Sanidad de España, IDIBAPS, Barcelona, Spain
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Toufen C, Costa ELV, Hirota AS, Li HY, Amato MBP, Carvalho CRR. Follow-up after acute respiratory distress syndrome caused by influenza a (H1N1) virus infection. Clinics (Sao Paulo) 2011; 66:933-7. [PMID: 21808854 PMCID: PMC3129942 DOI: 10.1590/s1807-59322011000600002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 02/20/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There are no reports on the long-term follow-up of patients with swine-origin influenza A virus infection that progressed to acute respiratory distress syndrome. METHODS Four patients were prospectively followed up with pulmonary function tests and high-resolution computed tomography for six months after admission to an intensive care unit. RESULTS Pulmonary function test results assessed two months after admission to the intensive care unit showed reduced forced vital capacity in all patients and low diffusion capacity for carbon monoxide in two patients. At six months, pulmonary function test results were available for three patients. Two patients continued to have a restrictive pattern, and none of the patients presented with abnormal diffusion capacity for carbon monoxide. All of them had a diffuse ground-glass pattern on high-resolution computed tomography that improved after six months. CONCLUSIONS Despite the marked severity of lung disease at admission, patients with acute respiratory distress syndrome caused by swine-origin influenza A virus infection presented a late but substantial recovery over six months of follow-up.
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Affiliation(s)
- Carlos Toufen
- Pulmonary Division, InCor, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
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Abstract
OBJECTIVES To evaluate quality of life at least 12 months after discharge from the intensive care unit of adult critically ill patients, to evaluate the methodology used to assess long-term quality of life, and to give an overview of factors influencing quality of life. DATA SOURCES EMBASE-PubMed, MEDLINE (OVID), SCI/Web of Science, the Cochrane Library, Google Scholar, and personal files. DATA EXTRACTION Data extraction was performed independently and cross-checked by two reviewers using a predefined data extraction form. Eligible studies were published between 1999 and 2009 and assessed quality of life ≥12 months after intensive care unit discharge by means of the Medical Outcomes Study 36-Item Short Form Health Survey, the RAND 36-Item Health Survey, EuroQol-5D, and/or the Nottingham Health Profile in adult intensive care unit patients. DATA SYNTHESIS Fifty-three articles (10 multicenters) were included, with the majority of studies performed in Europe (68%). The Medical Outcomes Study 36-Item Short Form Health Survey was used in 55%, and the EuroQol-5D, the Nottingham Health Profile, the RAND 36-Item Health Survey, or a combination was used in 21%, 9%, 8%, or 8%, respectively. A response rate of ≥80% was attained in 26 studies (49%). Critically ill patients had a lower quality of life than an age- and gender-matched population, but quality of life tended to improve over years. The worst reductions in quality of life were seen in cases of severe acute respiratory distress syndrome, prolonged mechanical ventilation, severe trauma, and severe sepsis. Study quality criteria, defined as a baseline quality of life assessment, the absence of major exclusion criteria, a description of nonresponders, and a comparison with a reference population were met in only four studies (8%). Results concerning the influence of severity of illness, comorbidity, preadmission quality of life, age, gender, or acquired complications were conflicting. CONCLUSIONS Quality of life differed on diagnostic category but, overall, critically ill patients had a lower quality of life than an age- and gender-matched population. A minority of studies met the predefined methodologic quality criteria. Results concerning the influence of the patients' characteristics and illnesses on long-term quality of life were conflicting.
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67
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Jubran A, Lawm G, Duffner LA, Collins EG, Lanuza DM, Hoffman LA, Tobin MJ. Post-traumatic stress disorder after weaning from prolonged mechanical ventilation. Intensive Care Med 2010; 36:2030-7. [PMID: 20661726 DOI: 10.1007/s00134-010-1972-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 05/23/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Weaning from prolonged mechanical ventilation may be associated with mental discomfort. It is not known whether such discomfort is linked with the development of post-traumatic stress disorder (PTSD). Accordingly, we investigated whether PTSD occurs in patients after weaning from prolonged ventilation. We also determined whether administering a questionnaire would identify patients at risk for developing PTSD. METHODS A prospective longitudinal study of patients transferred to a long-term acute-care hospital for weaning from prolonged ventilation was undertaken: 72 patients were studied 1 week after weaning, and 41 patients were studied again 3 months later. An experienced psychologist conducted a structured clinical interview 3 months after weaning to establish a diagnosis of PTSD. To assess for the presence of PTSD-related symptoms, the post-traumatic stress syndrome (PTSS-10) questionnaire was administered 1 week after weaning and 3 months later. RESULTS The psychologist diagnosed PTSD in 12% of patients 3 months after ventilator weaning. Patients who developed PTSD were more likely to have a previous history of psychiatric disorders (P < 0.02). A PTSS-10 score >20 one week after weaning reliably identified patients who were diagnosed with PTSD 3 months later: sensitivity 1.0; specificity 0.76; area under the receiver-operating characteristic curve 0.91. CONCLUSION PTSD was diagnosed in 12% of patients who were weaned from prolonged ventilation. A PTSS-10 score >20 one week after weaning identified patients diagnosed with PTSD 3 months later. This finding suggests that a simple questionnaire administered before hospital discharge can identify patients at risk for developing PTSD.
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Affiliation(s)
- Amal Jubran
- Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Affairs Hospital, Hines IL and Loyola University of Chicago Stritch School of Medicine, Maywood, IL, USA.
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68
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Ngai JC, Ko FW, Ng SS, To KW, Tong M, Hui DS. The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology 2010; 15:543-50. [PMID: 20337995 PMCID: PMC7192220 DOI: 10.1111/j.1440-1843.2010.01720.x] [Citation(s) in RCA: 315] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Severe acute respiratory syndrome (SARS) emerged in 2003 and its long-term sequelae remain largely unclear. This study examined the long-term outcome of pulmonary function, exercise capacity, health and work status among SARS survivors. METHODS A prospective cohort study of SARS patients at the Prince of Wales Hospital, Hong Kong was conducted, with serial assessments of lung function, 6MWD and 36 item Short Form General Health Survey at 3, 6, 12, 18 and 24 months after disease onset. The work status was also recorded. RESULTS Serial assessments were completed by 55 of the 123 (39.9%) subjects, of whom 27 were health-care workers (HCW). The mean age of the group was 44.4 (SD 13.2) years and 19 (34.5%) were males. At 24 months, 10 (18.2%), 9 (16.4%), 6 (10.9%) and 29 (52.7%) subjects had FEV(1), FVC, TLC and DL(CO) < 80% of predicted values, respectively. The mean (SD) 6MWD increased significantly from 439.0 (89.1) m at 3 months to 460.1 (102.8) m at 6 months (P 0.016) and became steady after 6 months. However, 6MWD and 36 item Short Form General Health Survey scores were lower than the normal population throughout the study. Moreover, 29.6% of HCW and 7.1% of non-HCW had not returned to work 2 years after illness onset. CONCLUSIONS This 2-year study of a selected population of SARS survivors, showed significant impairment of DL(CO), exercise capacity and health status persisted, with a more marked adverse impact among HCW.
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Affiliation(s)
- Jenny C Ngai
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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69
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Cuthbertson BH, Roughton S, Jenkinson D, MacLennan G, Vale L. Quality of life in the five years after intensive care: a cohort study. Crit Care 2010; 14:R6. [PMID: 20089197 PMCID: PMC2875518 DOI: 10.1186/cc8848] [Citation(s) in RCA: 300] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 11/05/2009] [Accepted: 01/20/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Data on quality of life beyond 2 years after intensive care discharge are limited and we aimed to explore this area further. Our objective was to quantify quality of life and health utilities in the 5 years after intensive care discharge. METHODS A prospective longitudinal cohort study in a University Hospital in the UK. Quality of life was assessed from the period before ICU admission until 5 years and quality adjusted life years calculated. RESULTS 300 level 3 intensive care patients of median age 60.5 years and median length of stay 6.7 days, were recruited. Physical quality of life fell to 3 months (P = 0.003), rose back to pre-morbid levels at 12 months then fell again from 2.5 to 5 years after intensive care (P = 0.002). Mean physical scores were below the population norm at all time points but the mean mental scores after 6 months were similar to those population norms. The utility value measured using the EuroQOL-5D quality of life assessment tool (EQ-5D) at 5 years was 0.677. During the five years after intensive care unit, the cumulative quality adjusted life years were significantly lower than that expected for the general population (P < 0.001). CONCLUSIONS Intensive care unit admission is associated with a high mortality, a poor physical quality of life and a low quality adjusted life years gained compared to the general population for 5 years after discharge. In this group, critical illness associated with ICU admission should be treated as a life time diagnosis with associated excess mortality, morbidity and the requirement for ongoing health care support.
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Affiliation(s)
- Brian H Cuthbertson
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada
| | - Siân Roughton
- Intensive Care Unit, Aberdeen Royal Infirmary, Westburn Road, Foresterhill, Aberdeen, AB25 2ZN, Scotland, UK
| | - David Jenkinson
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Ashgrove Road, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Ashgrove Road, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK
| | - Luke Vale
- Intensive Care Unit, Aberdeen Royal Infirmary, Westburn Road, Foresterhill, Aberdeen, AB25 2ZN, Scotland, UK
- Health Economics Research Unit & Health Service Research Unit, University of Aberdeen, Ashgrove Road, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK
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70
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Haunted by delusions: Trauma, delusional memories, and intensive care unit morbidity. Crit Care Med 2010; 38:300-1. [PMID: 20023470 DOI: 10.1097/ccm.0b013e3181b78176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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71
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Miwa C, Koyama S, Watanabe Y, Tsubochi H, Endo S, Nokubi M, Kawabata Y. Pathological findings and pulmonary dysfunction after acute respiratory distress syndrome for 5 years. Intern Med 2010; 49:1599-604. [PMID: 20686297 DOI: 10.2169/internalmedicine.49.3404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report the pathological findings of the lung after acute respiratory distress syndrome (ARDS), and pulmonary function tests during five years of follow-up. A 39-year-old woman, treated for acute myelogenous leukemia, developed ARDS. She recovered from ARDS but suffered from pulmonary aspergillosis. Her aspergilloma was removed surgically. Her lung function tests and diffusing capacity of the lung for carbon monoxide (DL(CO)) improved but diffusion impairment remained five years after recovery. Pathological examination of the resected material showed sclerosis in lobular septa and scattered fibrosis in alveolar ducts except for the aspergillosis. These fibrotic changes may be causally associated with her loss of DL(CO).
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Affiliation(s)
- Chihiro Miwa
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama.
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72
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Poulsen JB, Møller K, Kehlet H, Perner A. Long-term physical outcome in patients with septic shock. Acta Anaesthesiol Scand 2009; 53:724-30. [PMID: 19388891 DOI: 10.1111/j.1399-6576.2009.01921.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Limited information is available on physical function after septic shock. The aim of the present study was to assess the physical outcome in survivors 1 year after septic shock. METHODS The outcome status of all 174 adult patients admitted to a mixed ICU with the diagnosis septic shock in a 1-year period was registered. Survivors were interviewed about physical function and socioeconomic status using a questionnaire including the Short Form-36 survey. The pre-ICU-admission Functional Comorbidity Index (FCI) was also registered. RESULTS Of the 80 survivors, two were still hospitalised; thus, 78 were invited to participate and 70 replied (inclusion-rate 88%). Patients were followed up at median 351 days after hospital discharge. At follow-up the patients had a markedly reduced physical component summary score (PCS) compared with age- and sex-adjusted general population controls (36 vs. 47, P<0.0001). This was also observed in patients with no comorbidity before ICU admission (34 vs. 47, P<0.001). There was a negative correlation (r=-0.27, P=0.03) between pre-ICU-admission FCI values and the PCS at follow-up. According to 81% of the patients, loss of muscle mass was the main cause of decreased physical function. Only 43% (10 vs. 23, P=0.01) of the previously employed had returned to work, and the number of patients in need of home-based personal assistance had doubled (10/20, P=0.04). CONCLUSION Physical function is substantially reduced in survivors of septic shock 1 year after discharge.
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Affiliation(s)
- J B Poulsen
- Department of intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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73
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Hauer D, Weis F, Krauseneck T, Vogeser M, Schelling G, Roozendaal B. Traumatic memories, post-traumatic stress disorder and serum cortisol levels in long-term survivors of the acute respiratory distress syndrome. Brain Res 2009; 1293:114-20. [PMID: 19376097 DOI: 10.1016/j.brainres.2009.04.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Revised: 04/06/2009] [Accepted: 04/09/2009] [Indexed: 12/31/2022]
Abstract
Survivors of the acute respiratory distress syndrome (ARDS) often report traumatic memories from the intensive care unit (ICU) and display a high incidence of post-traumatic stress disorder (PTSD). As it is known that subjects with PTSD often show sustained reductions in circulating cortisol concentrations, we examined the relationship between serum cortisol, traumatic memories and PTSD in patients after ARDS. We evaluated 33 long-term survivors of ARDS (7.5+/-2.9 years after discharge from the ICU) for pre-defined categories of traumatic memory from the ICU, hypothalamic-pituitary-adrenocortical axis reactivity to corticotropin and PTSD (by psychiatric interview). During evaluation, patients with multiple traumatic memories had significantly lower basal serum cortisol levels when compared to patients with no or only 1 category of traumatic memory, with no differences in peak cortisol levels after corticotropin stimulation between both subgroups. There was a significant negative correlation between basal cortisol levels and the number of traumatic memories present. PTSD symptom scores correlated with the number of traumatic memories but not with cortisol levels. These findings indicate that lower baseline cortisol levels in long-term survivors of ARDS are associated with an increased incidence of traumatic memories from the ICU, and that more traumatic memories are related to a higher incidence and intensity of PTSD symptoms.
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Affiliation(s)
- Daniela Hauer
- Department of Anaesthesiology, Ludwig-Maximilians-University, Munich, Germany
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74
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Lindén VB, Lidegran MK, Frisén G, Dahlgren P, Frenckner BP, Larsen F. ECMO in ARDS: a long-term follow-up study regarding pulmonary morphology and function and health-related quality of life. Acta Anaesthesiol Scand 2009; 53:489-95. [PMID: 19226296 DOI: 10.1111/j.1399-6576.2008.01808.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A high survival rate can be achieved in patients with severe acute respiratory distress syndrome (ARDS) using extracorporeal membrane oxygenation (ECMO). The technique and the costs are, however, debated and follow-up studies in survivors are few. The aim of this study was to evaluate long-term pulmonary health after ECMO and severe ARDS. METHODS Twenty-one long-term survivors of severe ARDS and ECMO were studied in a follow-up program including high-resolution computed tomography (HRCT) of the lungs, extensive pulmonary function tests, pulmonary scintigraphy and the pulmonary disease-specific St George's Respiratory Questionnaire (SGRQ). RESULTS The majority of patients had residual lung parenchymal changes on HRCT suggestive of fibrosis, but the extension of morphologic abnormalities was limited and without the typical anterior localization presumed to indicate ventilator-associated lung injury. Pulmonary function tests revealed good restitution with mean values in the lower normal range, while T(1/2) for outwash of inhaled isotope was abnormal in all patients consistent with subclinical obstructivity. Most patients had reduced health-related quality of life (HRQoL), according to the SGRQ, but were stating less respiratory symptoms than conventionally treated ARDS patients in previous studies. The majority were integrated in normal work. CONCLUSION The majority of ECMO-treated ARDS patients have good physical and social functioning. However, lung parenchymal changes on HRCT suggestive of fibrosis and minor pulmonary function abnormalities remain common and can be detected more than 1 year after ECMO. Furthermore, most patients experience a reduction in HRQoL due to the pulmonary sequelae.
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Affiliation(s)
- V B Lindén
- Department of ECMO, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
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75
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[Outcome for adults with acute respiratory distress syndrome]. Presse Med 2008; 37:1803-8. [PMID: 18849139 DOI: 10.1016/j.lpm.2008.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Revised: 06/22/2008] [Accepted: 07/09/2008] [Indexed: 11/20/2022] Open
Abstract
Acute respiratory distress syndrome in adults (ARDS) is a relatively frequent disease, the mortality of which has diminished considerably in recent years. The long-term outcome of patients who have survived ARDS has been studied extensively and should in the future be taken into account in assessing new treatment modalities. The long-term respiratory sequelae are generally minimal and moderately disabling. Secondary deterioration of respiratory function is not part of the natural history of ARDS and should suggest other diagnoses. The various studies find a clear diminution in quality of life after ARDS (compared with the general population), essentially related to neuromuscular deficiencies associated with the neuromyopathies of resuscitation or to neuropsychological damage combining cognitive disorders and symptoms of posttraumatic stress. These symptoms are not at all specific to ARDS. They are found in varying degrees in patients who have survived intensive care or resuscitation. Appropriate management for these symptoms remains to be determined. Critical care units must now work at preventing the onset of these disorders, by limiting the treatments at risk when possible and by identifying these disorders before discharge to prepare for optimal subsequent management. Patients with ARDS are only a subgroup of more severe illness among all patients in critical care departments.
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76
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Neurocognitive and Psychiatric Sequelae Among Survivors of Acute Respiratory Distress Syndrome. ACTA ACUST UNITED AC 2008. [DOI: 10.1097/cpm.0b013e3181856410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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77
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The impact of development of acute lung injury on hospital mortality in critically ill trauma patients. Crit Care Med 2008; 36:2309-15. [PMID: 18664786 DOI: 10.1097/ccm.0b013e318180dc74] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The additional impact of development of acute lung injury on mortality in severely-injured trauma patients beyond baseline severity of illness has been questioned. We assessed the contribution of acute lung injury to in-hospital mortality in critically ill trauma patients. DESIGN Prospective cohort study. The contribution of acute lung injury to in-hospital mortality was evaluated in two ways. First, multivariable logistic regression models were used to test the independent association of acute lung injury with in-hospital mortality while adjusting for baseline confounding variables. Second, causal pathway models were used to estimate the amount of the overall association of baseline severity of illness with in-hospital mortality that is attributable to the interval development of acute lung injury. SETTING Academic level 1 trauma center. PATIENTS Two hundred eighty-three critically ill trauma patients without isolated head injury and with an Injury Severity Score > or = 16 were evaluated for development of acute lung injury in the first 5 days after trauma. MEASUREMENTS AND MAIN RESULTS Of the 283 patients, 38 (13.4%) died. The unadjusted mortality rate was nearly three-fold greater in the acute lung injury group (23.9% vs. 8.4%; odds ratio = 3.36; 95% confidence interval 1.67-6.77; p = 0.001). Acute lung injury remained an independent risk factor for death after adjustment for age, baseline Acute Physiologic and Chronic Health Evaluation III score, Injury Severity Score, and blunt mechanism of injury (odds ratio = 2.87; 95% confidence interval 1.29-6.37; p = 0.010). Forty percent of the total association of the baseline Acute Physiologic and Chronic Health Evaluation III score with mortality occurred via an indirect association through acute lung injury, and the remaining 60% via a direct effect. CONCLUSIONS Development of acute lung injury in critically ill trauma patients without isolated head injury contributes independently to in-hospital mortality beyond baseline severity of illness measures. In addition, a significant portion of the association between baseline illness severity and risk of death in these patients might be explained by the interval development of acute lung injury.
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78
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Hough CL, Needham DM. The role of future longitudinal studies in ICU survivors: understanding determinants and pathophysiology of weakness and neuromuscular dysfunction. Curr Opin Crit Care 2008; 13:489-96. [PMID: 17762224 DOI: 10.1097/mcc.0b013e3282efea3a] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW The goals of this review are to discuss the pathophysiology and determinants of muscle weakness and neuromuscular dysfunction after critical illness, and to offer thoughts regarding the role of future longitudinal studies in this area. RECENT FINDINGS While recent studies support the finding that neuromuscular dysfunction is common and important after critical illness, reversible risk factors and approaches to prevention and treatment remain unproven. Pathophysiologic studies implicate disease and treatment associated factors in the development of nerve and muscle damage during critical illness; these factors may provide targets for future studies. SUMMARY Additional studies with improved methodology that address epidemiology and that test interventions are needed to understand and to improve neuromuscular function after critical illness.
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Affiliation(s)
- Catherine L Hough
- Department of Medicine, University of Washington, Seattle, Washington, USA.
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79
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Abstract
Patients who survive critical illness are at risk of permanent physical and functional deficits which decrease the health-related quality of life. The reasons for physical morbidity include the nature of and treatment for the inciting critical illness, new decrements in organ function and worsening of pre-existing organ dysfunction, and prolonged physical immobility and long intensive care unit stay.
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Factors associated with posttraumatic stress symptoms in a prospective cohort of patients after abdominal sepsis: a nomogram. Intensive Care Med 2008; 34:664-74. [PMID: 18197398 PMCID: PMC2271079 DOI: 10.1007/s00134-007-0941-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 10/17/2007] [Indexed: 12/28/2022]
Abstract
Objective To determine to what extent patients who have survived abdominal sepsis suffer from symptoms of posttraumatic stress disorder (PTSD) and depression, and to identify potential risk factors for PTSD symptoms. Design and setting PTSD and depression symptoms were measured using the Impact of Events Scale–Revised (IES-R), the Post-Traumatic Symptom Scale 10 (PTSS-10) and the Beck Depression Inventory II (BDI-II). Patients and participants A total of 135 peritonitis patients were eligible for this study, of whom 107 (80%) patients completed the questionnaire. The median APACHE-II score was 14 (range 12–16), and 89% were admitted to the ICU. Measurements and results The proportion of patients with “moderate” PTSD symptom scores was 28% (95% CI 20–37), whilst 10% (95% CI 6–17) of patients had “high” PTSD symptom scores. Only 5% (95% CI 2–12) of the patients expressed severe depression symptoms. Factors associated with increased PTSD symptoms in a multivariate ordinal regression model were younger age (0.74 per 10 years older, p = 0.082), length of ICU stay (OR = 1.4 per doubling of duration, p = 0.003) and having some (OR = 4.9, p = 0.06) or many (OR = 55.5, p < 0.001) traumatic memories of the ICU or hospital stay. Conclusion As many as 38% of patients after abdominal sepsis report elevated levels of PTSD symptoms on at least one of the questionnaires. Our nomogram may assist in identifying patients at increased risk for developing symptoms of PTSD. Electronic supplementary material The online version of this article (doi:10.1007/s00134-007-0941-3) contains supplementary material, which is available to authorized users.
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Larson MJ, Weaver LK, Hopkins RO. Cognitive sequelae in acute respiratory distress syndrome patients with and without recall of the intensive care unit. J Int Neuropsychol Soc 2007; 13:595-605. [PMID: 17521481 DOI: 10.1017/s1355617707070749] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 01/06/2007] [Accepted: 01/08/2007] [Indexed: 11/07/2022]
Abstract
Some critically ill patients have dramatic recollections of the intensive care unit (ICU), whereas 23-50% have little or no recollection of their ICU stay. In addition, cognitive impairments are common following critical illness and ICU treatment. Little is known regarding the relationship between cognitive sequelae and ICU recall. We assessed recall of the ICU and its relationship to cognitive functioning at hospital discharge and 1 and 2 years after discharge in 70 consecutive acute respiratory distress syndrome (ARDS) patients. Seventeen patients (24%) had no recall of the ICU. Patients without ICU recall had increased rates of cognitive sequelae at hospital discharge and 1-year follow-up compared with the ICU recall group. Patients without ICU recall had a greater magnitude of cognitive impairments at hospital discharge, but not at 1- or 2-year follow-up. Profile analysis showed significant group differences in general intellectual functioning, executive function, processing speed, and spatial skills at hospital discharge, but not at 1- or 2-year follow-up. Estimated premorbid intelligence scores were inversely related to the magnitude of cognitive sequelae, suggesting greater "cognitive reserve" in patients with fewer cognitive decrements.
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Affiliation(s)
- Michael J Larson
- Psychology Department, Brigham Young University, Provo, Utah, USA
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82
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Cholette JM, Caserta M, Hardy D, Connolly HV. Outcome of pulmonary function in Lemierre's disease-associated acute respiratory distress syndrome. Pediatr Pulmonol 2007; 42:389-92. [PMID: 17330265 DOI: 10.1002/ppul.20573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pulmonary function in acute respiratory distress syndrome (ARDS) survivors typically returns to normal with the exception of a persistent reduction in carbon monoxide diffusion capacity (DL(co)). Septic thrombophlebitis of the internal jugular vein, (Lemierre's syndrome or postanginal sepsis) is a well-described, albeit uncommon cause of ARDS in which metastatic pulmonary thromboemboli precipitate respiratory failure requiring ventilatory support. We describe convalescent pulmonary function in two survivors of Lemierre's disease-associated ARDS, suggesting that the subset of Lemierre's syndrome induced ARDS survivors have an excellent long-term pulmonary prognosis.
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83
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Hopkins RO, Herridge MS. Quality of life, emotional abnormalities, and cognitive dysfunction in survivors of acute lung injury/acute respiratory distress syndrome. Clin Chest Med 2007; 27:679-89; abstract x. [PMID: 17085255 DOI: 10.1016/j.ccm.2006.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article provides a brief discussion of the recent literature linking quality-of-life impairment to physical dysfunction after acute lung injury/acute respiratory distress syndrome. Its main focus is a review of the current knowledge concerning cognitive and emotional outcomes after lung injury and their impact on long-term quality of life.
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Affiliation(s)
- Ramona O Hopkins
- Department of Medicine, Pulmonary and Critical Care Division, LDS Hospital, Salt Lake City, UT 84143, USA.
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84
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Knoester H, Grootenhuis MA, Bos AP. Outcome of paediatric intensive care survivors. Eur J Pediatr 2007; 166:1119-28. [PMID: 17823815 PMCID: PMC2039787 DOI: 10.1007/s00431-007-0573-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 07/10/2007] [Indexed: 01/26/2023]
Abstract
The development of paediatric intensive care has contributed to the improved survival of critically ill children. Physical and psychological sequelae and consequences for quality of life (QoL) in survivors might be significant, as has been determined in adult intensive care unit (ICU) survivors. Awareness of sequelae due to the original illness and its treatment may result in changes in treatment and support during and after the acute phase. To determine the current knowledge on physical and psychological sequelae and the quality of life in survivors of paediatric intensive care, we undertook a computerised comprehensive search of online databases for studies reporting sequelae in survivors of paediatric intensive care. Studies reporting sequelae in paediatric survivors of cardiothoracic surgery and trauma were excluded, as were studies reporting only mortality. All other studies reporting aspects of physical and psychological sequelae were analysed. Twenty-seven studies consisting of 3,444 survivors met the selection criteria. Distinct physical and psychological sequelae in patients have been determined and seemed to interfere with quality of life. Psychological sequelae in parents seem to be common. Small numbers, methodological limitations and quantitative and qualitative heterogeneity hamper the interpretation of data. We conclude that paediatric intensive care survivors and their parents have physical and psychological sequelae affecting quality of life. Further well-designed prospective studies evaluating sequelae of the original illness and its treatment are warranted.
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Affiliation(s)
- Hendrika Knoester
- Paediatric Intensive Care Unit, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
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85
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Parker CM, Heyland DK, Groll D, Caeser M. Mechanism of injury influences quality of life in survivors of acute respiratory distress syndrome. Intensive Care Med 2006; 32:1895-900. [PMID: 16983550 DOI: 10.1007/s00134-006-0344-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Accepted: 07/24/2006] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Growing evidence suggests that acute respiratory distress syndrome (ARDS) occurring as a consequence of primary (direct) lung injury differs from that resulting from secondary (indirect) lung injury in terms of radiographic appearance, response to interventions, and outcomes. We examined whether there are differences in quality of life (QOL) in survivors of ARDS attributable to the mechanism of underlying lung injury. DESIGN AND SETTING Prospective observational cohort study in 54 intensive care units in Canada and the United States. PATIENTS AND PARTICIPANTS Survivors of ARDS (n=73) were grouped according to underlying cause of ARDS (i.e., primary vs. secondary lung injury) and followed prospectively for 12months. MEASUREMENTS AND RESULTS QOL was assessed using the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and the St. George's Respiratory Questionnaire (SGRQ), and spirometry was performed at each outpatient follow-up visit. At 3months mortality and QOL outcomes were similar between the groups, but by 12months patients with primary lung injury had significantly better QOL scores in four of eight SF-36 domains and in two of three domains of the SGRQ. Differences were not attributable to duration of ICU or hospital length of stay, duration of mechanical ventilation, comorbidities prior to the index illness, or differences in spirometry during the follow-up period. CONCLUSIONS QOL in survivors of ARDS appears to be influenced by the mechanism of lung injury (primary vs. secondary), lending support to the concept that ARDS is a heterogeneous condition.
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Affiliation(s)
- Chris M Parker
- Department of Medicine, Queen's University, Kingston, Canada
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86
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Maggiore SM, Antonelli M. Expanding our horizons beyond the intensive care unit: does mechanism of lung injury influence the quality of life in ARDS survivors? Intensive Care Med 2006; 32:1683-5. [PMID: 16957902 DOI: 10.1007/s00134-006-0345-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 07/24/2006] [Indexed: 10/24/2022]
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87
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Scales DC, Tansey CM, Matte A, Herridge MS. Difference in reported pre-morbid health-related quality of life between ARDS survivors and their substitute decision makers. Intensive Care Med 2006; 32:1826-31. [PMID: 16957904 DOI: 10.1007/s00134-006-0333-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Accepted: 06/09/2006] [Indexed: 10/24/2022]
Abstract
CONTEXT Substitute decision makers may consider the pre-morbid health status of their critically ill loved one when making treatment decisions on her/his behalf. OBJECTIVE To compare estimates of pre-morbid health-related quality of life (HRQOL) obtained from survivors of the acute respiratory distress syndrome (ARDS) with those of their substitute decision makers using the Short Form 36 (SF-36). DESIGN Prospective cohort study. SETTING University-affiliated intensive care unit in Toronto, Canada. PATIENTS A sample of 46 ARDS survivors and their substitute decision makers drawn from a previously described cohort. INTERVENTIONS We measured agreement and differences between responses on the SF-36 obtained from survivors (at 3 months after ICU discharge) and their substitute decision makers (at study entry). MEASUREMENTS AND RESULTS Agreement was poor for all SF-36 components and differences reached significance in three domains. In multivariable analysis considering age; sex; Acute Physiology, Age, and Chronic Health Evaluation II score; and Lung Injury Score, only patient age was associated with the mean difference between estimates for the 'Mental Health' domain. On average, estimates of pre-morbid HRQOL obtained from substitute decision makers were lower than those obtained from survivors. CONCLUSION Agreement between estimates of pre-morbid HRQOL provided by ARDS survivors and their substitute decision makers was poor. Compared with survivors, proxies tended to provide lower estimates of pre-morbid HRQOL. Substitute decision making for incapacitated patients is an imperfect process during which family members may underestimate their loved ones' own perception of pre-morbid health status. Alternatively, survivors of critical illness may overestimate pre-morbid HRQOL.
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Affiliation(s)
- Damon C Scales
- Department of Critical Care Medicine, Sunnybrook and Women's Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Toronto, Canada.
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88
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Manteiga Riestra E, Martínez González Ó, Frutos Vivar F. [Epidemiology of acute pulmonary injury and acute respiratory distress syndrome]. Med Intensiva 2006; 30:151-61. [PMID: 16750078 PMCID: PMC7130804 DOI: 10.1016/s0210-5691(06)74496-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - F. Frutos Vivar
- Correspondencia: Dr. F. Frutos Vivar. Unidad de Cuidados Intensivos. Hospital Universitario de Getafe. Cra. de Toledo, km. 12,500. 28905 Getafe, Madrid. España.
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89
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Groll DL, Heyland DK, Caeser M, Wright JG. Assessment of Long-Term Physical Function in Acute Respiratory Distress Syndrome (ARDS) Patients. Am J Phys Med Rehabil 2006; 85:574-81. [PMID: 16788388 DOI: 10.1097/01.phm.0000223220.91914.61] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE It is often important to adjust for the effect of comorbid diseases on patient outcomes. This study compares the association between physical function in acute respiratory distress syndrome patients with scores on two comorbidity indices, the Charlson Comorbidity Index, designed to predict mortality, and the Functional Comorbidity Index (FCI), which was designed to predict physical function. DESIGN This is a prospective, longitudinal, observational study. A total of 73 survivors of acute respiratory distress syndrome were contacted at 3, 6, and 12 mos. Patient comorbidity was evaluated with the Charlson Comorbidity Index and the FCI. Physical function was measured using the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function Subscale and the Physical Component Subscale scores. RESULT Mean FCI and Charlson Comorbidity Index scores correlated fairly strongly (Spearman rho = 0.62, P < 0.001). FCI, but not the Charlson Comorbidity Index, scores correlated with the Physical Function Subscale and Physical Component Subscale scores. After controlling for other potentially confounding variables such as age and severity of illness through regression analysis, the FCI score was still significantly associated with both Physical Function Subscale and Physical Component Subscale scores. CONCLUSIONS The FCI is a better method of measuring comorbidity with physical function as the outcome. This study illustrates the importance of choosing the most appropriate comorbidity index for the outcome of interest.
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Affiliation(s)
- Dianne L Groll
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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90
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Dowdy DW, Eid MP, Dennison CR, Mendez-Tellez PA, Herridge MS, Guallar E, Pronovost PJ, Needham DM. Quality of life after acute respiratory distress syndrome: a meta-analysis. Intensive Care Med 2006; 32:1115-24. [PMID: 16783553 DOI: 10.1007/s00134-006-0217-3] [Citation(s) in RCA: 239] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 05/02/2006] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To summarize long-term quality of life (QOL) and the degree of variation in QOL estimates across studies of acute respiratory distress (ARDS) survivors. DESIGN A systematic review of studies evaluating QOL in ARDS survivors was conducted. Medline, EMBASE, CINAHL, pre-CINAHL, and the Cochrane Library were searched, and reference lists from relevant articles were evaluated. Two authors independently selected studies reporting QOL in adult survivors of ARDS or acute lung injury at least 30 days after intensive care unit discharge and extracted data on study design, patient characteristics, methods, and results. MEASUREMENTS AND RESULTS Thirteen independent observational studies (557 patients) met inclusion criteria. Eight of these studies used eight different QOL instruments, allowing only qualitative synthesis of results. The five remaining studies (330 patients) measured QOL using the Medical Outcomes Study 36-Item Short Form survey (SF-36). Mean QOL scores were similar across these studies, falling within a range of 20 points for all domains. Pooled domain-specific QOL scores in ARDS survivors 6 months or later after discharge ranged from 45 (role physical) to 66 (social functioning), or 15-26 points lower than population norms, in all domains except mental health (11 points) and role physical (39 points). Corresponding confidence intervals were no wider than +/-9 points. Six studies all found stable or improved QOL over time, but only one found significant improvement beyond 6 months after discharge. CONCLUSIONS ARDS survivors in different clinical settings experience similar decrements in QOL. The precise magnitude of these decrements helps clarify the long-term prognosis for ARDS survivors.
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Affiliation(s)
- David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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91
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Chang AT, Boots RJ, Henderson R, Paratz JD, Hodges PW. Case report: inspiratory muscle training in chronic critically ill patients--a report of two cases. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2006; 10:222-6. [PMID: 16411617 DOI: 10.1002/pri.14] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE Inspiratory muscle weakness and fatigue has been documented following prolonged mechanical ventilation despite successful weaning from mechanical ventilation. This report describes the application of inspiratory muscle training in two patients following successful discharge from an intensive care unit (ICU) after prolonged mechanical ventilation. METHODS Both patients undertook inspiratory muscle training in conjunction with standard physiotherapy rehabilitation. RESULTS Improvements in inspiratory muscle strength and endurance, exercise tolerance and functional performance following twice-daily inspiratory muscle training were recorded. In both cases, an improvement in maximal inspiratory pressure (MIP) and maximal tolerated inspiratory load (MIP(load)) was found following training. CONCLUSION These positive results indicate further research is needed to investigate the effect of inspiratory muscle training on respiratory function, exercise tolerance and functional performance, for the possible inclusion of inspiratory muscle training into the physiotherapy management of patients following prolonged mechanical ventilation.
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Affiliation(s)
- Angela T Chang
- Division of Physiotherapy, University of Queensland, School of Physiotherapy, Brisbane, Australia.
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92
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Lau HMC, Ng GYF, Jones AYM, Lee EWC, Siu EHK, Hui DSC. A randomised controlled trial of the effectiveness of an exercise training program in patients recovering from severe acute respiratory syndrome. ACTA ACUST UNITED AC 2006; 51:213-9. [PMID: 16321128 PMCID: PMC7130114 DOI: 10.1016/s0004-9514(05)70002-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to evaluate the effectiveness of an exercise training program on cardiorespiratory and musculoskeletal performance and health-related quality of life of patients who were recovering from severe acute respiratory syndrome (SARS). A 6-week supervised exercise training program was carried out in the physiotherapy department of a university teaching hospital. One hundred and thirty-three patients referred from a SARS Review Clinic solely for physiotherapy were included. Cardiorespiratory fitness (6-minute walk test, Chester Step Test for predicting VO2max), musculoskeletal performance (isometric deltoid and gluteal muscles strength, handgrip strength, 1-minute curl-up and push-up tests) and health-related quality of life (SF-36) were measured and evaluated. Patients were assigned randomly to either a control group (standardised educational session about exercise rehabilitation) or an exercise group. After 6 weeks, significantly greater improvement was shown in the exercise group in the 6-minute walk test (77.4 m vs 20.7 m, p < 0.001), VO2max (3.6 ml/kg/min vs 1 ml/kg/min, p = 0.04), and musculoskeletal performance (handgrip strength, curl-up and push-up tests, p < 0.05). Effects on health-related quality of life were not statistically significant. It was concluded that the exercise training program was effective in improving both the cardiorespiratory and musculoskeletal fitness in patients recovering from SARS. However, health-related quality of life was not affected by physical training.
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Affiliation(s)
- Herman Mun-Cheung Lau
- Department of Physiotherapy, The Prince of Wales Hospital, Shatin, Hong Kong, China.
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93
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Needham DM, Dennison CR, Dowdy DW, Mendez-Tellez PA, Ciesla N, Desai SV, Sevransky J, Shanholtz C, Scharfstein D, Herridge MS, Pronovost PJ. Study protocol: The Improving Care of Acute Lung Injury Patients (ICAP) study. Crit Care 2006; 10:R9. [PMID: 16420652 PMCID: PMC1550857 DOI: 10.1186/cc3948] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Accepted: 11/16/2005] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The short-term mortality benefit of lower tidal volume ventilation (LTVV) for patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) has been demonstrated in a large, multi-center randomized trial. However, the impact of LTVV and other critical care therapies on the longer-term outcomes of ALI/ARDS survivors remains uncertain. The Improving Care of ALI Patients (ICAP) study is a multi-site, prospective cohort study that aims to evaluate the longer-term outcomes of ALI/ARDS survivors with a particular focus on the effect of LTVV and other critical care therapies. METHODS Consecutive mechanically ventilated ALI/ARDS patients from 11 intensive care units (ICUs) at four hospitals in the city of Baltimore, MD, USA, will be enrolled in a prospective cohort study. Exposures (patient-based, clinical management, and ICU organizational) will be comprehensively collected both at baseline and throughout patients' ICU stay. Outcomes, including mortality, organ impairment, functional status, and quality of life, will be assessed with the use of standardized surveys and testing at 3, 6, 12, and 24 months after ALI/ARDS diagnosis. A multi-faceted retention strategy will be used to minimize participant loss to follow-up. RESULTS On the basis of the historical incidence of ALI/ARDS at the study sites, we expect to enroll 520 patients over two years. This projected sample size is more than double that of any published study of long-term outcomes in ALI/ARDS survivors, providing 86% power to detect a relative mortality hazard of 0.70 in patients receiving higher versus lower exposure to LTVV. The projected sample size also provides sufficient power to evaluate the association between a variety of other exposure and outcome variables, including quality of life. CONCLUSION The ICAP study is a novel, prospective cohort study that will build on previous critical care research to improve our understanding of the longer-term impact of ALI/ARDS, LTVV and other aspects of critical care management. Given the paucity of information about the impact of interventions on long-term outcomes for survivors of critical illness, this study can provide important information to inform clinical practice.
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Affiliation(s)
- Dale M Needham
- Instructor, Pulmonary/Critical Care Medicine, Johns Hopkins University, 5th floor, 1830 East Monument Street, Baltimore, MD 21205, USA
| | - Cheryl R Dennison
- Assistant professor, School of Nursing, Johns Hopkins University, Room 419, 525 North Wolfe Street, Baltimore, MD 21205, USA
| | - David W Dowdy
- Graduate student, School of Medicine, Johns Hopkins University, Suite 2-300, 1830 East Monument Street, Baltimore, MD 21205, USA
| | - Pedro A Mendez-Tellez
- Assistant professor, Anesthesiology/Critical Care Medicine, Johns Hopkins University, Meyer 295, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Nancy Ciesla
- Physical therapy supervisor, Johns Hopkins Hospital, Osler 159, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Sanjay V Desai
- Fellow, Pulmonary/Critical Care Medicine, Johns Hopkins University, 5th floor, 1830 East Monument Street, Baltimore, MD 21205, USA
| | - Jonathan Sevransky
- Assistant professor, Pulmonary/Critical Care Medicine, Johns Hopkins University, 5th floor, 1830 East Monument Street, Baltimore, MD 21205, USA
| | - Carl Shanholtz
- Associate professor, Pulmonary/Critical Care Medicine, University of Maryland, 10 South Pine Street, Suite 800, Baltimore, MD 21201, USA
| | - Daniel Scharfstein
- Associate professor, Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Room E3546, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Margaret S Herridge
- Assistant professor, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto General Hospital, 11 C 1180, 585 University Avenue, Toronto, Ontario M5G 2C4, Canada
| | - Peter J Pronovost
- Professor, Anesthesiology/Critical Care Medicine, Johns Hopkins University, Meyer 295, 600 North Wolfe Street, Baltimore, MD 21287, USA
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94
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Hui DS, Wong KT, Ko FW, Tam LS, Chan DP, Woo J, Sung JJY. The 1-year impact of severe acute respiratory syndrome on pulmonary function, exercise capacity, and quality of life in a cohort of survivors. Chest 2005; 128:2247-61. [PMID: 16236881 PMCID: PMC7094276 DOI: 10.1378/chest.128.4.2247] [Citation(s) in RCA: 239] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective To examine pulmonary function, exercise capacity, and health-related quality of life (HRQoL) among severe acute respiratory syndrome (SARS) survivors. Methods We evaluated survivors with confirmed SARS at the Prince of Wales Hospital, Hong Kong, at 3, 6, and 12 months after symptom onset. Our assessment included: lung volume (total lung capacity [TLC], vital capacity, residual volume, functional residual capacity), spirometry (FVC, FEV1), diffusing capacity of the lung for carbon monoxide (Dlco), inspiratory and expiratory respiratory muscle strength, 6-min walk distance (6MWD), chest radiographs (CXRs), and HRQoL by Medical Outcomes Study 36-Item Short-Form General Health Survey questionnaire. Results Ninety-seven patients completed the serial assessments. There were 39 male and 58 female patients, and 63 patients (70%) were health-care workers (mean age, 36.9 years [SD, 9.5 years]; body mass index, 23.7 kg/m2 [SD, 4.0 kg/m2]). At 1 year, 27 patients (27.8%) had abnormal CXR findings. Four patients (4.1%), 5 patients (5.2%), and 23 patients (23.7%) had FVC, TLC, and Dlco values < 80% of predicted values, respectively. The 6MWD at 12 months was 511.0 m (SD, 89.8 m), which was higher than at 3 months (mean difference, 47.0 m; 95% confidence interval [CI], 31.8 to 62.1 m; p < 0.01) but not different from 6 months (mean difference, 9.7 m; 95% CI, − 4.4 to 23.8 m; p = 0.18). The 6MWD was lower than that for normal control subjects of the same age groups, and there was impairment of HRQoL at 12 months. Patients who required ICU admission (n = 31) showed higher CXR scores (1.6 [SD, 3.1]; vs 0.4 [SD, 1.1]; p = 0.04) and lower percentage of predicted FVC, TLC, and Dlco than those who did not, but there were no differences in 6MWD and health status. Conclusion Significant impairment in Dlco was noted in 23.7% of survivors 1 year after illness onset. Exercise capacity and health status of SARS survivors were remarkably lower than those of a normal population.
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Affiliation(s)
- David S Hui
- Center for Emerging Infectious Diseases, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, NT, Hong Kong.
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95
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Williams TA, Dobb GJ, Finn JC, Webb SAR. Long-term survival from intensive care: a review. Intensive Care Med 2005; 31:1306-15. [PMID: 16132895 DOI: 10.1007/s00134-005-2744-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Accepted: 07/01/2005] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether the long-term benefit of an ICU requires prolonged patient follow-up we reviewed long-term survival of patients from general ICUs. METHOD We carried out a computerised search of online databases Medline (1966-2004), Embase (1966-2004) and Cochrane Library (1966-2004) for studies reporting patients' long-term survival for greater than 12 months from general ICUs. SELECTED STUDIES: We identified 19 studies that met the selection criteria. The casemix and severity of illness varied. Differences included the services provided, investigator inclusion/exclusion criteria and proportion of medical patients (range 13-79%). RESULTS Mean reported ICU length of stay was 5.3 days. The study initiation time for follow-up varied (mostly from time of ICU admission), as did the duration of follow-up (16 months-13 years). ICU and hospital mortality rates ranged from 8% to 33% and 11% to 64%, respectively. The reported 5-year mortality ranged from 40% to 58%. CONCLUSIONS Well designed studies on long-term outcomes are needed to demonstrate the value of intensive care. Deficiencies in design, methodology, and reporting make interpretation and comparison difficult. Recommendations are made for the reporting of outcome from the ICU. Optimum duration of follow-up has not been determined.
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96
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Lau HMC, Lee EWC, Wong CNC, Ng GYF, Jones AYM, Hui DSC. The impact of severe acute respiratory syndrome on the physical profile and quality of life. Arch Phys Med Rehabil 2005; 86:1134-40. [PMID: 15954051 PMCID: PMC7094462 DOI: 10.1016/j.apmr.2004.09.025] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the impact of severe acute respiratory syndrome (SARS) on the physical fitness and health-related quality of life (HRQOL) among SARS survivors. DESIGN A cohort study. SETTING An outpatient physiotherapy department in a major hospital in Hong Kong. PARTICIPANTS SARS patients (N=171) discharged from the hospital. Their mean age was 37.36+/-12.65 years, and the average number of days of hospitalization was 21.79+/-9.93 days. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Subjects cardiorespiratory (6-minute walk test [6MWT], Chester step test for predicting maximal oxygen uptake [Vo 2 max]), musculoskeletal (proximal/distal muscle strength and endurance test), and HRQOL status (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) were measured and compared with the normative data matched for age and sex. RESULTS Seventy-eight (45.61%) patients continued to require prednisolone (< 0.5mg.kg -1 .d -1 ) for residual lung opacities when data were collected. The values of 6MWT distance, predicted Vo 2 max, proximal and distal muscle strength, and the scores from all SF-36 domains, particularly perceived role-physical, were significantly lower than the normative data ( P <.05). CONCLUSIONS SARS survivors had deficits in cardiorespiratory and musculoskeletal performance, and their HRQOL appeared to be significantly impaired.
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Affiliation(s)
| | - Edwin Wai-Chi Lee
- Physiotherapy Department, Prince of Wales Hospital, Shatin
- Reprint requests to Edwin Wai-Chi Lee, MPhil, Physiotherapy Dept, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | | | - Gabriel Yin-Fat Ng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon
| | - Alice Yee-Men Jones
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon
| | - David Shu-Cheong Hui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
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97
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Heyland DK, Groll D, Caeser M. Survivors of acute respiratory distress syndrome: Relationship between pulmonary dysfunction and long-term health-related quality of life*. Crit Care Med 2005; 33:1549-56. [PMID: 16003061 DOI: 10.1097/01.ccm.0000168609.98847.50] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients who survive acute respiratory distress syndrome (ARDS) often report decreased general health-related quality of life (HRQOL) following hospital discharge. The extent to which this impairment is due to pulmonary or nonpulmonary causes is unclear. We describe the pattern of recovery of patients surviving ARDS to illuminate any relationships between lung spirometry values, pulmonary symptoms, and overall HRQOL. METHODS Seventy-three survivors of ARDS were enrolled in a 12-month follow-up study as part of a phase III randomized, multicenter trial. Patients were contacted at 3, 6, and 12 months after enrollment to complete generic and disease-specific HRQOL questionnaires and have lung spirometry tests performed. RESULTS For all domains of the Medical Outcomes Study Short Form-36 (SF-36) and the St. George's Respiratory Questionnaire (SGRQ) at all time intervals, survivors of ARDS had significantly lower scores than age- and sex-matched population values. Over the 12-month follow-up period, we observed significant improvements to the overall Physical Component Score, but the Mental Component Score of the SF-36 and the SGRQ scores were not statistically different. Physical performance measures suggested that by 12 months, 57% had not returned to "normal activity." At 12 months, lung spirometry tests demonstrated mild abnormalities that were stable over time (64% and 49% had <80% predicted forced expiratory volume in 1 sec [Fev1] and forced vital capacity [Fvc], respectively). At 12 months, the forced expiratory volume in 1 sec correlated strongly with the physical function domain of the SF-36 (correlation coefficient = 0.601; p < .01) and moderately with all domains of the SGRQ (correlation coefficient = -0.36, -50; p < .01 in all cases). In addition, there were several strong to moderate correlations between the various domains of the SF-36 and SGRQ. CONCLUSIONS Survivors of ARDS have considerable respiratory symptoms and reduced HRQOL that is still prevalent at 12 mos following onset of injury. There are significant correlations between lung spirometry, pulmonary symptoms, and overall HRQOL, thus suggesting the acute lung injury/ARDS is causally contributing to the observed long-term outcome.
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Affiliation(s)
- Daren K Heyland
- Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada
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98
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Schein RMH, Quartin AA. Acute respiratory distress syndrome and long-term outcomes: What should we follow?*. Crit Care Med 2005; 33:1656-8. [PMID: 16003085 DOI: 10.1097/01.ccm.0000170176.22020.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hui DS, Joynt GM, Wong KT, Gomersall CD, Li TS, Antonio G, Ko FW, Chan MC, Chan DP, Tong MW, Rainer TH, Ahuja AT, Cockram CS, Sung JJY. Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors. Thorax 2005; 60:401-9. [PMID: 15860716 PMCID: PMC1758905 DOI: 10.1136/thx.2004.030205] [Citation(s) in RCA: 342] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the impact of severe acute respiratory syndrome (SARS) on pulmonary function, exercise capacity, and health-related quality of life (HRQoL) among survivors. METHODS 110 survivors with confirmed SARS were evaluated at the Prince of Wales Hospital, HK at the end of 3 and 6 months after symptom onset. The assessment included lung volumes (TLC, VC, RV, FRC), spirometry (FVC, FEV1), carbon monoxide transfer factor (TLCO adjusted for haemoglobin), inspiratory and expiratory respiratory muscle strength (Pimax and Pemax), 6 minute walk distance (6MWD), chest radiographs, and HRQoL by SF-36 questionnaire. RESULTS There were 44 men and 66 women with a mean (SD) age of 35.6 (9.8) years and body mass index of 23.1 (4.8) kg/m2. Seventy (64%) were healthcare workers. At 6 months 33 subjects (30%) had abnormal chest radiographs; four (3.6%), eight (7.4%), and 17 (15.5%) patients had FVC, TLC, and TLCO below 80% of predicted values; and 15 (13.9%) and 24 (22.2%) had Pimax and Pemax values below 80 cm H2O, respectively. The 6MWD increased from a mean (SD) of 464 (83) m at 3 months to 502 (95) m (95% CI 22 to 54 m, p<0.001), but the results were lower than normal controls in the same age groups. There was impairment of HRQoL at 6 months. Patients who required ICU admission (n = 31) had significantly lower FVC, TLC, and TLCO than those who did not. CONCLUSION The exercise capacity and health status of SARS survivors was considerably lower than that of a normal population at 6 months. Significant impairment in surface area for gas exchange was noted in 15.5% of survivors. The functional disability appears out of proportion to the degree of lung function impairment and may be related to additional factors such as muscle deconditioning and steroid myopathy.
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Affiliation(s)
- D S Hui
- Center for Emerging Infectious Diseases, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Lin X, Yang H, Sakuragi T, Hu M, Mantell LL, Hayashi S, Al-Abed Y, Tracey KJ, Ulloa L, Miller EJ. Alpha-chemokine receptor blockade reduces high mobility group box 1 protein-induced lung inflammation and injury and improves survival in sepsis. Am J Physiol Lung Cell Mol Physiol 2005; 289:L583-90. [PMID: 15937067 DOI: 10.1152/ajplung.00091.2005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
High mobility group box 1 (HMGB1) protein, a late mediator of lethality in sepsis, can induce acute inflammatory lung injury. Here, we identify the critical role of alpha-chemokine receptors in the HMGB1-induced inflammatory injury and show that alpha-chemokine receptor inhibition increases survival in sepsis, in a clinically relevant time frame. Intratracheal instillation of recombinant HMGB1 induces a neutrophilic leukocytosis, preceded by alveolar accumulation of the alpha-chemokine macrophage inflammatory protein-2 and accompanied by injury and increased inflammatory potential within the air spaces. To investigate the role of alpha-chemokine receptors in the injury, we instilled recombinant HMGB1 (0.5 microg) directly into the lungs and administered a subcutaneous alpha-chemokine receptor inhibitor, Antileukinate (200 microg). alpha-Chemokine receptor blockade reduced HMGB1-induced inflammatory injury (neutrophils: 2.9 +/- 3.2 vs. 8.1 +/- 2.4 x 10(4) cells; total protein: 120 +/- 48 vs. 311 +/- 129 microg/ml; reactive nitrogen species: 2.3 +/- 0.3 vs. 3.5 +/- 1.3 microM; and macrophage migration inhibitory factor: 6.4 +/- 4.2 vs. 37.4 +/- 15.9 ng/ml) within the bronchoalveolar lavage fluid, indicating that HMGB1-induced inflammation and injury are alpha-chemokine mediated. Because HMGB1 can mediate late septic lethality, we administered Antileukinate to septic mice and observed increased survival (from 58% in controls to 89%) even when the inhibitor treatment was initiated 24 h after the induction of sepsis. These data demonstrate that alpha-chemokine receptor inhibition can reduce HMGB1-induced lung injury and lethality in established sepsis and may provide a novel treatment in this devastating disease.
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Affiliation(s)
- Xinchun Lin
- Department of Surgery, North Shore University Hospital, Long Island Jewish Medical Center, Manhasset, NY 11030, USA
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