Embracing physical and neuropsychological dysfunction in acute lung injury survivors: the time has come.
Embracing physical and neuropsychological dysfunction in acute lung injury survivors: the time has come.
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拥抱急性肺损伤幸存者的身体和神经心理功能障碍：时机已经到来。
DOI：
10.1164/rccm.201201-0013ed
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发表时间：
2012
影响因子：
24.7
通讯作者：
Moss,Marc
中科院分区：
文献类型：
--
作者：
Azoulay,Elie;Moss,Marc
在过去的十年中，急性肺损伤（ALI）的管理取得了突破性进展，包括低潮气量通气和保守液体策略的实施（1，2）。因此，更多的患者在ALI中存活。根据每年190，000例的发病率和最近低至20%的病死率，仅在美国每年将有超过150，000例新的ALI幸存者（3-5）。肺部和重症监护社区已经开始关注了解和治疗ICU后相关的非肺部疾病，这些疾病发生在越来越多的ALI幸存者中。最近对ICU后后果的兴趣主要集中在神经肌肉功能障碍上（6）。神经肌肉无力在ALI幸存者中很常见，不幸的是，出院后可能持续多年（7）。5年后，ALI幸存者在6分钟内行走的中位距离仅为年龄和性别匹配的对照人群的76%，这与运动能力的持续下降一致（8）。心理问题，包括抑郁，焦虑和创伤后应激障碍的症状，也是常见的ALI幸存者（9，10）。最初的研究报告称，20%至50%的ALI幸存者在1年后出现抑郁症状（11-13）。ALI后抑郁症状的风险因素包括肥胖、低血糖、酒精依赖、女性、年轻和认知功能障碍（14）。中度至重度抑郁症的症状也持续存在，并且在5年后仍存在于近20%的ALI幸存者中（15）。这些5年的随访数据表明，生活质量和运动能力的下降可能是由于持续的虚弱，以及一系列的神经心理损伤的ALI幸存者。在本期杂志中，Bienvenu及其同事（pp. 517-524）前瞻性随访186名ALI幸存者2年（16）。在ALI发作后3、6、12和24个月对患者进行评估。使用医院焦虑和抑郁量表评估抑郁症状，身体功能受损的定义是在基线无损害的患者中，在工具性日常生活活动中至少有两种依赖性。抑郁症状的点患病率在1年为24%，在2年为32%，总累积发病率为40%。2年累积的身体功能受损发生率为66%。抑郁症状的存在与身体功能受损的发展独立相关，这项研究提供了另一个很好的图片在ALI幸存者的长期结果，并显着增加了我们对身体和神经心理损伤之间复杂的相互作用的理解。出色的随访率和连续数据收集反映了该研究团队的极端勤奋，并描述了ICU后负担如何随着时间的推移而持续。最重要的是，这项研究证实了抑郁症状在ALI幸存者中很常见且持续存在。在ICU出院后照顾患者的医疗保健提供者应考虑筛查抑郁症状。本研究的方法也引起了对结果解释的一些关注。医院焦虑和抑郁量表是一种筛查工具，已被验证可以识别是否存在明显的抑郁症状或实际抑郁的风险。症状持续超过21个月表明，一些患者可能患有实际的精神疾病。个人结构化访谈的定性数据将有助于.
Over the last decade, ground-breaking advances have occurred in the management of acute lung injury (ALI), including low tidal volume ventilation and the implementation of a conservative fluid strategy (1, 2). As a result, more patients are surviving ALI. Based on an incidence of 190,000 cases per year and recent case fatality rates as low as 20%, there will be more than 150,000 new ALI survivors annually in the United States alone (3–5). The pulmonary and critical care community has started to focus on understanding and treating post-ICU–related nonpulmonary disorders that occur in the growing number of ALI survivors. Much of the recent interest in post-ICU consequences has been concentrated on the neuromuscular dysfunction (6). Neuromuscular weakness is common in ALI survivors and unfortunately can persist for years after hospital discharge (7). After 5 years, the median distance walked in 6 minutes by ALI survivors was only 76% of the distance of an age-matched and sex-matched control population, consistent with a persistent reduction in exercise capacity (8). Psychological issues, including symptoms of depression, anxiety, and post-traumatic stress disorder, are also common in ALI survivors (9, 10). Initial studies reported that between 20 and 50% of ALI survivors had symptoms of depression after 1 year (11–13). Risk factors for post-ALI depressive symptoms include obesity, hypoglycemia, alcohol dependence, female sex, younger age, and cognitive dysfunction (14). Symptoms of moderate to severe depression also persist and remain in nearly 20% of ALI survivors after 5 years (15). These 5-year follow-up data suggest that the decrements in quality of life and exercise capacity may have resulted from persistent weakness, as well as a spectrum of neuropsychological impairments in ALI survivors. In this issue of the Journal, Bienvenu and colleagues (pp. 517–524) prospectively followed 186 ALI survivors for 2 years (16). Patients were evaluated at 3, 6, 12, and 24 months after the onset of ALI. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale, and impaired physical function was defined by having at least two dependencies in instrumental activities of daily living in patients without baseline impairment. The point prevalence of depressive symptoms was 24% at 1 year and 32% at 2 years with an overall cumulative incidence of 40%. The 2-year cumulative incidence of impaired physical function was 66%. The presence of depressive symptoms was independently associated with the development of impaired physical function.This study provides another excellent picture of long-term outcomes in ALI survivors and adds significantly to our understanding of the complex interactions between physical and neuropsychological impairments. The outstanding follow-up rates and serial data collection reflect the extreme diligence of this research team and depict how post-ICU burden is sustained over time. Most importantly, this study confirms that depressive symptoms are common and persistent in ALI survivors. Healthcare providers who care for patients after ICU discharge should consider screening for symptoms of depression. The methodology of the present study also raises some concern about the interpretation of the results. The Hospital Anxiety and Depression Scale is a screening tool that has been validated to identify the presence of significant depressive symptoms or the risk of actual depression. The persistence of symptoms for more than 21 months suggests that some patients may have actual psychiatric diseases. Qualitative data from individual structured interviews would have been useful to …
影响因子：
158.5
作者：
Rubenfeld, GD;Caldwell, E;Hudson, LD
通讯作者：
Hudson, LD
影响因子：
158.5
作者：
Brower, RG;Matthay, MA;Sibbald, WJ
通讯作者：
Sibbald, WJ
影响因子：
120.7
作者：
Davidson, TA;Caldwell, ES;Steinberg, KP
通讯作者：
Steinberg, KP