Risk Factors for Physical Impairment after Acute Lung Injury in a National, Multicenter Study
Risk Factors for Physical Impairment after Acute Lung Injury in a National, Multicenter Study
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DOI：
10.1164/rccm.201401-0158oc
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发表时间：
2014-05-15
影响因子：
24.7
通讯作者：
Hopkins, Ramona O.
中科院分区：
文献类型：
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作者：
Needham, Dale M.;Wozniak, Amy W.;Hopkins, Ramona O.
基本原理：现有的急性肺损伤（ALI）幸存者身体损伤危险因素的研究可能受到单中心设计或相对较小样本量的限制。目的：评估ALI幸存者在住院后第一年内通常经历的三种身体损伤指标的危险因素。方法：6个月和12个月身体结局的前瞻性纵向研究（肌肉力量，6分钟步行距离，和SF-36躯体功能评分）对参加ARDS网络随机试验的12家医院的203名ALI幸存者进行研究。多变量回归分析评估了危重病相关变量和重症监护干预与每项身体结局指标损害的独立相关性，调整了患者人口统计学、合并症和基线功能状态后。分别在6个月和12个月时，规格的平均值（+/- SD）（表示为使用手动肌肉测试评估的最大力量评分的比例）分别为92%（+/- 8%）和93%（+/- 9%），6分钟步行距离（按照预期）为64%（+/- 22%）和67%（+/- 26%），SF-36身体功能评分（按照预期）为61%（+/- 36%）和67%（+/- 37%）。在考虑患者的基线状态后，皮质类固醇的平均日剂量和重症监护室的住院时间与身体结局的损害有显著的相关性和统计学相互作用：患者有实质性的损害，从预测值，6分钟步行距离和SF-36身体功能结局指标。最大限度地减少皮质类固醇剂量和实施现有的循证方法，以减少重症监护室的停留时间和相关的患者固定可能是改善ALI幸存者的身体结果的重要干预措施。
Rationale: Existing studies of risk factors for physical impairments in acute lung injury (ALI) survivors were potentially limited by single-center design or relatively small sample size.Objectives: To evaluate risk factors for three measures of physical impairments commonly experienced by survivors of ALI in the first year after hospitalization.Methods: A prospective, longitudinal study of 6- and 12-month physical outcomes (muscle strength, 6-minute-walk distance, and Short Form [SF]-36 Physical Function score) for 203 survivors of ALI enrolled from 12 hospitals participating in the ARDS Network randomized trials. Multivariable regression analyses evaluated the independent association of critical illness-related variables and intensive care interventions with impairments in each physical outcome measure, after adjusting for patient demographics, comorbidities, and baseline functional status.Measurements and Main Results: At 6 and 12 months, respectively, mean (+/- SD) values for strength (presented as proportion of maximum strength score evaluated using manual muscle testing) was 92% (+/- 8%) and 93% (+/- 9%), 6-minute-walk distance (as percent-predicted) was 64% (+/- 22%) and 67% (+/- 26%), and SF-36 Physical Function score (as percent-predicted) was 61% (+/- 36%) and 67% (+/- 37%). After accounting for patient baseline status, there was significant association and statistical interaction of mean daily dose of corticosteroids and intensive care unit length of stay with impairments in physical outcomes.Conclusions: Patients had substantial impairments, from predicted values, for 6-minute-walk distance and SF-36 Physical Function outcome measures. Minimizing Corticosteroid dose and implementing existing evidence-based methods to reduce duration of intensive care unit stay and associated patient immobilization may be important interventions for improving ALI survivors' physical outcomes.