Physical complications in acute lung injury survivors: a two-year longitudinal prospective study.
Physical complications in acute lung injury survivors: a two-year longitudinal prospective study.
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DOI：
10.1097/ccm.0000000000000040
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发表时间：
2014-04
影响因子：
8.8
通讯作者：
Needham DM
中科院分区：
文献类型：
--
作者：
Fan E;Dowdy DW;Colantuoni E;Mendez-Tellez PA;Sevransky JE;Shanholtz C;Himmelfarb CR;Desai SV;Ciesla N;Herridge MS;Pronovost PJ;Needham DM
严重危重疾病的幸存者经常出现实质性和持续性的身体并发症，包括肌肉无力、身体功能受损和与健康相关的生活质量(HRQOL)下降。我们的目标是确定肌肉无力、身体功能和HRQOL的纵向流行病学，以及它们与危重疾病和重症监护病房暴露的关系。一项多部位前瞻性研究，在急性肺损伤后3、6、12和24个月进行纵向随访。4所专科教学医院的13个重症监护室。222例急性肺损伤幸存者。在每个时间点，患者接受标准化的临床评估，包括四肢、握力和呼吸肌力量；人体测量学(身高、体重、臂围和三头肌皮褶厚度)、6分钟步行距离和医疗结果简表36(SF-36)HRQOL调查。在住院期间，幸存者还对危重疾病和相关的治疗变量进行了详细的日常评估。超过三分之一的幸存者在出院时有客观证据表明肌肉无力，大多数人在12个月内有所改善。这种虚弱与持续24个月的身体功能和HRQOL的实质性损害有关。在24个月的随访中，危重疾病期间卧床休息的时间一直与虚弱有关。重症监护病房中全身糖皮质激素的累积剂量和神经肌肉阻滞剂的使用与虚弱无关。ALI后肌肉无力是常见的，通常在12个月内恢复。这种虚弱与持续超过24个月的身体功能和HRQOL的实质性损害有关。这些结果为ALI后的身体恢复提供了有价值的预后信息。减少危重疾病期间卧床休息时间的循证方法对于改善这些长期损害可能是重要的。
Survivors of severe critical illness frequently develop substantial and persistent physical complications, including muscle weakness, impaired physical function, and decreased health-related quality of life (HRQOL). Our objective was to determine the longitudinal epidemiology of muscle weakness, physical function, and HRQOL, and their associations with critical illness and intensive care unit exposures. A multi-site prospective study with longitudinal follow-up at 3, 6, 12, and 24 months after acute lung injury. 13 intensive care units from 4 academic teaching hospitals. 222 survivors of acute lung injury. At each time point, patients underwent standardized clinical evaluations of extremity, hand grip, and respiratory muscle strength; anthropometrics (height, weight, mid-arm circumference, and triceps skin fold thickness), 6-minute walk distance, and the Medical Outcomes Short-Form 36 (SF-36) HRQOL survey. During their hospitalization, survivors also had detailed daily evaluation of critical illness and related treatment variables. Over one-third of survivors had objective evidence of muscle weakness at hospital discharge, with most improving within 12 months. This weakness was associated with substantial impairments in physical function and HRQOL that persisted at 24 months. The duration of bed rest during critical illness was consistently associated with weakness throughout 24-month follow-up. The cumulative dose of systematic corticosteroids and use of neuromuscular blockers in the intensive care unit were not associated with weakness. Muscle weakness is common after ALI, usually recovering within 12 months. This weakness is associated with substantial impairments in physical function and HRQOL that continue beyond 24 months. These results provide valuable prognostic information regarding physical recovery after ALI. Evidence-based methods to reduce the duration of bed rest during critical illness may be important for improving these long-term impairments.