Physical declines occurring after hospital discharge in ARDS survivors: a 5-year longitudinal study

doi:10.1007/s00134-016-4530-1

Multicenter Study

. 2016 Oct;42(10):1557-1566.

doi: 10.1007/s00134-016-4530-1. Epub 2016 Sep 16.

Physical declines occurring after hospital discharge in ARDS survivors: a 5-year longitudinal study

Elizabeth R Pfoh^{1

2}, Amy W Wozniak³, Elizabeth Colantuoni^{3

4}, Victor D Dinglas^{4

5}, Pedro A Mendez-Tellez^{4

6}, Carl Shanholtz⁷, Nancy D Ciesla⁴, Peter J Pronovost^{4

6

8

9}, Dale M Needham^{10

11

12}

Affiliations

¹ Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
² Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, Fifth Floor, Baltimore, MD, USA.
⁶ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
⁸ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁹ Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁰ Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA. dale.needham@jhmi.edu.
¹¹ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, Fifth Floor, Baltimore, MD, USA. dale.needham@jhmi.edu.
¹² Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA. dale.needham@jhmi.edu.

PMID: 27637716
DOI: 10.1007/s00134-016-4530-1

Multicenter Study

Physical declines occurring after hospital discharge in ARDS survivors: a 5-year longitudinal study

Elizabeth R Pfoh et al. Intensive Care Med. 2016 Oct.

. 2016 Oct;42(10):1557-1566.

doi: 10.1007/s00134-016-4530-1. Epub 2016 Sep 16.

Authors

Affiliations

¹ Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
² Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, Fifth Floor, Baltimore, MD, USA.
⁶ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
⁸ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁹ Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁰ Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA. dale.needham@jhmi.edu.
¹¹ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, Fifth Floor, Baltimore, MD, USA. dale.needham@jhmi.edu.
¹² Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA. dale.needham@jhmi.edu.

PMID: 27637716
DOI: 10.1007/s00134-016-4530-1

Abstract

Purpose: Survivors of acute respiratory distress syndrome (ARDS) are at high risk for new or ongoing physical declines after hospital discharge. The objective of our study was to evaluate the epidemiology of physical declines over 5-year follow-up and identify patients at risk for decline.

Methods: This multi-site prospective cohort study evaluated ARDS survivors who completed a physical status assessment at 3 or 6 months post-discharge. Three measures were evaluated: muscle strength (Medical Resource Council sumscore); exercise capacity [6-min walk test (6MWT)]; physical functioning [36-Item Short Form Health Survey (SF-36 survey)]. Patients were defined as "declined" if a comparison of their current and prior score showed a decrease that was greater than the Reliable Change Index-or if the patient died. Risk factors [pre-ARDS baseline status, intensive care unit (ICU) illness severity, and other intensive care variables] were evaluated using longitudinal, generalized linear regression models for each measure.

Results: During the follow-up of 193 ARDS survivors (55 % male; median age 49 years), 166 (86 %) experienced decline in ≥1 physical measure (including death) and 133 (69 %) experienced a physical decline (excluding death). For all measures, age was a significant risk factor [odds ratios (OR) 1.34-1.69 per decade; p < 0.001]. Pre-ARDS comorbidity (Charlson Index) was independently associated with declines in strength and exercise capacity (OR 1.10 and 1.18, respectively; p < 0.02), and organ failure [maximum daily Sequential Organ Failure Assessment (SOFA) score in ICU] was associated with declines in strength (OR 1.06 per 1 point of SOFA score; p = 0.02).

Conclusions: Over the follow-up period, the majority of ARDS survivors experienced a physical decline, with older age and pre-ICU comorbidity being important risk factors for this decline.

Keywords: Acute respiratory distress syndrome; Intensive care unit; Physical function; Recovery of function.

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Comment in

Long-term physical morbidity in ARDS survivors.
Mehta S, Povoa P. Mehta S, et al. Intensive Care Med. 2017 Jan;43(1):101-103. doi: 10.1007/s00134-016-4586-y. Epub 2016 Oct 5. Intensive Care Med. 2017. PMID: 27709264 No abstract available.

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References

1. Crit Care Med. 2011 Feb;39(2):371-9 - PubMed
1. Semin Respir Crit Care Med. 2012 Aug;33(4):327-38 - PubMed
1. Psychol Med. 2013 Dec;43(12):2657-71 - PubMed
1. Am J Respir Crit Care Med. 2016 Oct 1;194(7):831-844 - PubMed
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[1] Crit Care Med. 2011 Feb;39(2):371-9 - PubMed

[2] Crit Care Med. 2011 Feb;39(2):371-9 - PubMed

[3] Semin Respir Crit Care Med. 2012 Aug;33(4):327-38 - PubMed

[4] Semin Respir Crit Care Med. 2012 Aug;33(4):327-38 - PubMed

[5] Psychol Med. 2013 Dec;43(12):2657-71 - PubMed

[6] Psychol Med. 2013 Dec;43(12):2657-71 - PubMed

[7] Am J Respir Crit Care Med. 2016 Oct 1;194(7):831-844 - PubMed

[8] Am J Respir Crit Care Med. 2016 Oct 1;194(7):831-844 - PubMed

[9] Am J Respir Crit Care Med. 2016 Aug 1;194(3):299-307 - PubMed

[10] Am J Respir Crit Care Med. 2016 Aug 1;194(3):299-307 - PubMed

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Physical declines occurring after hospital discharge in ARDS survivors: a 5-year longitudinal study

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Physical declines occurring after hospital discharge in ARDS survivors: a 5-year longitudinal study

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