title: Physical complications in acute lung injury survivors: a two-year longitudinal prospective study.
abstract: OBJECTIVE
  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. Our objective was to determine the longitudinal epidemiology of muscle weakness, physical function, and health-related quality of life and their associations with critical illness and ICU exposures.
  
  
  METHODS
  A multisite prospective study with longitudinal follow-up at 3, 6, 12, and 24 months after acute lung injury.
  
  
  METHODS
  Thirteen ICUs from four academic teaching hospitals.
  
  
  METHODS
  Two hundred twenty-two survivors of acute lung injury.
  
  
  METHODS
  None.
  
  
  RESULTS
  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 health-related quality of life 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 health-related quality of life 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 ICU were not associated with weakness.
  
  
  CONCLUSIONS
  Muscle weakness is common after acute lung injury, usually recovering within 12 months. This weakness is associated with substantial impairments in physical function and health-related quality of life that continue beyond 24 months. These results provide valuable prognostic information regarding physical recovery after acute lung injury. Evidence-based methods to reduce the duration of bed rest during critical illness may be important for improving these long-term impairments.
authors.affiliation: 1Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 2Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD. 3Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 4Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 5Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 6Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, GA. 7Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD. 8Johns Hopkins University School of Nursing, Baltimore, MD. 9Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 10Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 11Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.forename: David W
authors.initials: DW
authors.lastname: Dowdy
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Mendez-Tellez
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Sevransky
authors.forename: Carl
authors.initials: C
authors.lastname: Shanholtz
authors.forename: Cheryl R Dennison
authors.initials: CR
authors.lastname: Himmelfarb
authors.forename: Sanjay V
authors.initials: SV
authors.lastname: Desai
authors.forename: Nancy
authors.initials: N
authors.lastname: Ciesla
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Herridge
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D055371:Acute Lung Injury / Q000150:complications*; D000328:Adult; D000368:Aged; D001837:Body Weights and Measures; D016638:Critical Illness; D005080:Exercise Test; D005260:Female; D018737:Hand Strength; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018908:Muscle Weakness / Q000209:etiology*; D011446:Prospective Studies; D011788:Quality of Life; D017741:Survivors