Depressive Symptoms and Impaired Physical Function after Acute Lung Injury

Abstract

Rationale: Survivors of acute lung injury (ALI) frequently have substantial depressive symptoms and physical impairment, but the longitudinal epidemiology of these conditions remains unclear. Objectives: To evaluate the 2-year incidence and duration of depressive symptoms and physical impairment after ALI, as well as risk factors for these conditions. Methods: This prospective, longitudinal cohort study recruited patients from 13 intensive care units (ICUs) in four hospitals, with follow-up 3, 6, 12, and 24 months after ALI. The outcomes were Hospital Anxiety and Depression Scale depression score greater than or equal to 8 ("depressive symptoms") in patients without a history of depression before ALI, and two or more dependencies in instrumental activities of daily living ("impaired physical function") in patients without baseline impairment. Measurements and Main Results: During 2-year follow-up of 186 ALI survivors, the cumulative incidences of depressive symptoms and impaired physical function were 40 and 66%, respectively, with greatest incidence by 3-month follow-up; modal durations were greater than 21 months for each outcome. Risk factors for incident depressive symptoms were education 12 years or less, baseline disability or unemployment, higher baseline medical comorbidity, and lower blood glucose in the ICU. Risk factors for incident impaired physical function were longer ICU stay and prior depressive symptoms. Conclusions: Incident depressive symptoms and impaired physical function are common and long-lasting during the first 2 years after ALI. Interventions targeting potentially modifiable risk factors (e.g., substantial depressive symptoms in early recovery) should be evaluated to improve ALI survivors' long-term outcomes.Keywords: depression; recovery of function; critical illness; critical care; acute lung injury Survivors of acute lung injury/acute respiratory distress syndrome (ALI) and other critical illnesses frequently have substantial depressive symptoms and impaired physical functioning, with associated decrements in quality of life (1-9). At present, there are gaps in knowledge regarding the incidence and duration of these conditions in ALI survivors, as well as their risk factors.Our objective was to longitudinally examine the incidence and duration of depressive symptoms and impaired physical functioning in the first 2 years after ALI. We also sought to determine risk factors for each of these conditions, to help inform future prevention and treatment efforts. Some of the results of this study have been reported previously in the form of an abstract (10). METHODS Study PopulationMechanically ventilated patients with ALI (11) were enrolled consecutively in a prospective cohort study involving 13 intensive care units (ICUs) at four hospitals in Baltimore, Maryland, between October 2004 and October 2007 (12). To avoid inclusion of patients with primary neurologic disease or head trauma, neurologic specialty ICUs at the participating hospitals were excluded. Key exclusion criteria were (1) ...

The Adult Respiratory Distress Syndrome Cognitive Outcomes Study

“…Potential solutions to improve retention and test completion in future studies include increasing the flexibility of scheduling by centralizing test administration in different time-zones to minimize potential conflicts with work or healthcare visits; increasing the number of trained staff to administer the neuropsychological battery and identifying and using the most effective strategies to ensure test completion; selecting an intermediate testing time point (e.g., 3 mo), which minimizes mortal losses yet ensures adequate time for survivors to transition through the healthcare system to home (24,25,62,63); using a shorter test battery (64) or limiting the domains to be assessed (62); and using multiple strategies in a systematic fashion to retain participants (60,61). Through the effective use of many of these strategies, more recent studies are demonstrating the ability to recruit and retain survivors of ALI successfully (61,65,66). Finally, compared with nonparticipants, ACOS subjects were more likely to be female and white; as such, our findings may not generalize to other populations.…”

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“…post traumatic stress disorder] [5,6]. Međunarodna nacionalna baza podataka iznalazi da se u više od 24.000 bolesnika koji su preživjeli poslije provedenog liječenja uporabom suportivnih metoda liječenja, posebice respiracije, verificira simptomatologija iz domene psihijatrijskih poremećaja [anksioznost i/ili depresija], a kod 19% bolesnika postoji indikacija za uzimanje psihoaktivnih lijekova [5].…”

“…Prema rezultatima recentnih studija učestalost iznosi do 78% [6,8]. Rezultati provedene studije grupe autora [Johns Hopkins University School of Medicine, Baltimore, Maryland, USA], koja je uključila 821 ispitanika iznalazi sljedeće: odmah nakon završena bolničkog liječenja 6% bolesnika ima kognitivna oštećenja; tri mjeseca nakon otpusta iz JIL-a 40% bolesnika ima promjene koje su slične u bolesnika s umjerenim traumatskim ozljedama mozga, a 26% ima promjene koje su slične blagoj demenciji.…”