Functional Disability 5 Years after Acute Respiratory Distress Syndrome

Herridge, Margaret S.; Cm, Tansey; Matté, Andrea; Tomlinson, George; Diaz-Granados, Natalia; Cooper, Andrew B.; Cb, Guest; Mazer, C. David; Mehta, Sangeeta; Te, Stewart; Kudlow, Paul; Cook, Deborah J.; Slutsky, A. S.; Cheung, Angela M.

doi:10.1056/nejmoa1011802

Cited by 2,388 publications

(1,978 citation statements)

References 75 publications

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“…First, the authors provide valuable, objective data to further support the persistence of physical limitation after critical illness months after the resolution of the aggressive and relentless muscle proteolysis documented in recent studies [5]; similar data have been reported in survivors of acute lung injury even 5 years after hospital discharge [6]. Second, they confirm that severe sepsis is an important cause of long-lasting physical dysfunction and muscle weakness after acute illness, as suggested by a recent official American Thoracic Society clinical practice guideline [7].…”

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confidence: 59%

Unraveling the myriad contributors to persistent diminished exercise capacity after critical illness

Latronico

Herridge

2015

Intensive Care Med

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''Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it'' (Plato).In an article recently published in Intensive Care Medicine [1], Cerqueira Borges and colleagues report their results on measuring daily life physical activity levels, muscle strength, and exercise capacity in survivors of severe sepsis and septic shock. Measurements were taken on the ward for 12 h after ICU discharge and then again at 3 months after discharge at the patients' home and over a time period of 2 days using physical activity monitors worn by the patients. Various activities including sitting, lying, standing, walking, and changes in body position and energy expenditure were recorded. Values obtained during this 2-day period were compared with those of a control group of 50 healthy sedentary subjects. During hospitalization, patients spent 90 % of their time lying in bed or sitting. Physical activity improved to 3 months but ICU patients achieved only 63 % of the walking time compared to healthy sedentary subjects. Exercise capacity was evaluated using the 6-min walk distance (6MWD) test. Dominant upper (hand) and lower (quadriceps) limb muscle strength was quantified using a digital dynamometer, and inspiratory muscle strength was captured by measuring maximal inspiratory pressure. These data were compared with age-and sex-matched control reference data. Exercise capacity, limb and inspiratory muscle strength were reduced by half compared to predicted values and improved to 70 % of predicted values by 3 months. Therefore, even several months after discharge from the hospital, the time spent in physical activities and measured muscle strength were considerably lower when compared to those of healthy people. Similar data were obtained by Denehy and colleagues in a prospective cohort study of 49 critically ill patients with varied ICU admission diagnoses [2]. Twenty-four percent of patients had significant weakness during the ICU stay. At 2 months after discharge, participants wearing an accelerometer for a mean of 13 h per day for 7 days spent 90 % of their time inactive and only 3 % of their time was spent walking. The 6MWD was 64 % of predicted normal values. Persistently diminished exercise capacity may be a robust theme across different disease states and not just affecting those patients after critical illness. In a series of COPD patients suffering acute exacerbations, patients had very low levels of physical activity during and after hospitalization captured by activity monitors [3]. The accuracy of these activity monitors in detecting the time spent in walking, different postures, counting steps, and estimating the energy

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supporting

confidence: 59%

Unraveling the myriad contributors to persistent diminished exercise capacity after critical illness

Latronico

Herridge

2015

Intensive Care Med

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“…2 However, both syndromes continue to be associated with high mortality and morbidity. 3,4 Despite decades of clinical trials, eff ective pharmacotherapy for either syndrome remains elusive. 5,6 A growing body of evidence suggests that cell-based therapy with stem or progenitor cells holds substantial therapeutic promise for a host of infl ammatory disorders, including ARDS and sepsis.…”

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confidence: 99%

Mesenchymal stem cells: mechanisms of potential therapeutic benefit in ARDS and sepsis

Walter

Ware

Matthay

2014

The Lancet Respiratory Medicine

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“…Studies have argued that critical illnesses and their associated treatment-related exposures may have a causal role in increasing the risk of subsequent depression; 9–13 these studies have motivated an NIH-funded randomized controlled trial of empiric escitalopram for patients undergoing mechanical ventilation (ClinicalTrials.gov identifier: NCT00872027). However, very few studies of post-critical illness depression are appropriately designed to test this hypothesis – only two have examined the contribution of premorbid depression using a standardized measure, 14,15 of which only one examined pre-critical illness depressive symptoms prospectively in a small sample of critical illness survivors.…”

Section: Introductionmentioning

confidence: 99%

Symptoms of Depression in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans

Davydow¹,

Hough²,

Langa³

et al. 2013

The American Journal of Geriatric Psychiatry

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Objectives To examine if incident severe sepsis is associated with increased risk of subsequent depressive symptoms and to assess which patient characteristics are associated with increased risk of depressive symptoms. Design Prospective longitudinal cohort study. Setting Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998–2006). Participants 439 patients who survived 471 hospitalizations for severe sepsis and completed at least one follow-up interview. Measurements Depressive symptoms were assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. Severe sepsis was identified using a validated algorithm in Medicare claims. Results The point prevalence of substantial depressive symptoms was 28% at a median of 1.2 years before sepsis, and remained 28% at a median of 0.9 years after sepsis. Neither incident severe sepsis [Relative Risk (RR) 1.00, 95%Confidence Interval (95%CI) (0.73, 1.34)] nor severe sepsis-related clinical characteristics were significantly associated with subsequent depressive symptoms. These results were robust to potential threats from missing data or alternative outcome definitions. After adjustment, pre-sepsis substantial depressive symptoms [RR 2.20, 95%CI (1.66, 2.90)] and worse post-sepsis functional impairment [RR 1.08 per new limitation, 95%CI (1.03, 1.13)] were independently associated with substantial depressive symptoms following sepsis. Conclusions The prevalence of substantial depressive symptoms in severe sepsis survivors is high, but is not increased relative to their pre-sepsis levels. Identifying this large subset of severe sepsis survivors at increased risk for major depression, and beginning interventions prior to hospital discharge, may improve outcomes.

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Functional Disability 5 Years after Acute Respiratory Distress Syndrome

Abstract: Exercise limitation, physical and psychological sequelae, decreased physical quality of life, and increased costs and use of health care services are important legacies of severe lung injury.

Cited by 2,388 publications

References 75 publications

Unraveling the myriad contributors to persistent diminished exercise capacity after critical illness

Unraveling the myriad contributors to persistent diminished exercise capacity after critical illness

Mesenchymal stem cells: mechanisms of potential therapeutic benefit in ARDS and sepsis

Symptoms of Depression in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans

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