Physical Complications in Acute Lung Injury Survivors

TLDR

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. The study aimed to determine the longitudinal epidemiology of muscle weakness, physical function, and health‑related quality of life in acute lung injury survivors and their associations with critical illness and ICU exposures. A multisite prospective cohort of 222 survivors was followed at 3, 6, 12, and 24 months with standardized assessments of muscle strength, anthropometrics, 6‑minute walk distance, and the SF‑36, alongside daily documentation of critical illness and treatment variables during hospitalization. One‑third of acute lung injury survivors had muscle weakness at discharge, most of whom recovered by 12 months, yet weakness remained linked to impaired physical function and quality of life through 24 months, with prolonged bed rest predicting persistent weakness while corticosteroid and neuromuscular blocker exposure did not; these results highlight the need for strategies to shorten bed rest to improve long‑term recovery.

Abstract

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.A multisite prospective study with longitudinal follow-up at 3, 6, 12, and 24 months after acute lung injury.Thirteen ICUs from four academic teaching hospitals.Two hundred twenty-two survivors of acute lung injury.None.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.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.