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Multicenter Study
. 2017 Mar;45(3):446-453.
doi: 10.1097/CCM.0000000000002208.

Muscle Weakness and 5-Year Survival in Acute Respiratory Distress Syndrome Survivors

Victor D Dinglas  1 , Lisa Aronson Friedman, Elizabeth Colantuoni, Pedro A Mendez-Tellez, Carl B Shanholtz, Nancy D Ciesla, Peter J Pronovost, Dale M Needham
Affiliations
Multicenter Study

Muscle Weakness and 5-Year Survival in Acute Respiratory Distress Syndrome Survivors

Victor D Dinglas et al. Crit Care Med. 2017 Mar.

Abstract

Objectives: To longitudinally evaluate the association of post-ICU muscle weakness and associated trajectories of weakness over time with 5-year survival.

Design: Longitudinal prospective cohort study over 5 years of follow-up.

Setting: Thirteen ICUs in four hospitals in Baltimore, MD.

Patients: One hundred fifty-six acute respiratory distress syndrome survivors.

Interventions: None.

Measurements and main results: Strength was evaluated with standardized manual muscle testing using the Medical Research Council sum score (range, 0-60; higher is better), with post-ICU weakness defined as sum score less than 48. Muscle strength was assessed at hospital discharge and at 3, 6, 12, 24, 36, and 48 months after acute respiratory distress syndrome. At discharge, 38% of patients had muscle weakness. Every one point increase in sum score at discharge was associated with improved survival (hazard ratio [95% CI], 0.96 [0.94-0.98]), with similar findings longitudinally (0.95 [0.93-0.98]). Having weakness at discharge was associated with worse 5-year survival (1.75 [1.01-3.03]), but the association was attenuated (1.54 [0.82-2.89]) when evaluated longitudinally over follow-up. Persisting and resolving trajectories of muscle weakness, occurring in 50% of patients during follow-up, were associated with worse survival (3.01 [1.12-8.04]; and 3.14 [1.40-7.03], respectively) compared to a trajectory of maintaining no muscle weakness.

Conclusions: At hospital discharge, greater than one third of acute respiratory distress syndrome survivors had muscle weakness. Greater strength at discharge and throughout follow-up was associated with improved 5-year survival. In patients with post-ICU weakness, both persisting and resolving trajectories were commonly experienced and associated with worse survival during follow-up.

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Figures

Figure 1
Figure 1
Patient Flow Chart
Figure 2
Figure 2
Kaplan-Meier curve of 5-year survival after hospital discharge for 156 ARDS patients comparing those with muscle weakness vs. those without muscle weakness at hospital discharge* * Log-rank test p-value = 0.002
See this image and copyright information in PMC

Comment in

References

    1. Lilly CM, Zuckerman IH, Badawi O, Riker RR. Benchmark data from more than 240,000 adults that reflect the current practice of critical care in the United States. Chest. 2011 Nov;140(5):1232–42. - PubMed
    1. Zimmerman JE, Kramer AA, Knaus WA. Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care. 2013;17(2):R81. - PMC - PubMed
    1. Zambon M, Vincent JL. Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest. 2008 May;133(5):1120–7. - PubMed
    1. Sigurdsson MI, Sigvaldason K, Gunnarsson TS, Moller A, Sigurdsson GH. Acute respiratory distress syndrome: nationwide changes in incidence, treatment and mortality over 23 years. Acta Anaesthesiol Scand. 2013 Jan;57(1):37–45. - PubMed
    1. Wunsch H, Guerra C, Barnato AE, Angus DC, Li G, Linde-Zwirble WT. Three-year outcomes for Medicare beneficiaries who survive intensive care. JAMA. 2010 Mar 3;303(9):849–56. - PubMed

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