As many as 86% of survivors of acute respiratory distress syndrome (ARDS) decline physically in the years after ICU discharge. Survivors with a greater risk for physical decline are older or have a comorbidity before going into the ICU, according to a study published October 1, 2016 in Intensive Care Medicine.
“Many people assume that once you survive a stay in the intensive care unit, you’re on a constant upward trajectory of recovery,” said senior author Dale Needham, MD, PhD, Professor of Pulmonary and Critical Care Medicine at the Johns Hopkins University School of Medicine, in Baltimore, MD. “We found that the vast majority of patients do not follow that pathway, instead following a rocky course with fluctuating recovery or a downward trajectory of physical decline.”
For this study, Dr. Needham and colleagues sought to identify which survivors were at the highest risk for physical decline in the 5 years after discharge.
“These findings have helped us determine that older survivors and those who enter the ICU with other pre-existing illnesses have the highest risk of physical decline, and support future efforts to design and evaluate post-ICU rehabilitation specifically targeting these types of patients,” Dr. Needham explained.
The study researchers included 193 ARDS survivors from 13 ICUs in Baltimore who completed at least 1 physical status assessment at 3 or 6 months after discharge. Each survivor also completed an annual assessment for 5 consecutive years. The researchers evaluated 3 measures of physical status: muscle strength, exercise capacity, and physical functioning.
Of the 193 survivors, 166 (86%) experienced at least 1 measure of physical decline, including death. Excluding death, 133 survivors (69%) experienced a physical decline. Risk factors of older age and pre-ICU comorbidity—rather than severity of illness and other ICU factors—were most strongly and consistently associated with physical decline, the results showed.
Of the patients with any physical decline (including death), 92% declined in muscle strength, 62% declined in exercise capacity, 66% declined in physical functioning, and 47% had declines in all 3 physical status measures or died during follow-up.
“This study was one of the first to look at long-term declines after hospital discharge in three distinct physical measures. The results give us a clearer picture of what types of patients require ongoing support and when,” said co-first author Elizabeth Pfoh, PhD, former research fellow at Johns Hopkins, and now on staff at the Center for Value-Based Care Research at the Cleveland Clinic.
These findings are especially important for targeting specific patient populations for future studies, since existing research evaluating post-discharge interventions hasn’t been especially fruitful.
“Generally, ICU survivors receive physical and occupational rehabilitation immediately following hospital discharge, but not necessarily for long after,” Dr. Needham noted. “These results show that additional research is needed to determine the potential effects of prolonged rehabilitation, specifically for older survivors and those who entered the ICU with pre-existing illnesses. This would also complement ongoing research evaluating the short- and long-term effects of rehabilitation started early while patients are in the ICU.”