Kitty S Chan1, Marina Mourtzakis2, Lisa Aronson Friedman3,4, Victor D Dinglas3,4, Catherine L Hough5, E Wesley Ely6,7, Peter E Morris8, Ramona O Hopkins9,10,11, Dale M Needham3,4,12. 1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 2. Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada. 3. Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD. 4. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 5. Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA. 6. Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 7. Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN. 8. Division of Pulmonary, Critical Care & Sleep Medicine, University of Kentucky, Lexington, KY. 9. Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT. 10. Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT. 11. Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT. 12. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract
OBJECTIVES: Rapid muscle wasting occurs during acute respiratory failure, resulting in muscle weakness and functional impairments. This study examines survivors' body composition in the year after acute respiratory distress syndrome and tests associations of patient characteristics, hospital exposures, and survivors' strength and physical functioning with whole body percent lean mass. DESIGN: Prospective cohort study with 6- and 12-month follow-up. SETTING: National study enrolling patients from five study centers. PATIENTS: Acute respiratory distress syndrome survivors (n = 120). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Lean and fat mass from dual energy x-ray absorptiometry. On average, survivors gained whole body total mass (+1.4 kg; 0.1-2.7) and fat mass (+1.2 kg; 0.2-2.2) and maintained lean mass (+0.2 kg; -0.4 to 0.8) between 6 and 12 months. Proportionally, percent fat mass increased and percent lean mass decreased for the whole body, trunk, and legs (p < 0.05). Greater whole body percent lean mass was associated with younger age, male sex, and lower baseline body mass index, but not other patient characteristics or ICU/hospital exposures. Greater percent lean mass was also significantly associated with gait speed and 6-minute walk distance, but not volitional strength or self-reported functional status. CONCLUSIONS: In the first year after acute respiratory distress syndrome, patients gained fat mass and maintained lean mass. We found no association of whole body percent lean mass with commonly hypothesized hospital risk factors. Direct measurement of body composition and performance-based functional measures may be helpful for understanding functional recovery in ICU survivors.
OBJECTIVES: Rapid muscle wasting occurs during acute respiratory failure, resulting in muscle weakness and functional impairments. This study examines survivors' body composition in the year after acute respiratory distress syndrome and tests associations of patient characteristics, hospital exposures, and survivors' strength and physical functioning with whole body percent lean mass. DESIGN: Prospective cohort study with 6- and 12-month follow-up. SETTING: National study enrolling patients from five study centers. PATIENTS: Acute respiratory distress syndrome survivors (n = 120). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Lean and fat mass from dual energy x-ray absorptiometry. On average, survivors gained whole body total mass (+1.4 kg; 0.1-2.7) and fat mass (+1.2 kg; 0.2-2.2) and maintained lean mass (+0.2 kg; -0.4 to 0.8) between 6 and 12 months. Proportionally, percent fat mass increased and percent lean mass decreased for the whole body, trunk, and legs (p < 0.05). Greater whole body percent lean mass was associated with younger age, male sex, and lower baseline body mass index, but not other patient characteristics or ICU/hospital exposures. Greater percent lean mass was also significantly associated with gait speed and 6-minute walk distance, but not volitional strength or self-reported functional status. CONCLUSIONS: In the first year after acute respiratory distress syndrome, patients gained fat mass and maintained lean mass. We found no association of whole body percent lean mass with commonly hypothesized hospital risk factors. Direct measurement of body composition and performance-based functional measures may be helpful for understanding functional recovery in ICU survivors.
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