Fatigue Symptoms During the First Year Following ARDS

  • Karin J. Neufeld
    Correspondence
    CORRESPONDENCE TO: Karin J. Neufeld, MD, MPH, A4Center, Ste 457, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, Baltimore, MD 21224
    Affiliations
    Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD

    Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD
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  • Jeannie-Marie S. Leoutsakos
    Affiliations
    Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD

    Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD
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  • Haijuan Yan
    Affiliations
    Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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  • Shihong Lin
    Affiliations
    Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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  • Jeffrey S. Zabinski
    Affiliations
    Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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  • Victor D. Dinglas
    Affiliations
    Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

    Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD
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  • Megan M. Hosey
    Affiliations
    Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD

    Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD
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  • Ann M. Parker
    Affiliations
    Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

    Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD
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  • Ramona O. Hopkins
    Affiliations
    Neuroscience Center and Psychology Department, Brigham Young University, Provo, UT

    Pulmonary and Critical Care Medicine, Intermountain Healthcare, and Center for Humanizing Critical Care, Intermountain Medical Center, Murray, UT
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  • Dale M. Needham
    Affiliations
    Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

    Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD

    Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD
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      Background

      Fatigue is commonly reported by ARDS survivors, but empirical data are scarce.

      Research Question

      This study evaluated fatigue prevalence and associated variables in a prospective study of ARDS survivors.

      Study Design and Methods

      This analysis is part of the ARDSNet Long-Term Outcomes Study (ALTOS) conducted at 38 US hospitals. Using age- and sex-adjusted, time-averaged random effects regression models, we evaluated associations between the validated Functional Assessment of Chronic Illness Therapy-Fatigue Scale with patient and critical illness variables, and with physical, cognitive, and mental health status at 6 and 12 months following ARDS.

      Results

      Among ARDS survivors, 501 of 711 (70%) and 436 of 659 (66%) reported clinically significant symptoms of fatigue at 6 and 12 months, respectively, with 41% and 28% reporting clinically important improvement and worsening (n = 638). At 6 months, the prevalence of fatigue (70%) was greater than that of impaired physical functioning (50%), anxiety (42%), and depression (36%); 46% reported both impaired physical function and fatigue, and 27% reported co-existing anxiety, depression, and fatigue. Fatigue was less severe in men and in those employed prior to ARDS. Critical illness variables (eg, illness severity, length of stay) had little association with fatigue symptoms. Worse physical, cognitive, and mental health symptoms were associated with greater fatigue at both the 6- and 12-month follow-up.

      Interpretation

      During the first year following ARDS, more than two-thirds of survivors reported clinically significant fatigue symptoms. Due to frequent co-occurrence, clinicians should evaluate and manage survivors’ physical, cognitive, and mental health status when fatigue is endorsed.

      Key Words

      Abbreviations:

      APACHE III ( Acute Physiology and Chronic Health Evaluation III), FACIT-F ( Functional Assessment of Chronic Illness Therapy-Fatigue Scale), SF-36v2 ( Short Form-36 Version 2)
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