Acute Lung Injury (ALI) is a syndrome characterized by acute, diffuse pulmonary capillary leak resulting in hypoxic respiratory failure. It is caused by a diverse group of pulmonary (e.g. aspiration) and non-pulmonary (e.g. sepsis) factors. ALI imposes a significant public health burden with an incidence that is much higher than previously recognized (86 per 100,000 person years) and a total number of deaths similar to breast cancer or HIV infection. Due to advances in medical care, the mortality rate for ALI has decreased from ~70 per cent to ~40 per cent. Patients who previously may have died now survive ALI; however, their recovery is often long and complicated. Research studying the long-term outcomes of these ALI survivors has become increasingly important. Recent studies have demonstrated important and persistent morbidity in ALI survivors. However, these studies were limited in sample size and duration of follow-up, and provided little information on the effect of intensive care unit (ICU) therapies on long-term outcomes. Consequently, our goal is to learn how existing ICU therapies can be used to minimize long-term physical and mental health morbidities and improve patients' functional status and quality of life after ALI. We propose to extend our existing cohort study, which follows patients for 2 years after ALI, to allow 5- year follow-up. In this proposed research, we will study new relationships of ICU therapies with patients' long term outcomes. Specifically, we will study the epidemiology of muscle weakness, and symptoms of anxiety, depression and post-traumatic stress disorder at up to 5 years after ALI, and the association of these sequelae with limitations in patients' physical function and quality of life [Aims 1a and 2a]. We will then determine the association of nutrition and corticosteroids in the ICU with long-term muscle weakness [Aim 1b]. We also will determine the association of delirium and corticosteroids in the ICU with long-term symptoms of post-traumatic stress disorder [Aim 2b]. Through this research, we will understand how existing ICU therapies and exposures can improve long-term physical and mental health after acute lung injury.

Public Health Relevance

Acute lung injury (ALI) usually requires artificial life support in the intensive care unit (ICU) and is common, costly and associated with significant long-term muscle weakness and symptoms of anxiety, depression and post-traumatic stress disorder in surviving patients. This research will provide new knowledge regarding the frequency of these morbidities, their consequences for patients, and how nutrition, corticosteroids and delirium in the ICU may reduce or exacerbate these morbidities up to 5 years after ALI. ? ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
1R01HL088045-01A2
Application #
7516018
Study Section
Infectious Diseases, Reproductive Health, Asthma and Pulmonary Conditions Study Section (IRAP)
Program Officer
Harabin, Andrea L
Project Start
2008-09-30
Project End
2012-06-30
Budget Start
2008-09-30
Budget End
2009-06-30
Support Year
1
Fiscal Year
2008
Total Cost
$760,834
Indirect Cost
Name
Johns Hopkins University
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Heins, Sara E; Wozniak, Amy W; Colantuoni, Elizabeth et al. (2018) Factors associated with missed assessments in a 2-year longitudinal study of acute respiratory distress syndrome survivors. BMC Med Res Methodol 18:55
Brodsky, Martin B; De, Ishani; Chilukuri, Kalyan et al. (2018) Coordination of Pharyngeal and Laryngeal Swallowing Events During Single Liquid Swallows After Oral Endotracheal Intubation for Patients with Acute Respiratory Distress Syndrome. Dysphagia 33:768-777
Chan, Kitty S; Mourtzakis, Marina; Aronson Friedman, Lisa et al. (2018) Upper arm anthropometrics versus DXA scan in survivors of acute respiratory distress syndrome. Eur J Clin Nutr 72:613-617
Bienvenu, O Joseph; Friedman, Lisa Aronson; Colantuoni, Elizabeth et al. (2018) Psychiatric symptoms after acute respiratory distress syndrome: a 5-year longitudinal study. Intensive Care Med 44:38-47
Kamdar, Biren B; Sepulveda, Kristin A; Chong, Alexandra et al. (2018) Return to work and lost earnings after acute respiratory distress syndrome: a 5-year prospective, longitudinal study of long-term survivors. Thorax 73:125-133
Chan, Kitty S; Mourtzakis, Marina; Aronson Friedman, Lisa et al. (2018) Evaluating Muscle Mass in Survivors of Acute Respiratory Distress Syndrome: A 1-Year Multicenter Longitudinal Study. Crit Care Med 46:1238-1246
Brodsky, Martin B; Huang, Minxuan; Shanholtz, Carl et al. (2017) Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study. Ann Am Thorac Soc 14:376-383
Ruhl, A Parker; Huang, Minxuan; Colantuoni, Elizabeth et al. (2017) Healthcare Resource Use and Costs in Long-Term Survivors of Acute Respiratory Distress Syndrome: A 5-Year Longitudinal Cohort Study. Crit Care Med 45:196-204
Dinglas, Victor D; Aronson Friedman, Lisa; Colantuoni, Elizabeth et al. (2017) Muscle Weakness and 5-Year Survival in Acute Respiratory Distress Syndrome Survivors. Crit Care Med 45:446-453
Bienvenu, O Joseph; Colantuoni, Elizabeth; Mendez-Tellez, Pedro A et al. (2015) Cooccurrence of and remission from general anxiety, depression, and posttraumatic stress disorder symptoms after acute lung injury: a 2-year longitudinal study. Crit Care Med 43:642-53

Showing the most recent 10 out of 17 publications