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• W3025668843 abstract "FOR RELATED ARTICLE, SEE PAGE 999In the last decades, the world of critical care is becoming increasingly focused not only on survival rates, but also on the well-being of critical care survivors. ARDS continues to represent an important public health problem despite an improvement in survival of approximately 60%.1Schenck E.J. Oromendia C. Torres L.K. et al.Rapidly improving ARDS in therapeutic randomized controlled trials.Chest. 2019; 155: 474-482Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 2Bellani G. Laffey J.G. Pham T. et al.Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries.JAMA. 2016;23; 315: 788-800Crossref PubMed Scopus (1872) Google Scholar, 3Spadaro S. Park M. Turrini C. et al.Biomarkers for acute respiratory distress syndrome and prospects for personalised medicine.J Inflamm (Lond). 2019; 16: 1Crossref PubMed Scopus (69) Google Scholar The long-lasting impairment after ARDS has been suggested as a more meaningful outcome measure than mortality.4Hopkins R.O. Weaver L.K. Collingridge D. et al.Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome.Am J Respir Crit Care Med. 2005;15; 171: 340-347Crossref PubMed Scopus (495) Google Scholar Accordingly, the research has focused on the postcritical sequelae that include physical, psychological, and emotional aspects. Patients who survive ARDS are at risk for physical dysfunction, neurocognitive disorders, and worsened quality of life 6 to 12 months after discharge from the ICU.4Hopkins R.O. Weaver L.K. Collingridge D. et al.Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome.Am J Respir Crit Care Med. 2005;15; 171: 340-347Crossref PubMed Scopus (495) Google Scholar FOR RELATED ARTICLE, SEE PAGE 999 Some years ago, a consensus workshop involving a spectrum of stakeholders identified research priorities in the field of integrative oncology through a Delphi survey.5Weeks L.C. Seely D. Balneaves L.G. et al.Canadian integrative oncology research priorities: results of a consensus-building process.Curr Oncol. 2013; 20: 289-299Crossref PubMed Scopus (10) Google Scholar The first-ranked research topic was the “impact of integrative oncology on symptom management and quality of life (for example, dyspnea, nausea, and fatigue).”5Weeks L.C. Seely D. Balneaves L.G. et al.Canadian integrative oncology research priorities: results of a consensus-building process.Curr Oncol. 2013; 20: 289-299Crossref PubMed Scopus (10) Google Scholar This finding emphasizes how patients and stakeholders value these symptoms. Among these symptoms, there is fatigue, perceived by the individual as an overwhelming sense of tiredness during rest.6Finsterer J. Mahjoub S.Z. Fatigue in healthy and diseased individuals.Am J Hosp Palliat Care. 2014; 31: 562-575Crossref PubMed Scopus (114) Google Scholar The clinical expression of fatigue is multidimensional making evaluation challenging. Patients with ARDS experience a long-term stay in ICU along with prolonged mechanical ventilation, which may lead to an impairment of muscular/cardiorespiratory functions, increasing the risk of chronic fatigue. As long-term sequelae, patients might suffer from a chronic state of exhaustion, which may interfere with their functional capacity. Different types of measurement tools have been used in the reporting of functional impairment in critically ill patients to explore various domains within the different cognitive components of cognitive, physical, emotional, and social functioning. In this field, the use of tools assessing patient-reported outcomes is widespread, and as far as fatigue is concerned, a dedicated tool to appraise the perceived fatigue in detail has been developed.7Cella D. Lai J.S. Chang C.H. Peterman A. Slavin M. Fatigue in cancer patients compared with fatigue in the general United States population.Cancer. 2002; 94: 528-538Crossref PubMed Scopus (496) Google Scholar In this issue of CHEST, Neufeld et al8Neufeld K.J. Leoutsakos J.-M.S. Yan H. et al.Fatigue symptoms during the first year following ARDS.Chest. 2020; 158: 999-1007Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar investigated the occurrence of fatigue assessed by the Functional Assessment of Chronic Illness Therapy (FACIT-F), after 6 and 12 months, in ARDS survivors. Interestingly, 70% and 66% of former patients with ARDS reported clinically significant symptoms of fatigue at 6 and 12 months, respectively. In a previous study, our research group validated the FACIT-F in a mixed population of ICU survivors 1 year after hospital discharge.9Spadaro S. Capuzzo M. Valpiani G. et al.Fatigue in intensive care survivors one year after discharge.Health Qual Life Outcomes. 2016; 14: 148Crossref PubMed Scopus (16) Google Scholar The mean transformed FACIT-F score ± SD that we found in the patients was 66 ± 12, which is quite similar to the 62 ± 18 found by Neufeld et al.8Neufeld K.J. Leoutsakos J.-M.S. Yan H. et al.Fatigue symptoms during the first year following ARDS.Chest. 2020; 158: 999-1007Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar This finding may be surprising considering that the patients we presented were less critically ill than those of Neufeld et al8Neufeld K.J. Leoutsakos J.-M.S. Yan H. et al.Fatigue symptoms during the first year following ARDS.Chest. 2020; 158: 999-1007Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar (mean ICU length of stay, 10 ± 11 and 14 ± 11 days, respectively). Considering that the transformed FACIT-F score for the normal US population is 74.7 ± 15,7Cella D. Lai J.S. Chang C.H. Peterman A. Slavin M. Fatigue in cancer patients compared with fatigue in the general United States population.Cancer. 2002; 94: 528-538Crossref PubMed Scopus (496) Google Scholar both studies8Neufeld K.J. Leoutsakos J.-M.S. Yan H. et al.Fatigue symptoms during the first year following ARDS.Chest. 2020; 158: 999-1007Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar,9Spadaro S. Capuzzo M. Valpiani G. et al.Fatigue in intensive care survivors one year after discharge.Health Qual Life Outcomes. 2016; 14: 148Crossref PubMed Scopus (16) Google Scholar suggest that, generally, ICU survivors at 1 year suffer from symptoms of fatigue, especially younger patients with ARDS (mean age, 49 ± 15 years8Neufeld K.J. Leoutsakos J.-M.S. Yan H. et al.Fatigue symptoms during the first year following ARDS.Chest. 2020; 158: 999-1007Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar and 68 ± 11 years, respectively).9Spadaro S. Capuzzo M. Valpiani G. et al.Fatigue in intensive care survivors one year after discharge.Health Qual Life Outcomes. 2016; 14: 148Crossref PubMed Scopus (16) Google Scholar Furthermore, the authors pointed out that the prevalence of fatigue at 6 months was greater than impaired physical function, impaired cognition, anxiety, or depression. Interestingly, fatigue was less severe in men and in those employed before ARDS. Specifically, patients employed prior to ARDS reported less fatigue, with a mean difference of 6 points. This association between employment prior to ARDS and fatigue over 6 and 12 months may suggest that other factors might play a role in both. We may hypothesize that employment is a proxy of social integration, which may affect both perceived fatigue and health-related quality of life (HRQoL). Orwelius et al10Orwelius L. Backman C. Mats F. et al.Social integration: an important factor for health-related quality of life after critical illness.Intensive Care Med. 2011; 37: 831-838Crossref PubMed Scopus (20) Google Scholar showed that the level of social integration significantly affected HRQoL of former ICU patients. Indeed, social integration affected HRQoL to a larger extent than age, sex, and the ICU-related factors examined, but to a lower extent than the preexisting diseases.10Orwelius L. Backman C. Mats F. et al.Social integration: an important factor for health-related quality of life after critical illness.Intensive Care Med. 2011; 37: 831-838Crossref PubMed Scopus (20) Google Scholar The strengths of the study of Neufeld et al8Neufeld K.J. Leoutsakos J.-M.S. Yan H. et al.Fatigue symptoms during the first year following ARDS.Chest. 2020; 158: 999-1007Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar include the multicenter longitudinal prospective design, the follow-up at 6 and 12 months after discharge, the high rate of responders, and the use of comprehensive measures of neurocognitive outcome in a well-defined ARDS population. Nevertheless, the high number of hospitals involved in the study (n = 38) and the long period taken to enroll patients (7 years) may reflect a selection bias, possibly testified by the quite young mean age of participants (49 years of age) and the high percentage of those living independently prior to admission in the ICU (91%). This selection bias may reduce the generalizability of the study. However, a high proportion of these ARDS survivors, who suffer from fatigue, require higher attention. What is the next step? We first need to know whether fatigue occurs in survivors of other critical illnesses. For instance, the patients admitted to the ICU because of severe sepsis or septic shock could also perceive long-lasting fatigue, and those admitted to ICU for neurologic disease. Interestingly, Goërtz et al11Goërtz Y.M.J. Spruit M.A. Van ‘t Hul A.J. et al.Fatigue is highly prevalent in patients with COPD and correlates poorly with the degree of airflow limitation.Ther Adv Respir Dis. 2019; 13 (1753466619878128)Crossref PubMed Scopus (22) Google Scholar found that fatigue is more prevalent in patients with COPD with airflow limitation. The latter is common among ICU patients and correlates with adverse outcome.12Volta C.A. Dalla Corte F. Ragazzi R. et al.Expiratory flow limitation in intensive care: prevalence and risk factors.Crit Care. 2019; 23: 395Crossref PubMed Scopus (9) Google Scholar Future studies should focus on the influence of physical, psychological, behavioral, and systemic factors that could potentially perpetuate fatigue in patients with COPD. Malnutrition could be another factor in the complex mechanism of the development of fatigue in ARDS survivors. We also need to understand whether the use of optimal support nutrition may represent another way in which daily practice in the ICU could affect patients’ fatigue. Moreover, it would be useful to assess any relationship between fatigue and social integration. If there is a relationship, we might investigate whether interventions that promote interpersonal relationships affect fatigue and possibly introduce these interventions in the clinical practice. Fatigue Symptoms During the First Year Following ARDSCHESTVol. 158Issue 3PreviewDuring 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. Full-Text PDF" @default.
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• W3025668843 title "Fatigue of ICU Survivors, No Longer to Be Neglected" @default.
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