Purpose

To evaluate aerobic exercise capacity in 5-year intensive care unit (ICU) survivors and to assess the association between severity of organ failure in ICU and exercise capacity up to 5-year follow-up.

Methods

Secondary analysis of the EPaNIC follow-up cohort (NCT00512122) including 433 patients screened with cardiopulmonary exercise testing (CPET) between 1 and 5 years following ICU admission. Exercise capacity in 5-year ICU survivors (N = 361) was referenced to a historic sedentary population and further compared to demographically matched controls (N = 49). In 5-year ICU survivors performing a maximal CPET (respiratory exchange ratio > 1.05, N = 313), abnormal exercise capacity was defined as peak oxygen consumption (VO₂peak) < 85% of predicted peak oxygen consumption (%predVO₂peak), based on the historic sedentary population. Exercise liming factors were identified. To study the association between severity of organ failure, quantified as the maximal Sequential Organ Failure Assessment score during ICU-stay (SOFA-max), and exercise capacity as assessed with VO₂peak, a linear mixed model was built, adjusting for predefined confounders and including all follow-up CPET studies.

Results

Exercise capacity was abnormal in 118/313 (37.7%) 5-year survivors versus 1/48 (2.1%) controls with a maximal CPET, p < 0.001. Aerobic exercise capacity was lower in 5-year survivors than in controls (VO₂peak: 24.0 ± 9.7 ml/min/kg versus 31.7 ± 8.4 ml/min/kg, p < 0.001; %predVO₂peak: 94% ± 31% versus 123% ± 25%, p < 0.001). Muscular limitation frequently contributed to impaired exercise capacity at 5-year [71/118 (60.2%)]. SOFA-max independently associated with VO₂peak throughout follow-up.

Conclusions

Critical illness survivors often display abnormal aerobic exercise capacity, frequently involving muscular limitation. Severity of organ failure throughout the ICU stay independently associates with these impairments.

中文翻译：

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危重疾病长期幸存者的有氧运动能力：EPaNIC 后随访研究的二次分析

目的

评估 5 年重症监护病房 (ICU) 幸存者的有氧运动能力，并评估 ICU 器官衰竭严重程度与长达 5 年随访的运动能力之间的关联。

方法

EPaNIC 随访队列 (NCT00512122) 的二级分析，包括 433 名在入住 ICU 后 1 至 5 年内接受心肺运动测试 (CPET) 筛查的患者。5 年 ICU 幸存者 ( N  = 361) 的运动能力参考历史久坐人群，并进一步与人口统计学匹配的对照 ( N  = 49) 进行比较。在进行最大 CPET（呼吸交换比 > 1.05，N  = 313）的5 年 ICU 幸存者中，异常运动能力被定义为峰值耗氧量（VO ₂峰值）< 预测峰值耗氧量的 85%（%predVO ₂峰值），基于历史上久坐不动的人口。确定了运动限制因素。为了研究器官衰竭的严重程度（量化为 ICU 住院期间的最大顺序器官衰竭评估评分 (SOFA-max)）与使用 VO ₂峰值评估的运动能力之间的关联，构建了线性混合模型，调整了预定义的混杂因素并包括所有后续的 CPET 研究。

结果

118/313 (37.7%) 5 年存活者与 1/48 (2.1%) 对照组的运动能力异常，最大 CPET，p  < 0.001。5 年幸存者的有氧运动能力低于对照组（VO ₂峰值：24.0 ± 9.7 ml/min/kg 与 31.7 ± 8.4 ml/min/kg，p  < 0.001；%predVO ₂峰值：94% ± 31%与 123% ± 25%，p  < 0.001）。肌肉受限经常导致 5 年时运动能力受损 [71/118 (60.2%)]。SOFA-max 与整个随访期间的VO ₂峰值独立相关。

结论

危重病幸存者经常表现出异常的有氧运动能力，经常涉及肌肉受限。ICU 住院期间器官衰竭的严重程度与这些损伤独立相关。