Fatigue Symptoms during the First Year after ARDS, 2020, Neufeld et al

Andy

Andy

Retired committee member
Background
Fatigue is commonly reported by acute respiratory distress syndrome (ARDS) survivors, but empirical data are scarce.

Research Question
We 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 U.S. 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 (FACIT-F) with patient and critical illness variables, and with physical, cognitive and mental health status at 6- and 12-months post-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, respectively (n=638). At 6 months, the prevalence of fatigue (70%) was greater than impaired physical functioning (50%), anxiety (42%) or depression (36%); 33% 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 before ARDS. Critical illness variables (e.g., 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 6- and 12-month follow-up.

Interpretation
During the first year after ARDS, over two-thirds of survivors report 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.
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Paywall, https://journal.chestnet.org/article/S0012-3692(20)30686-3/pdf
Sci hub, https://sci-hub.tw/10.1016/j.chest.2020.03.059
 
Interesting. Is the fatigue caused by the ARDS, PVFS, or both? It will be hard to separate the two. Lots to separate here.

Because frankly a lot of arrows are starting to point to oxygen as the main driver of fatigue, or rather how the body uses oxygen anyway.

Which frankly makes a lot of sense, if the body does switch to anaerobic energy, regardless of why, you're going to have very impaired system performance. No matter the reason for that impairment, whether it is because the lungs aren't exchanging it efficiently, hemoglobin is not delivering it adequately or whether the metabolism is unable to make use of it, say as a defense mechanism.

Because lots of COVID patients did not have severe respiratory illness, but wonky oxygen saturation is very common. I see a lot of dizziness, shortness of breath, tachycardia, blurry vision, nausea, confusion, etc. Lots of things that all revolve around either impacts of low oxygen or systems compensating for low oxygen.

It would also explain most of the "psychological" symptoms, as obviously low oxygen to the brain, at a level that is sustainable but not optimal for performance, would explain why the brain is running like on molasses fumes.
 
Trish said:
I dont think ME is related to oxygen saturation in the blood. According to my pulse oximeter mine is perfectly normal, despite me having ME for 30 years.
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Right, since it's normal it neither concerns the lungs themselves or even its transport, rather its metabolism. Although it's not really clear why oxsat is low, even wildly fluctuating, in COVID patients who do not develop pneumonia, or even severe respiratory symptoms. There seem to even be cases where low oxsat is the only meaningful symptom, which is plain bizarre.

Which would point more to PVFS as the critical factor, rather than ARDS. Would be worth comparing, but with the SARS-1 it's more difficult as respiratory symptoms are nearly universal. COVID will be more likely to settle that.
 
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