Long-term evaluation of functional capacity, muscle function, lung function and quality of life in patients after ventilator-associated pneumonia

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is considered the most frequent complication associated with mechanical ventilator, representing a major cause of morbidity and mortality, which prolongs the length of hospital stay. The number of patients who develop VAP has progressively increased and this has generated a huge amount of survivors who are not followed up in the long term, generating a huge burden on the health system. The evaluation of the dysfunctions resulting from VAP is necessary through the use of specific tools that demonstrate its effect on the health of the individual, since it is a disease still little studied with regard to functional capacity, pulmonary function, muscle strength and quality of life (QoL) in the long term. A few years ago, the AVD-Glittre test (TGlittre) was created to assess functional capacity on exertion, but it has not yet been studied in VAP survivors. Objective: The aim of this study was to evaluate the long-term functional capacity of patients who developed VAP during hospitalization and its relationship with pulmonary function, peripheral muscle strength, degree of general fatigue and QoL. Methods: This cross-sectional observational study evaluated 30 VAP survivors between 6 months and 1 year after hospital discharge. Participants underwent the following assessments: TGlittre to assess functional capacity; respiratory muscle strength; handgrip strength; spirometric test to measure lung function; Functional Assessment of Chronic Therapy (FACIT-F) to estimate overall fatigue; and the Short Form-36 (SF-36) questionnaire to assess QoL. Results: Among the results found, the median TGlittre time was 95 (81–130) % predicted, and 30% of the participants had a low performance in TGlittre. In spirometry, 33.3% of participants had an abnormal test. There were significant correlations between TGlittre time and several parameters, including: weight (rs = -0.412, p =
0.023); body mass index (BMI, rs = -0.400, p = 0.029); forced vital capacity (FVC, rs = -0.401, p = 0.030); handgrip (rs = -0.571, p = 0.0009); FACIT-F scale (rs = - 0.405, p = 0.026) and SF-36 domains. Participants who returned to work showed shorter TGlittre time compared to those who did not (89 (69–104) vs. (129 (102– 183) % predicted). In multiple linear regression, FVC and BMI explained 39% of TGlittre variability. Conclusion: It is concluded that in VAP survivors, about one third of them show reduced functional capacity assessed by TGlittre, low pulmonary function and general fatigue 10 months after discharge. In these patients, the longer the TGlittre time, the worse the pulmonary function, muscle function, general fatigue and QoL and the lower the return to work.