Assessment of 1-year Outcomes in Survivors of Severe Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation or Mechanical Ventilation

Abstract

Background:Little is known about the long-term outcomes of severe acute respiratory distress syndrome (ARDS) patients requiring extracorporeal membrane oxygenation (ECMO). This study aimed to investigate the 1-year outcomes of these patients or patients receiving mechanical ventilation (MV) and compare their health-related quality of life (HRQoL) to the general population.Methods:Severe ARDS survivors admitted to two ICUs in China between January 2012 and January 2014 were enrolled. Of the severe ARDS survivors enrolled, 1-year postdischarge, HRQoL assessment using the Short-Form 36 (SF-36) and EuroQol questionnaire dimensions, 6-min walking distance, chest computed tomography scan, pulmonary function, and arterial blood gas analysis were compared for ARDS patients with or without ECMO.Results:ARDS patients receiving ECMO had a significantly higher Acute Physiology and Chronic Health Evaluation II score (30.3 ± 6.7 vs. 26.5 ± 7.3, P = 0.036), lung injury score (3.3 ± 0.4 vs. 2.8 ± 0.5, P = 0.000), Sequential Organ Failure Assessment score (10.8 ± 3.5 vs. 7.9 ± 3.1, P = 0.000), lower PaO2/FiO2 ratio ([mmHg, 1 mmHg = 0.133 kPa], 68.3 ± 16.1 vs. 84.8 ± 16.5, P = 0.000), and increased extrapulmonary organ failure (2 [1, 3] vs. 1 [1, 1], P = 0.025) compared with patients not receiving ECMO. ECMO and non-ECMO survivors showed similar pulmonary function, morphological abnormalities, resting arterial blood gas values, and 6-min walking distance. Mild pulmonary dysfunction and abnormal morphology were observed in a few survivors. In addition, ECMO and non-ECMO survivors showed a similar quality of life. ECMO survivors showed lower SF-36 physical functioning and role-physical domain scores (minimum clinically significant difference at least 5 points), and non-ECMO survivors had similar outcome.Conclusions:One-year posthospital discharge, severe ARDS survivors receiving ECMO or MV demonstrated comparable outcomes. Compared with the general population, ARDS survivors showed reduced HRQoL. Pulmonary function and lung morphology revealed sufficient recovery with minor lung impairment.

Return to work after critical illness: a systematic review and meta-analysis

“…Among these articles, 52 unique studies evaluated return to work in previously employed ICU survivors (figure 1, table 1, online supplementary eTable 2). 4 5 13–63 These studies included 13 retrospective16 18 23 30 33 39 42 43 47 48 52 56 62 and 39 prospective4 5 13–15 17 19–22 24–28 30–32 34–38 40 41 44–46 49–51 53–55 57–61 63 cohort studies, of which three were longitudinal follow-up within a randomised trial 4 37 59. Eleven (21%) studies included more than one follow-up time point after discharge 4 5 26 28 29 34 37 45 49 51 55 62.…”

“…Eleven studies conducted employment assessments during either the first (2000–2004) or second (2008–2010) global economic downturns occurring during the publication period 4 32 36 46–48 50–52 55 63 64. Twenty-eight (54%) studies were conducted in Europe,15 17 18 20 22 25–27 30–36 38–42 44 48–51 58 62 63 14 (27%) in North America,4 5 13 14 16 19 23 24 28 29 37 45 52 55 60 8 (15%) in Australia/New Zealand21 43 46 47 53 54 59 61 and 2 (4%) in Asia 56 57. Nine studies (17%) evaluated return to work in survivors of ARDS 4 5 19 24 39 45 47 57 63.…”

“…Twenty-eight (54%) studies were conducted in Europe,15 17 18 20 22 25–27 30–36 38–42 44 48–51 58 62 63 14 (27%) in North America,4 5 13 14 16 19 23 24 28 29 37 45 52 55 60 8 (15%) in Australia/New Zealand21 43 46 47 53 54 59 61 and 2 (4%) in Asia 56 57. Nine studies (17%) evaluated return to work in survivors of ARDS 4 5 19 24 39 45 47 57 63. Employment evaluation occurred via in-person visit in 18 (35%) studies,18 19 21 26–29 31 36 39 43 45 50 55 57–60 63 telephone interview in 18 (35%) studies,4 5 13–15 23 30 32 34 42 46 47 49 52–54 56 61 mailed questionnaire in 15 (29%) studies16 17 20 22 24 25 33 35 37 38 40 41 44 48 51 and national database in 1 study 62.…”

Prevalence of Post Intensive Care Syndrome Among Japanese Intensive Care Unit Patients: A Prospective, Multicenter, Observational J-PICS Study

“…Five of the 16 ICUs were university-a liated hospitals and the others were tertiary teaching hospitals. The median number of ICU beds was 10 [interquartile range (IQR), [8][9][10][11][12][13][14][15]. All ICUs were mixed ICUs and were managed by intensivists.…”

“…Only a few studies focusing on the co-occurrence of PICS symptoms in individual patients have been conducted [6,7]. Second, limited data regarding PICS after implementation of PICS prophylaxis strategy are available, especially for Asian populations with different cultural backgrounds and races from Western countries [8][9][10][11]. Growing awareness about PICS; many guidelines and bundle strategies; clinical practice guidelines for the prevention and management of pain, agitation, sedation, delirium, immobility, and sleep disruption in adult patients in the ICU [12]; guidelines for family centered care in the neonatal, pediatric, and adult ICU [13]; and ABCDEFGH bundle [14] have been published and implemented to decrease the occurrence of PICS.…”