Long-Term Pulmonary Function and Quality of Life in Children After Acute Respiratory Distress Syndrome: A Feasibility Investigation

Abstract

Objective Determine the feasibility of pulmonary function (PFT) and quality of life (QOL) evaluations in children after Acute Respiratory Distress Syndrome (ARDS). Design A prospective follow-up feasibility study Setting A tertiary pediatric intensive care unit Patients Children <18 year old with ARDS admitted between 2000 and 2005. Measurements and Main Results PFTs and QOL questionnaires performed approximately 12-months post-illness were analyzed and correlated to in-hospital clinical parameters. QOL data was compared to published pediatric chronic asthma and general pediatric norms. 180 patients met ARDS criteria; 37 (20%) died, 90 (51%) declined participation, 28 (16%) consented but did not return, and 24 (13%) returned for follow up visit. Twenty-three patients completed QOL testing and 17 completed PFTs. Clinical characteristics of those who returned were no different from those who did not except for age (median age 4.9 vs. 1.8 years). One third had mild to moderate pulmonary function deficits. QOL scores were marginal with general health perception, physical functioning, and behavior being areas of concern. These scores were lower than scores in children with chronic asthma. Parental QOL assessments report lower scores in single parent homes but no differences were noted by race or parental employment status. Conclusion Valuable information may be discerned from ARDS patients who return for follow-up evaluation. In this pilot study up to one-third of children with ARDS exhibit pulmonary function deficits and 12-month post-illness QOL scores are lower than in children with chronic asthma. Parental perceptions of post-illness QOL may be negatively impacted by socioeconomic constraints. Long term follow of children with ARDS is feasible and bears further investigation.

Post‐intensive care syndrome: its pathophysiology, prevention, and future directions

“…With a focus on specific diseases and conditions, the SPROUT study, a recent international point prevalence study of pediatric sepsis, showed that 17% of sepsis survivors suffered moderate to severe disability . Among children who survived ARDS, Ward et al . suggested that up to one‐third showed pulmonary dysfunction and that their quality‐of‐life scores 12 months after discharge were lower than those in asthmatic children.…”

Post‐discharge respiratory outcomes of children with acute respiratory distress syndrome

“…A recent longitudinal study of 29 PARDS survivors highlighted that 80% experienced pulmonary function abnormalities at 3 months after ICU discharge . Another documented mild‐to‐moderate obstructive pulmonary function deficits or diffusion abnormalities in one‐third of the 17 survivors who performed pulmonary function testing 12 months after an ARDS episode . However, both studies used adult ARDS diagnostic criteria.…”

“…10 Another documented mild-to-moderate obstructive pulmonary function deficits or diffusion abnormalities in one-third of the 17 survivors who performed pulmonary function testing 12 months after an ARDS episode. 11 However, both studies used adult ARDS diagnostic criteria. Compared to the adult Berlin 3 and American European Consensus Conference 12 definitions, the PALICC definition identifies nearly twice as many children with ARDS, including many with milder disease but also a subset of patients with severe ARDS that were not identified by adult definitions.…”

How We Treat Fever and Hypotension in Pediatric Hematopoietic Cell Transplant Patients

“…A multimodal approach to prevent, detect, and treat delirium should be implemented (47). Long-term effects on renal, hepatic, and lung function should be monitored as survivors frequently have prolonged impairment (48). Lastly, many survivors have prolonged functional impairment that may benefit from rehabilitation services (49).…”