Long-Term Survival in Patients With Severe Acute Respiratory Distress Syndrome and Rescue Therapies for Refractory Hypoxemia*

Abstract

Objective To describe long-term survival in patients with severe acute respiratory distress syndrome (ARDS) and assess differences in patient characteristics and outcomes among those who receive rescue therapies (prone position ventilation, inhaled nitric oxide, or inhaled epoprostenol) versus conventional treatment. Design and Setting Cohort study of patients with severe hypoxemia at a University-affiliated Level 1 trauma center. Patients Patients diagnosed with severe ARDS within 72 hours of ICU admission between 1/1/2008 and 12/31/2011. Methods Data were abstracted from the medical record and included demographic and clinical variables, hospital and ICU length of stay, discharge disposition, and hospital costs. Patient-level data were linked to the Washington State Death Registry. Kaplan-Meier methods and Cox's proportional hazards models were used to estimate survival and hazard ratios. Main Results 428 patients meeting study inclusion criteria were identified; 62 (14%) were initiated on a rescue therapy. PaO2/FIO2 ratios were comparable at admission between patients treated with a rescue therapy and those treated conventionally, but were substantially lower by 72 hours in those who received rescue therapies (54 ± 17 versus 69 ± 17 mmHg; p<.01). For the entire cohort, estimated survival probability at three years was 55% (95% CI: 51%, 61%). Among 280 hospital survivors (65%), three-year survival was 85% (95% CI: 80%, 89%). The relative hazard of in-hospital mortality was 68% higher among patients who received rescue therapy compared to patients treated conventionally (95% CI: 8%, 162%; p=0.02). For long-term survival, the hazard ratio of death following ICU admission was 1.56 (95% CI: 1.02, 2.37; p=0.04), comparing rescue versus conventional treatment. Conclusions Despite high hospital mortality, severe ARDS patients surviving to hospital discharge have relatively good long-term survival. Worsening hypoxemia was associated with initiation of rescue therapy. Patients on rescue therapy had higher in-hospital mortality; however, survivors to hospital discharge had long-term survival that was comparable to other ARDS survivors.

Epidemiology, Mechanical Power, and 3-Year Outcomes in Acute Respiratory Distress Syndrome Patients Using Standardized Screening. An Observational Cohort Study

“…Previous studies examining 3-year outcomes in patients with ARDS are limited. A previous smaller single-center study looking only at patients with severe ARDS observed a survival rate of 55% at 3 years, which was much higher than our survival rate of 29.9% in severe ARDS (33). We observed that among those patients with ARDS who survived to hospital discharge, 77% survived to 3 years, which was lower when compared with the severe ARDS only cohort examined in the study by Khandelwal and coworkers (33).…”

Prevalence of Post-traumatic Stress Symptoms and Its Associations With Quality of Life, Demographic and Clinical Characteristics in COVID-19 Survivors During the Post-COVID-19 Era

“…For instance, the total mortality from COVID-19 cases is around 2% (35), while corresponding figures were 10% during the 2003 SARS outbreak and 34% during the MERS outbreak (34)(35)(36). In addition, the median intensive care unit (ICU) stay duration for SARS and MERS survivors were 15 and 11 days (37,38), both of which are longer than that (8 days) of COVID-19 survivors (39). Moreover, the longterm complications of SARS and MERS among survivors were more persistent and severe.…”

Interleukin-22 mitigates acute respiratory distress syndrome (ARDS)

“…In the United States, ARDS is common, occurring in approximately 200,000 Americans per year [1,2], with numbers likely to be increasing during the coronavirus disease of 2019 (covid-19) pandemic. ARDS has high morbidity and mortality, with death rates ranging up to 80% [3,4]. For those that survive ARDS, there are significant long-term negative effects on quality of life, mental health, and neurocognitive function [5][6][7].…”