Chest
Volume 139, Issue 6, June 2011, Pages 1340-1346
Journal home page for Chest

Original Research
Critical Care
Quality of Life, Pulmonary Function, and Tomographic Scan Abnormalities After ARDS

https://doi.org/10.1378/chest.10-2438Get rights and content

Background

ARDS can produce a loss of lung function with persistent sequelae. This study aimed to evaluate health-related quality of life (HRQL) in survivors of ARDS compared with a healthy reference population and to determine the middle/long-term radiographic abnormalities and functional status, as well as their relation to observed HRQL, in these patients.

Methods

This was a prospective study carried out in three ICUs. HRQL in patients was determined with the Nottingham Health Profile immediately after ARDS diagnosis and 6 months after diagnosis. Patients underwent complete respiratory function testing, chest CT scan study, and the 6-min walk test.

Results

Follow-up was conducted in 38 patients with ARDS. Survivors of ARDS presented a poorer overall HRQL vs the general population, mainly because of lower scores in the dimensions related to mobility, energy, and social isolation. Limitations in daily life activities were documented in 40%. Respiratory function was altered in 67%, with a restrictive respiratory pattern in 58%. Radiologic study disclosed alterations in 76% (mainly reticular pattern). Patients were able to cover only 366 m (318-411 m) in the 6-min walk test and had a minimum pulse oximetry of 93% (90%-94%). A significant correlation was documented between the overall quality of life at first and at 6 months (r = 0.68, P < .01).

Conclusions

Survivors of ARDS after 6 months had a poorer HRQL than the healthy population and showed mild radiographic and functional involvement. Early HRQL study in these patients enabled early detection of those who would present more long-term HRQL morbidity.

Section snippets

Materials and Methods

A detailed description of methods can be found in e-Appendix 1. Briefly, a prospective, observational, longitudinal study was carried out for 6 years in three ICUs in Barcelona, Spain. The study was approved by the ethics committee, and informed consent for participation was obtained initially from a next of kin and later confirmed by each patient.

During the study period, daily screening was performed of all patients admitted to the participating ICUs; those who met the criteria for ARDS6 were

General Characteristics of the Population Studied

A total of 204 patients were diagnosed with ARDS during the study period. The patient enrollment process is summarized in Figure 1. The study population consisted of 38 patients evaluated in the 6-month follow-up, representing 43.1% of those included. Only 15 patients were able to respond to the HRQL test at 1 month (39.4% of the total of patients assessed at 6 months). The main characteristics of the population included in the 6-month study, the survivors who could not be included, and

Discussion

To our knowledge, this is the first multicentric prospective study that evaluates quality of life, pulmonary function alterations, HRCT findings, and exercise test results in 6-month survivors of ARDS. The results show considerable alterations in HRQL in comparison with the healthy reference population. Moreover, most patients presented a mild restrictive pattern and Dlco decrease in PFT, accompanied by mild reticular alterations in CT scans and a moderate deficit in exercise capacity.

Conclusions

In summary, this study documented persistent alterations in HRQL at 6 months after critical illness, in comparison with a healthy reference population. Moreover, most patients presented mild/moderate radiologic and functional abnormalities. An early HRQL study in these patients enabled early detection of those who would present more 6-month HRQL morbidity. Therefore, early follow-up seems advisable, as well as performing follow-up after hospital discharge. These patients may benefit from

Acknowledgments

Author contributions: Dr Masclans: contributed to the conception and design of this study, acquisition of data, analysis and interpretation of data, and manuscript preparation.

Dr Roca: contributed to the acquisition of data, analysis and interpretation of data, and manuscript preparation.

Dr Muñoz: contributed to the conception and design of this study, acquisition of data, analysis and interpretation of data, and manuscript preparation.

Dr Pallisa: contributed to the conception and design of

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