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Previous Volume 348:683-693 February 20, 2003 Number 8 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Hudson, L. D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background As more patients survive the acute respiratory distress syndrome, an understanding of the long-term outcomes of this condition is needed.

Methods We evaluated 109 survivors of the acute respiratory distress syndrome 3, 6, and 12 months after discharge from the intensive care unit. At each visit, patients were interviewed and underwent a physical examination, pulmonary-function testing, a six-minute–walk test, and a quality-of-life evaluation.

Results Patients who survived the acute respiratory distress syndrome were young (median age, 45 years) and severely ill (median Acute Physiology, Age, and Chronic Health Evaluation score, 23) and had a long stay in the intensive care unit (median, 25 days). Patients had lost 18 percent of their base-line body weight by the time they were discharged from the intensive care unit and stated that muscle weakness and fatigue were the reasons for their functional limitation. Lung volume and spirometric measurements were normal by 6 months, but carbon monoxide diffusion capacity remained low throughout the 12-month follow-up. No patients required supplemental oxygen at 12 months, but 6 percent of patients had arterial oxygen saturation values below 88 percent during exercise. The median score for the physical role domain of the Medical Outcomes Study 36-item Short-Form General Health Survey (a health-related quality-of-life measure) increased from 0 at 3 months to 25 at 12 months (score in the normal population, 84). The distance walked in six minutes increased from a median of 281 m at 3 months to 422 m at 12 months; all values were lower than predicted. The absence of systemic corticosteroid treatment, the absence of illness acquired during the intensive care unit stay, and rapid resolution of lung injury and multiorgan dysfunction were associated with better functional status during the one-year follow-up.

Conclusions Survivors of the acute respiratory distress syndrome have persistent functional disability one year after discharge from the intensive care unit. Most patients have extrapulmonary conditions, with muscle wasting and weakness being most prominent.

Source Information

From the Department of Medicine, University Health Network (M.S.H., A.M.C., C.M.T., A.M.-M., F.A.-S.); the Interdepartmental Division of Critical Care Medicine (M.S.H., A.B.C., C.B.G., C.D.M., S.M., T.E.S., A.S.S.); the Department of Public Health Sciences (A.M.C., N.D.-G., A.B.); the Departments of Critical Care Medicine and Anaesthesia, Sunnybrook and Women's College Health Sciences Centre (A.B.C., C.B.G.); the Departments of Anesthesia and Critical Care Medicine (C.D.M.) and Medicine and Critical Care Medicine (A.S.S.), St. Michael's Hospital; the Departments of Medicine (S.M., T.E.S.) and Anesthesia (T.E.S.), Mount Sinai Hospital and the University of Toronto — all in Toronto; and the Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Canada (D.C.).

Address reprint requests to Dr. Herridge at Toronto General Hospital, EN 10-212, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada, or at margaret.herridge{at}uhn.on.ca.

Full Text of this Article

Related Letters:

Survivors of the Acute Respiratory Distress Syndrome
Bihari D. J., Leijten F. S.S., Spruit M. A., Nemery B., Decramer M., Herridge M. S., the Toronto ARDS Outcomes Group
Extract | Full Text | PDF  
N Engl J Med 2003; 348:2149-2150, May 22, 2003. Correspondence

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