Ma. Cristina Cassandra B.

Carbajal

Long-Term Effects of ARDS After ICU Stay

July 2011, Although its name implies a short-term condition, acute respiratory distress syndrome (ARDS) can mean long-term trouble for patients. Just how long, however, has been unclear because follow-up studies have been limited to two years at most. To fill this information gap, a prospective study tracked 109 ARDS survivors for five years. The investigators evaluated patients with ARDS at four academic medical surgical ICUs in Toronto who survived long enough to be discharged. After one year, patients were asked to consent to an additional four years of follow-up; 83 patients were followed for a total of five years. The median age at the onset of ARDS was 44, and 83% of patients had no or one coexisting condition. The most common risk factors for ARDS were pneumonia and sepsis. Patients were evaluated at three, six, 12, and 24 months and then yearly. Evaluations included a detailed interview, physical examination, pulmonary-function testing, chest radiography, and the six-minute walk test; participants also completed a 36-item health survey, and family caregivers were interviewed. The study's most striking finding was that although pulmonary function was "near-normal to normal" at five years and patients didn't show "demonstrable weakness on examination," all participants reported that they felt weaker and less able to engage in vigorous exercise. Patients also reported new and continued impairments across a spectrum of physical and neuropsychological disorders, which in turn resulted in social isolation and sexual dysfunction. Moreover, mental health problems were reported by family members in 27% of cases, and 51% of patients reported at least one episode of physician-diagnosed depression, anxiety, or both. These results underscore that the harm caused by ARDS may not show up on direct measures of lung function and that nurses need to be attentive to subtleties. "Lung function may go back to normal, but there may be many residual sequelae that make it look more like a chronic illness. It's very important that nurses be aware that acute ARDS may have long-term complications, even five, 10 years out," said Susan J. Corbridge, director of the Acute Care Nurse Practitioner and Clinical Nurse Specialist programs at the University of Illinois at Chicago College of Nursing. "This needs to be looked at more as a chronic process after patients are discharged, especially with the depressive symptoms and with the decreased ability to exercise.

REFERENCES http://www.medterms.com/script/main/art.asp?articlekey=23895 Herridge MS, et al. N Engl J Med 2011; 364(14):1293-304. PubMed | CrossRef

Ma. Cristina Cassandra B. Carbajal

CONCLUSION I therefore conclude that there have been few detailed, in-person interviews and examinations to obtain follow-up data on 5-year outcomes among survivors of the acute respiratory distress syndrome (ARDS). Based on this reports they evaluated 109 survivors of ARDS at 3, 6, and 12 months and at 2, 3, 4, and 5 years after discharge from the intensive care unit. At each visit, patients were interviewed and examined; underwent pulmonary-function tests, the 6-minute walk test, resting and exercise oximetry, chest imaging, and a quality-of-life evaluation; and reported their use of health care services. At 5 years, the median 6-minute walk distance was 436 m (76% of predicted distance) and the Physical Component Score on the Medical Outcomes Study 36-Item Short-Form Health Survey was 41 (mean norm score matched for age and sex, 50). With respect to this score, younger patients had a greater rate of recovery than older patients, but neither group returned to normal predicted levels of physical function at 5 years. Pulmonary function was normal to near-normal. A constellation of other physical and psychological problems developed or persisted in patients and family caregivers for up to 5 years. Patients with more coexisting illnesses incurred greater 5-year costs. And I only suggest that exercise limitation, physical and psychological sequelae, decreased physical quality of life, and increased costs and use of health care services are important legacies of severe lung injury. ICU-acquired weakness may continue to be an important contributor to long-term function and quality-of-life outcomes in survivors of ARDS. The spectrum of physical and neuropsychological impairments that compound such weakness may also contribute to these outcomes. These data are consistent with other reports of long-term sequelae(A pathological condition resulting from a prior disease, injury, or attack. As for example, a sequela of polio. Verbatim from the Latin "sequela" (meaning sequel). Plural: sequelae.) in survivors of critical illness. However, our study shows that such dysfunction persists over a period of 5 years and that heterogeneous issues contribute to this reported disability over time. Our study also shows that psychological and emotional dysfunction persists in both patients and caregivers for up to 5 years after discharge from the ICU.