Assessment of 1-year Outcomes in Survivors of Severe Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation or Mechanical Ventilation: A Prospective Observational Study.

Zhi-yong Wang; Tong LI; Chun-ting Wang; Lei XU; Xin-jing Gao

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Assessment of 1-year Outcomes in Survivors of Severe Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation or Mechanical Ventilation: A Prospective Observational Study.

Author: Zhi-Yong WANG ¹ ; Tong LI ² ; Chun-Ting WANG ³ ; Lei XU ¹ ; Xin-Jing GAO ¹
Author Information

1. Department of Critical Care Medicine, Tianjin Third Central Hospital, Artificial Cells Key Laboratory of Tianjin, Tianjin 300170, China.
2. Heart Center, Tianjin Third Central Hospital, Tianjin 300170, China.
3. Department of Critical Care Medicine, Shandong Provincial Hospital, Jinan, Shandong 250021, China.
Publication Type:Journal Article
MeSH: Adult; Extracorporeal Membrane Oxygenation; methods; Female; Humans; Male; Middle Aged; Prospective Studies; Quality of Life; Respiration, Artificial; methods; Respiratory Distress Syndrome, Adult; mortality; therapy; Surveys and Questionnaires; Treatment Outcome; Young Adult
From:Chinese Medical Journal 2017;130(10):1161-1168
CountryChina
Language:English
Abstract:
BACKGROUNDLittle is known about the long-term outcomes of severe acute respiratory distress syndrome (ARDS) patients requiring extracorporeal membrane oxygenation (ECMO). This study aimed to investigate the 1-year outcomes of these patients or patients receiving mechanical ventilation (MV) and compare their health-related quality of life (HRQoL) to the general population.
METHODSSevere ARDS survivors admitted to two ICUs in China between January 2012 and January 2014 were enrolled. Of the severe ARDS survivors enrolled, 1-year postdischarge, HRQoL assessment using the Short-Form 36 (SF-36) and EuroQol questionnaire dimensions, 6-min walking distance, chest computed tomography scan, pulmonary function, and arterial blood gas analysis were compared for ARDS patients with or without ECMO.
RESULTSARDS patients receiving ECMO had a significantly higher Acute Physiology and Chronic Health Evaluation II score (30.3 ± 6.7 vs. 26.5 ± 7.3, P= 0.036), lung injury score (3.3 ± 0.4 vs. 2.8 ± 0.5, P= 0.000), Sequential Organ Failure Assessment score (10.8 ± 3.5 vs. 7.9 ± 3.1, P= 0.000), lower PaO2/FiO2ratio ([mmHg, 1 mmHg = 0.133 kPa], 68.3 ± 16.1 vs. 84.8 ± 16.5, P= 0.000), and increased extrapulmonary organ failure (2 [1, 3] vs. 1 [1, 1], P= 0.025) compared with patients not receiving ECMO. ECMO and non-ECMO survivors showed similar pulmonary function, morphological abnormalities, resting arterial blood gas values, and 6-min walking distance. Mild pulmonary dysfunction and abnormal morphology were observed in a few survivors. In addition, ECMO and non-ECMO survivors showed a similar quality of life. ECMO survivors showed lower SF-36 physical functioning and role-physical domain scores (minimum clinically significant difference at least 5 points), and non-ECMO survivors had similar outcome.
CONCLUSIONSOne-year posthospital discharge, severe ARDS survivors receiving ECMO or MV demonstrated comparable outcomes. Compared with the general population, ARDS survivors showed reduced HRQoL. Pulmonary function and lung morphology revealed sufficient recovery with minor lung impairment.