Changes of health-related quality of life in survivors of acute respiratory distress syndrome

Introduction

Few studies have analyzed health-related quality of life (HRQOL) in survivors of acute respiratory distress syndrome (ARDS) taking prehospitalization baseline data into account.

Patients and methods

From June 1997 to May 1999, all admissions (≥ 18 years) to our medical intensive care unit (ICU), an academic referral center, who developed ARDS according to the American-European Consensus Conference definition were eligible. Baseline HRQOL measures were collected by interview during the first 24 hours of the ICU stay and 6 months after admission using a HRQOL questionnaire specifically designed for critically ill patients [1]. A clinically relevant change score was determined by survivors ratings of global health change since ICU admission.

Results

The 265 enrolled patients had a mean age of 59 ± 16 (± SD) years, median 62 years; 58% were male. The mean ICU length of stay was 19 ± 23 days, median 11 days; the mean APACHE II score after 24 hours was 27 ± 9, mean time requiring mechanical ventilation was 17 ± 22 days, median 9 days. The most prevalent predisposing conditions for ARDS were pneumonia and severe sepsis. Cumulative mortality rates were 51% in the ICU, 59% in the hospital, and 65% at 6 months followup. At followup, HRQOL data could be obtained in 87 ARDS survivors; six patients were lost to followup. A change score of -15% was considered as a relevant deterioration using survivors ratings of health transition. Compared with baseline data, a relevant deterioration of HRQOL was reported by 18 (21%) patients in the domain basic physiologic activities, by 31 (35%) patients in the domain activities of daily life, and by 29 (33%) patients in the mental health domain. The majority of the survivors (84%) were living at home and 76% of those previously in employment had returned to their former work. Eighty-one survivors (93%) reported that they would be willing to undergo intensive care again if medically necessary in the future.

Conclusion

Compared with prehospitalization HRQOL, about one-third of our ARDS survivors reported a relevant deterioration in various HRQOL domains. Satisfaction with care and the return-to-work rate was high in our sample of medical ARDS survivors.