Giuseppe
Emeritus
Functional Disability 5 Years after Acute Respiratory Distress Syndrome (N Engl J Med, abstract, edited)
[Source: The New England Journal of Medicine, full text: <cite cite="http://www.nejm.org/doi/full/10.1056/NEJMoa1011802?query=TOC&">Functional Disability 5 Years after Acute Respiratory Distress Syndrome ? NEJM</cite>. Abstract, edited.]
Original Article
Functional Disability 5 Years after Acute Respiratory Distress Syndrome
Margaret S. Herridge, M.D., M.P.H., Catherine M. Tansey, M.Sc., Andrea Matt?, B.Sc., George Tomlinson, Ph.D., Natalia Diaz-Granados, M.Sc., Andrew Cooper, M.D., Cameron B. Guest, M.D., C. David Mazer, M.D., Sangeeta Mehta, M.D., Thomas E. Stewart, M.D., Paul Kudlow, B.Sc., Deborah Cook, M.D., Arthur S. Slutsky, M.D., and Angela M. Cheung, M.D., Ph.D. for the Canadian Critical Care Trials Group
N Engl J Med 2011; 364:1293-1304
April 7, 2011
Background
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).
Methods
We 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.
Results
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.
Conclusions
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.
Supported by grants from the Canadian Intensive Care Foundation, the Physician's Services Incorporated Foundation, and the Ontario Thoracic Society.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
No potential conflict of interest relevant to this article was reported.
We thank our patients with ARDS and their families for their perseverance and commitment to the successful completion of the 5-year follow-up.
From the Department of Medicine, University Health Network (M.S.H., C.M.T., A.M., G.T., P.K., A.M.C.); the Interdepartmental Division of Critical Care (M.S.H., A.C., C.B.G., C.D.M., S.M., T.E.S., A.S.S.); the Department of Public Health Sciences (N.D.-G., A.M.C.); the Departments of Critical Care Medicine and Anesthesia, Sunnybrook Health Sciences Centre (A.C., C.B.G.); the Departments of Anesthesia (C.D.M.) and Medicine and Critical Care Medicine (A.S.S.) and the Keenan Research Center at the Li Ka Shing Knowledge Institute (C.D.M., A.S.S.), St. Michael's Hospital; the Dalla Lana School of Public Health (G.T., N.D.-G., A.M.C.) and the Departments of Medicine (S.M., T.E.S.) and Anesthesia (T.E.S.), Mount Sinai Hospital ? all at the University of Toronto, Toronto; and the Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada (D.C.).
Address reprint requests to Dr. Herridge at Toronto General Hospital, NCSB 11C-1180, 585 University Ave., Toronto, ON M5G 2N2, Canada, or at margaret.herridge@uhn.on.ca.
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[Source: The New England Journal of Medicine, full text: <cite cite="http://www.nejm.org/doi/full/10.1056/NEJMoa1011802?query=TOC&">Functional Disability 5 Years after Acute Respiratory Distress Syndrome ? NEJM</cite>. Abstract, edited.]
Original Article
Functional Disability 5 Years after Acute Respiratory Distress Syndrome
Margaret S. Herridge, M.D., M.P.H., Catherine M. Tansey, M.Sc., Andrea Matt?, B.Sc., George Tomlinson, Ph.D., Natalia Diaz-Granados, M.Sc., Andrew Cooper, M.D., Cameron B. Guest, M.D., C. David Mazer, M.D., Sangeeta Mehta, M.D., Thomas E. Stewart, M.D., Paul Kudlow, B.Sc., Deborah Cook, M.D., Arthur S. Slutsky, M.D., and Angela M. Cheung, M.D., Ph.D. for the Canadian Critical Care Trials Group
N Engl J Med 2011; 364:1293-1304
April 7, 2011
Background
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).
Methods
We 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.
Results
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.
Conclusions
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.
Supported by grants from the Canadian Intensive Care Foundation, the Physician's Services Incorporated Foundation, and the Ontario Thoracic Society.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
No potential conflict of interest relevant to this article was reported.
We thank our patients with ARDS and their families for their perseverance and commitment to the successful completion of the 5-year follow-up.
From the Department of Medicine, University Health Network (M.S.H., C.M.T., A.M., G.T., P.K., A.M.C.); the Interdepartmental Division of Critical Care (M.S.H., A.C., C.B.G., C.D.M., S.M., T.E.S., A.S.S.); the Department of Public Health Sciences (N.D.-G., A.M.C.); the Departments of Critical Care Medicine and Anesthesia, Sunnybrook Health Sciences Centre (A.C., C.B.G.); the Departments of Anesthesia (C.D.M.) and Medicine and Critical Care Medicine (A.S.S.) and the Keenan Research Center at the Li Ka Shing Knowledge Institute (C.D.M., A.S.S.), St. Michael's Hospital; the Dalla Lana School of Public Health (G.T., N.D.-G., A.M.C.) and the Departments of Medicine (S.M., T.E.S.) and Anesthesia (T.E.S.), Mount Sinai Hospital ? all at the University of Toronto, Toronto; and the Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada (D.C.).
Address reprint requests to Dr. Herridge at Toronto General Hospital, NCSB 11C-1180, 585 University Ave., Toronto, ON M5G 2N2, Canada, or at margaret.herridge@uhn.on.ca.
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