Healthrelated Quality of Life

There are an increasing number of studies that have examined the long-term effect of ARDS or other critical illnesses requiring mechanical ventilation on the quality of life and health status of survivors. McHugh and colleagues, using the Sickness Impact Profile (SIP), demonstrated a significant decrement in health status among survivors of ARDS and showed that health status improved during the first 3

months after discharge from the hospital but remained relatively stable thereafter [18]. Davidson and colleagues, using the Medical Outcomes Study Short Form-36 (SF-36) and the Saint George's Respiratory Questionnaire, showed that there were significant decrements in most domains of health status among survivors of ARDS and that these decrements were significantly worse for patients with ARDS compared to patients with a comparable severity of illness from sepsis or trauma, but who did not meet criteria for ARDS [25] (Fig. 4). This study suggested decrements in physical function might be the most severe.

Similarly, in the largest and most complete follow-up study of ARDS survivors, Herridge found severe impairment in health status using the SF-36 at 3 months, with marked improvement at 6 months that continued to one year. Despite this improvement, at one year the median scores in all but one domain remained significantly reduced compared with age and gender matched controls [19]. Wein-ert and colleagues studied 24 survivors of ALI with the SF-36, also showing reductions in many domains of health status and particularly severe reductions in social functioning and mental health domains [26]. Finally, Angus and colleagues used the Quality of Well Being questionnaire to assess health status in a cohort of 200 previously healthy patients who developed ARDS and showed marked decrements in many domains of health status at 6 months and no significant change from 6 to 12 months [27].

In addition to ARDS, studies have demonstrated reductions in health status for patients with other critical illnesses requiring prolonged mechanical ventilation,

Fev1 Scores
Fig. 4. Symptom scores on the St. George's Respiratory Questionnaire (SGRQ) of ARDS survivors, matched controls and historical controls. Note: lower scores denote lesser symptoms. COPD patients have a mean FEV1 of 1.3 L (45% predicted). From [23] with permission

including sepsis [28], multiple organ dysfunction [29], and general ICU patients [17,30,31]. Although results vary, these studies also suggest decrements in a wide range of the domains of health status.

A number of studies have attempted to define the predictors of decreased health status among survivors of ARDS or other critical illness. Several studies suggest that the health status prior to admission to the ICU is a strong predictorofthe health status after discharge [32, 33]. A study by Wehler and colleagues showed that patients with the best health status prior to critical illness were more likely to have reductions in their health status while those patients with the lowest health status prior to admission to an ICU were actually more likely to improve from their baseline health status [32]. Similarly, Konopad and colleagues showed that among the very elderly, health status may actually increase from baseline after an ICU admission [34]. Severity of illness is also a significant predictor of health status after discharge from the ICU [18,32,33]. Increasing age predicts decreased health status after critical illness in some studies [32, 33], but other studies did not find age to be an important independent predictor of health status [17] and suggest that even those over the age of 70 who receive more than 30 days of intensive care are often satisfied with their health status and would choose to receive ICU care again if needed [30]. Schelling and colleagues showed that pulmonary function impairment predicted worse health status suggesting that treatment strategies designed to minimize lung injury may have diverse effects improving health status in ARDS survivors [35].

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