One-year outcomes in survivors of the acute respiratory distress syndrome
One-year outcomes in survivors of the acute respiratory distress syndrome
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DOI：
10.1056/nejmoa022450
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发表时间：
2003-02-20
影响因子：
158.5
通讯作者：
Slutsky, AS
中科院分区：
文献类型：
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作者：
Herridge, MS;Cheung, AM;Slutsky, AS
背景：随着越来越多的患者从急性呼吸窘迫综合征中幸存下来，有必要了解这种情况的长期结局。方法：我们评估了109名急性呼吸窘迫综合征患者出院后3、6和12个月的存活情况。结果：存活的急性呼吸窘迫综合征患者年轻(中位年龄45岁)和重病(中位急性生理学、年龄和慢性健康评估评分23分)，并在重症监护病房住了很长时间(中位25天)。患者从重症监护病房出院时，他们的基线体重已经下降了18%，并表示肌肉无力和疲劳是他们功能受限的原因。肺容量和肺活量测量在6个月时正常，但在整个12个月的随访中一氧化碳弥散能力仍然很低。12个月时没有患者需要补充氧气，但6%的患者在运动期间动脉血氧饱和度低于88%。医疗结果研究36项简式一般健康调查(与健康相关的生活质量测量)的身体角色领域的中位数从3个月时的0分增加到12个月时的25分(在正常人群中，得分为84)。6分钟步行距离由3个月的中位数281 m增加到12个月的422 m，均低于预期。在一年的随访中，没有接受全身皮质类固醇治疗、在重症监护病房期间没有获得性疾病、肺损伤和多器官功能障碍的快速缓解与较好的功能状态相关。结论：急性呼吸窘迫综合征的幸存者在出院一年后仍有持续性的功能障碍。大多数患者都有肺外症状，以肌肉萎缩和虚弱最为突出。
BACKGROUND:As more patients survive the acute respiratory distress syndrome, an understanding of the long-term outcomes of this condition is needed.METHODS:We evaluated 109 survivors of the acute respiratory distress syndrome 3, 6, and 12 months after discharge from the intensive care unit. At each visit, patients were interviewed and underwent a physical examination, pulmonary-function testing, a six-minute-walk test, and a quality-of-life evaluation.RESULTS:Patients who survived the acute respiratory distress syndrome were young (median age, 45 years) and severely ill (median Acute Physiology, Age, and Chronic Health Evaluation score, 23) and had a long stay in the intensive care unit (median, 25 days). Patients had lost 18 percent of their base-line body weight by the time they were discharged from the intensive care unit and stated that muscle weakness and fatigue were the reasons for their functional limitation. Lung volume and spirometric measurements were normal by 6 months, but carbon monoxide diffusion capacity remained low throughout the 12-month follow-up. No patients required supplemental oxygen at 12 months, but 6 percent of patients had arterial oxygen saturation values below 88 percent during exercise. The median score for the physical role domain of the Medical Outcomes Study 36-item Short-Form General Health Survey (a health-related quality-of-life measure) increased from 0 at 3 months to 25 at 12 months (score in the normal population, 84). The distance walked in six minutes increased from a median of 281 m at 3 months to 422 m at 12 months; all values were lower than predicted. The absence of systemic corticosteroid treatment, the absence of illness acquired during the intensive care unit stay, and rapid resolution of lung injury and multiorgan dysfunction were associated with better functional status during the one-year follow-up.CONCLUSIONS:Survivors of the acute respiratory distress syndrome have persistent functional disability one year after discharge from the intensive care unit. Most patients have extrapulmonary conditions, with muscle wasting and weakness being most prominent.