The quality of acute intensive care and the incidence of critical events have an impact on health-related quality of life in survivors of the acute respiratory distress syndrome - a nationwide prospective multicenter observational study.

Abstract

Background: Initial treatment (ventilator settings, rescue therapy, supportive measures), and prevention of critical events improve survival in ARDS patients, but little data exists on its effect on health-related quality of life (HRQOL) and return to work (RtW) in survivors. We analyzed the association of the intensity of treatment at ARDS onset and the incidence of critical events on HRQOL and RtW a year after ICU discharge. Methods: In a prospective multi-centre cohort study, the intensity of treatment and the incidence of critical events were determined at 61 ICUs in Germany. At 3, 6, and 12 months, 396 survivors reported their HRQOL (Short-Form 12) and RtW. The parameters of the intensity of acute management (lung protective ventilation, prone position, hemodynamic stabilization, neuromuscular blocking agents), and critical events (hypoxemia, hypoglycemia, hypotension) were associated with HRQOL and RtW. Results: Patients ventilated at ARDS onset with a low tidal volume (VT≤7 ml/kg) had higher arterial carbon dioxide levels (PaCO2=57.5±17 mmHg) compared to patients ventilated with VT>7ml/kg (45.7±12, p=0.001). In a multivariate adjusted dichotomized analysis, a better mental 3-month SF-12 was observed in the higher VT-group (mean 43.1±12) compared to the lower VT-group (39.5±9, p=0.042), while a dichotomized analysis for driving pressures (≤14 mbar vs >14 mbar) did not show any difference neither in PaCO2 levels nor in HRQOL parameters. A decrease in the mental (6-month: 40.0±11 vs 44.8±13, p=0.038) and physical SF-12 (12-month: 38.3±11 vs 43.0±13, p=0.015) was reported from patients with hypoglycemia (blood glucose <70 mg/dl) compared to those without hypoglycemic episodes. More frequent vasopressor use with mean arterial pressure ≥65 mmHg was associated with an impaired physical SF-12 (6-month: 38.8±10) compared to less vasopressor use (43.0±11, p=0.019). Conclusions: In acute management of ARDS, a lower VT strategy associated with hypercapnia, as well as the frequent usage of catecholamines and the management of blood glucose may influence short-term HRQOL of survivors. The awareness of these findings is of clinical importance for the acute and post-ICU care.

• Authors: Thomas Bein, Steffen Weber-Carstens, Christian Apfelbacher, Susanne Brandstetter, Sebastian Blecha, Frank Dodoo-Schittko, Magdalena Brandl, Michael Quintel, Stefan Kluge, Christian Putensen, Sven Bercker, Björn Ellger, Thomas Kirschning, Christian Arndt, Patrick Meybohm, Florian Zeman, Christian Karagiannidis
• Journal: German medical science : GMS e-journal (Ger Med Sci) Vol. 18 Pg. Doc01 ( 2020) ISSN: 1612-3174 [Electronic] Germany
• PMID: 32047416 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2020 Bein et al.

Chemical References

• Catecholamines

Topics

• Catecholamines (therapeutic use)
• Causality
• Critical Care (methods, psychology, standards)
• Female
• Germany (epidemiology)
• Humans
• Hypercapnia (etiology, psychology)
• Hypoglycemia (etiology, psychology)
• Incidence
• Intensive Care Units (standards, statistics & numerical data)
• Male
• Middle Aged
• Patient Reported Outcome Measures
• Quality of Life
• Respiratory Distress Syndrome (epidemiology, physiopathology, psychology, therapy)
• Return to Work (psychology, statistics & numerical data)
• Survivors (psychology)
• Survivorship
• Tidal Volume