Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome

Objectives: Despite considerable progress in intensive care management of the acute respiratory distress syndrome (ARDS), little is known about health-related quality of life in long term survivors. In addition, intensive care treatment can be extremely stressful, and many survivors of ARDS report adverse experiences such as respiratory distress, anxiety, or pain during intensive care unit (ICU) treatment. This study was performed to assess health related quality of life in survivors of ARDS and to test the hypothesis that adverse experiences during ICU treatment result in post-traumatic stress disorder (PTSD) and negative effects on health related quality of life. Design: Retrospective, cohort, case controlled analyses. Setting: A 12-bed multidisciplinary ICU of a tertiary cake university hospital, capable of providing extracorporeal life support for adults with severe ARDS. Patients: We studied 80 patients who were admitted to our hospital from 1985 to 1995 and who survived an episode of ARDS. ARDS was defined according to the criteria of the American-European Consensus Conference on ARDS. Interventions: Health-related quality of life was measured us ing the Health Status Questionnaire of the self-administered Medical Outcomes Study Short Form Survey that consists of 36 questions (SF-36) and the German version of the Post Traumatic Stress Syndrome 10-Questions Inventory (PTSS-10), a sell report scale for the diagnosis of posttraumatic stress disorder based on the Diagnostic and Statistical Manual (Third Edition) criteria (American Psychiatric Association). The number of adverse experiences (anxiety, respiratory distress, pain, and nightmares) during intensive care was evaluated by means of a structured questionnaire. For each patient with ARDS, three age and gender-comparable con trols were randomly selected from databases providing normal values for the SF-36 and PTSS-10 scores in populations at risk for posttraumatic stress disorder. Measurements and Main Results: Survivors of ARDS showed statistically significant impairments in all eight health dimensions of the SF-36 when compared with normal controls (median reduction 21.3%, p <.006) with maximal impairments in physical function (median reduction 28.9%, p =.000) and a 38% higher frequency of chronic pain (p =.0001). Three of 34 patients reporting none, or one, adverse experience had evidence of posttraumatic stress disorder vs. 19 of 46 patients remembering multiple traumatic episodes (p =.007). Patients reporting multiple adverse experiences described the lowest health-related quality of life, with maximal impairments in psychosocial functioning (p <.005) and only small limitations in physical function. Conclusions: Long-term survivors of ARDS describe a good overall health related quality of life. Major impairments in mental health domains of health-related quality of life are associated with the development of posttraumatic stress disorder and are a possible result of traumatic experiences during ICU therapy.