Pulmonary function and health-related quality of life in a sample of long-term survivors of the acute respiratory distress syndrome

Objective: We performed a follow-up cohort analysis in order to delineate the correlation between pulmonary function (PF) and health-related quality of life (HRQL) in patients after ARDS. Design: Follow-up cohort study. Setting: A 20-bed ICU of a university teaching hospital. Patients: A cohort of 50 long-term survivors of ARDS. Measurements and results: Measurements of PF (FVC, FEV1, TLC, D-LCO) and HRQL (SF-36 Health Status Questionnaire) were made 5.5 years (median value) after discharge from the ICU. Impairments in PF (defined as PF results below 80% of the predicted value) were frequent but generally mild. Twenty patients had a single PF impairment (with limitations in FEV1/FVC ratio in 12 patients being the most common), four patients had two (with D-LCO and FEV1/FVC ratio impairment the most common) and three patients had pathologic results in three PF tests (FEV1/FVC ratio, TLC and capillary pO(2) during exercise in one case, FVC, TLC and capillary pO(2) during exercise in the second patient and FVC, TLC and D-LCO in the third). Compared to normal controls, survivors of ARDS showed impairments in all SF36 health dimensions (p < 0.001). Patients with multiple (> 1) PF impairments described the lowest HRQL with major limitations in all SF-36 categories (p < 0.037) including physical and mental summary scores (36.5 vs 46.9, p = 0.037 and 31.3 vs 51.4, p = 0.003) when compared to patients with no or only one PF impairment. Conclusions: Long-term survivors of ARDS have a significant reduction in HRQL and the presence of multiple PF impairments is associated with maximal decrements in HRQL.