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Long-term Outcomes of Pandemic 2009 Influenza A(H1N1)-Associated Severe ARDS

      Background

      No data on long-term outcomes of survivors of 2009 influenza A(H1N1) (A[H1N1])-associated ARDS are available. The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate.

      Methods

      Survivors of ARDS (12 with ECLA use vs 25 without, corresponding to 75% and 54% of the eligible patients for each group, respectively) selected from the Réseau Européen de Ventilation Artificielle (REVA) registry had previously been healthy, with only pregnancy and/or moderate obesity (BMI ≤ 35 kg/m2) as known risk factors for A(H1N1) infection. Lung function and morphology, health-related quality of life (HRQoL), and psychologic impairment were evaluated.

      Results

      At 1 year post-ICU discharge for the ECLA and no-ECLA groups, respectively, 50% and 40% reported significant exertion dyspnea, 83% and 64% had returned to work, and 75% and 64% had decreased diffusion capacity across the blood-gas barrier, despite their near-normal and similar lung function test results. For both groups, exercise test results showed diminished but comparable exercise capacities, with similar alveolar-arterial oxygen gradients at peak exercise, and CT scans showed minor abnormal findings. HRQoL assessed by the 36-Item Short-Form Health Survey was poorer for both groups than for a sex- and age-matched general population group, but without between-group differences. ECLA and no-ECLA group patients, respectively, had symptoms of anxiety (50% and 56%) and depression (28% and 28%) and were at risk for posttraumatic stress disorder (41% and 44%).

      Conclusions

      One year post-ICU discharge, a majority of survivors of A(H1N1)-associated ARDS had minor lung disabilities with diminished diffusion capacities across the blood-gas barrier, and most had psychologic impairment and poorer HRQoL than a sex- and age-matched general population group. ECLA and no-ECLA group patients had comparable outcomes.

      Trial registry

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      Linked Article

      • The Homogeneous and Robust Clinical Phenotype of Severe Lung Injury
        CHESTVol. 142Issue 3
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          Acute-onset severe lung injury, regardless of etiology or associated risk factors, is universally recognized in terms of its sameness. Patients with this condition share many similarities, including younger age, few comorbidities, recovery of lung function in those without preexisting lung disease, ICU-acquired weakness (ICUAW), and neuropsychologic dysfunction. These patients also share resilience and recovery from a profound, multisystem, and exuberant inflammatory response. These outcomes are robust over time and across different countries and investigators.
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