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/m
2) 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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Article Info
Publication History
Accepted:
January 10,
2012
Received:
August 30,
2011
Footnotes
Members of the REVA Study Group are listed in e-Appendix 1.
Funding/Support: This study was funded by a grant from the INSERM-Institut de Microbiologie et Maladies Infectieuses, France, and French Ministry of Health.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
Identification
Copyright
© 2012 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
ScienceDirect
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- The Homogeneous and Robust Clinical Phenotype of Severe Lung InjuryCHESTVol. 142Issue 3
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