Chest
Volume 123, Issue 3, March 2003, Pages 845-853
Journal home page for Chest

Clinical Investigations in Critical Care
Long-term Assessment of Lung Function in Survivors of Severe ARDSa

https://doi.org/10.1378/chest.123.3.845Get rights and content

Study objectives

To investigate the long-term outcome of lung function in survivors of severe ARDS after modern treatment strategies including lung protective mechanical ventilation and prone positioning maneuvers.

Design

Follow-up cohort study.

Setting

University hospital pulmonary division and level 1 trauma center.

Patients

Sixteen survivors of severe ARDS (from 1992 to 1994) with a lung injury score ≥ 2.5.

Measurements

The follow-up study (from 1995 to 1996) included interview, physical examination, chest radiographs, static and dynamic lung volumes, diffusion capacity of the lung for carbon monoxide (Dlco), blood gas analysis, and cardiopulmonary exercise testing (CPET).

Results

The mean ± SD interval between hospital discharge and functional assessment was 29.5 ± 8.7 months (range, 15.0 to 40.7 months). In approximately one half of the patients, mild abnormalities in static and dynamic lung volumes were found. In 25% (4 of 16 patients), lung function was obstructive; in 25% (4 of 16 patients), lung function was restrictive; and in 6.3% (1 of 16 patients), a combined obstructive-restrictive pattern was revealed. Dlco was impaired in 12.5% (2 of 16 patients); gas exchange during exercise was impaired in 45.5% (5 of 11 patients).

Conclusions

Residual obstructive and restrictive defects as well as impaired pulmonary gas exchange remain common after severe ARDS. CPET is a very sensitive measure to evaluate residual impairment of lung function after ARDS. Using CPET, reduced pulmonary gas exchange can be detected in many patients with normal Dlco.

Section snippets

Materials and Methods

Between 1992 and 1994, 1,394 patients were admitted to our trauma surgical ICU and registered in a central ICU database. In 1995, this patient database was used to identify patients with ARDS or other lung-related problems. In a second step, the original patient records were screened. Only patients who retrospectively met the diagnostic criteria for ARDS as defined by the American-European Consensus Conference on ARDS in 19946 and who additionally showed a lung injury score (LIS) of > 2.5 as

Results

Mean interval between hospital discharge and follow-up examination was 29.5 ± 8.7 months (range, 15.0 to 40.7 months). The mean age of the study population at the time of functional assessment was 43.0 ± 14.1 years. Nine patients (56%) were smokers before onset of ARDS. Six patients (67%) resumed smoking, while the remaining three patients (33%) did not resume smoking after recovery, and seven patients (44%) remained nonsmokers.

Discussion

Clinical studies focusing on ARDS have most commonly been performed during the acute phase or within the first months after recovery. Less data are available on lung function during long-term follow-up of ARDS survivors. Residual impairment has been investigated by several groups since the beginning of the 1980s and seems to be common. Between 1972 and 2001, 30 studies and case reports including up to 51 patients have been published. The longest elapse of lung function testing after ARDS ranged

Conclusion

We conclude that residual obstructive and restrictive defects as well as an impaired gas exchange remain common up to 3 years after ARDS. Furthermore, our data confirm that CPET is a very sensitive measure to evaluate residual impairment of lung function after severe ARDS and show that impaired pulmonary gas exchange can be detected in many patients with normal Dlco.

Acknowledgment

We thank Professor Peter A. Ward, Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, for linguistic advice.

References (48)

  • R Llamas

    Adult respiratory distress syndrome: report of survival after two episodes

    Chest

    (1974)
  • R Stocker et al.

    Prone positioning and low-volume pressure-limited ventilation improve survival in patients with severe ARDS

    Chest

    (1997)
  • A Artigas et al.

    Clinical presentation, prognostic factors and outcome of ARDS in the European Collaborative Study (1985–1987)

  • P Krafft et al.

    The acute respiratory distress syndrome: definitions, severity and clinical outcome: an analysis of 101 clinical investigations

    Intensive Care Med

    (1996)
  • F Jardin et al.

    Improved prognosis of acute respiratory distress syndrome 15 years on

    Intensive Care Med

    (1999)
  • MD Eisner et al.

    Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome

    Am J Respir Crit Care Med

    (2001)
  • GR Bernard et al.

    The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination

    Am J Respir Crit Care Med

    (1994)
  • A Artigas et al.

    The American-European Consensus Conference on ARDS. Part 2: ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling; acute respiratory distress syndrome

    Am J Respir Crit Care Med

    (1998)
  • RS Connell et al.

    The development of pulmonary ultrastructural lesions during hemorrhagic shock

    J Trauma

    (1975)
  • S Lakshminarayan et al.

    Prognosis after recovery from adult respiratory distress syndrome

    Am Rev Respir Dis

    (1976)
  • G Schelling et al.

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

    Intensive Care Med

    (2000)
  • O Luhr et al.

    Pulmonary function in adult survivors of severe acute lung injury treated with inhaled nitric oxide

    Acta Anaesthesiol Scand

    (1998)
  • I Weiss et al.

    Respiratory and cardiac function in children after acute hypoxemic respiratory failure

    Crit Care Med

    (1996)
  • LG McHugh et al.

    Recovery of function in survivors of the acute respiratory distress syndrome

    Am J Respir Crit Care Med

    (1994)
  • Cited by (91)

    • Genome-wide transcriptional profiling of pulmonary functional sequelae in ARDS- secondary to SARS-CoV-2 infection

      2022, Biomedicine and Pharmacotherapy
      Citation Excerpt :

      Although the mortality rate has significantly decreased in the last decade, a great percentage of survivors of ARDS are affected by abnormalities in pulmonary structure and function [10]. Reduction of lung diffusion capacity for carbon monoxide (DLCO) is the most common alteration, being described in 33–82% of patients several months after ARDS resolution [11,12]. In survivors of ARDS secondary to SARS-CoV-2 infection, our group reported an abnormal DLCO in up to 80% of the patients at a 3-month follow-up [13].

    View all citing articles on Scopus
    View full text