title: One-year outcomes in survivors of the acute respiratory distress syndrome.
abstract: BACKGROUND
  As more patients survive the acute respiratory distress syndrome, an understanding of the long-term outcomes of this condition is needed.
  
  
  METHODS
  We evaluated 109 survivors of the acute respiratory distress syndrome 3, 6, and 12 months after discharge from the intensive care unit. At each visit, patients were interviewed and underwent a physical examination, pulmonary-function testing, a six-minute-walk test, and a quality-of-life evaluation.
  
  
  RESULTS
  Patients who survived the acute respiratory distress syndrome were young (median age, 45 years) and severely ill (median Acute Physiology, Age, and Chronic Health Evaluation score, 23) and had a long stay in the intensive care unit (median, 25 days). Patients had lost 18 percent of their base-line body weight by the time they were discharged from the intensive care unit and stated that muscle weakness and fatigue were the reasons for their functional limitation. Lung volume and spirometric measurements were normal by 6 months, but carbon monoxide diffusion capacity remained low throughout the 12-month follow-up. No patients required supplemental oxygen at 12 months, but 6 percent of patients had arterial oxygen saturation values below 88 percent during exercise. The median score for the physical role domain of the Medical Outcomes Study 36-item Short-Form General Health Survey (a health-related quality-of-life measure) increased from 0 at 3 months to 25 at 12 months (score in the normal population, 84). The distance walked in six minutes increased from a median of 281 m at 3 months to 422 m at 12 months; all values were lower than predicted. The absence of systemic corticosteroid treatment, the absence of illness acquired during the intensive care unit stay, and rapid resolution of lung injury and multiorgan dysfunction were associated with better functional status during the one-year follow-up.
  
  
  CONCLUSIONS
  Survivors of the acute respiratory distress syndrome have persistent functional disability one year after discharge from the intensive care unit. Most patients have extrapulmonary conditions, with muscle wasting and weakness being most prominent.
authors.affiliation: Department of Medicine, University Health Network, Toronto, Ont., Canada. margaret.herridge@uhn.on.ca
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Herridge
authors.forename: Angela M
authors.initials: AM
authors.lastname: Cheung
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Tansey
authors.forename: Andrea
authors.initials: A
authors.lastname: Matte-Martyn
authors.forename: Natalia
authors.initials: N
authors.lastname: Diaz-Granados
authors.forename: Fatma
authors.initials: F
authors.lastname: Al-Saidi
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Cooper
authors.forename: Cameron B
authors.initials: CB
authors.lastname: Guest
authors.forename: C David
authors.initials: CD
authors.lastname: Mazer
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Stewart
authors.forename: Aiala
authors.initials: A
authors.lastname: Barr
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Slutsky
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D000505:Alopecia / Q000209:etiology; D000704:Analysis of Variance; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology*; D011788:Quality of Life; D012119:Respiration; D012128:Respiratory Distress Syndrome / Q000145:classification / Q000150:complications* / Q000503:physiopathology; D012129:Respiratory Function Tests; D017741:Survivors; D016138:Walking