title: Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome.
abstract: BACKGROUND
  Little is known about the long-term outcomes and costs of survivors of acute respiratory distress syndrome (ARDS).
  
  
  OBJECTIVE
  To describe functional and quality of life outcomes, health care use, and costs of survivors of ARDS 2 yr after intensive care unit (ICU) discharge.
  
  
  METHODS
  We recruited a cohort of ARDS survivors from four academic tertiary care ICUs in Toronto, Canada, and prospectively monitored them from ICU admission to 2 yr after ICU discharge.
  
  
  METHODS
  Clinical and functional outcomes, health care use, and direct medical costs.
  
  
  RESULTS
  Eighty-five percent of patients with ARDS discharged from the ICU survived to 2 yr; overall 2-yr mortality was 49%. At 2 yr, survivors continued to have exercise limitation although 65% had returned to work. There was no statistically significant improvement in health-related quality of life as measured by Short-Form General Health Survey between 1 and 2 yr, although there was a trend toward better physical role at 2 yr (p = 0.0586). Apart from emotional role and mental health, all other domains remained below that of the normal population. From ICU admission to 2 yr after ICU discharge, the largest portion of health care costs for a survivor of ARDS was the initial hospital stay, with ICU costs accounting for 76% of these costs. After the initial hospital stay, health care costs were related to hospital readmissions and inpatient rehabilitation.
  
  
  CONCLUSIONS
  Survivors of ARDS continued to have functional impairment and compromised health-related quality of life 2 yr after discharge from the ICU. Health care use and costs after the initial hospitalization were driven by hospital readmissions and inpatient rehabilitation.
authors.affiliation: Department of Medicine, University Health Network, Toronto, ON, Canada. angela.cheung@uhn.on.ca
authors.forename: Angela M
authors.initials: AM
authors.lastname: Cheung
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Tansey
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.forename: Natalia
authors.initials: N
authors.lastname: Diaz-Granados
authors.forename: Andrea
authors.initials: A
authors.lastname: Matté
authors.forename: Aiala
authors.initials: A
authors.lastname: Barr
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.forename: C David
authors.initials: CD
authors.lastname: Mazer
authors.forename: Cameron B
authors.initials: CB
authors.lastname: Guest
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Stewart
authors.forename: Fatma
authors.initials: F
authors.lastname: Al-Saidi
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Cooper
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Slutsky
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Herridge
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology; D012128:Respiratory Distress Syndrome / Q000191:economics* / Q000503:physiopathology / Q000628:therapy*; D012129:Respiratory Function Tests; D013997:Time Factors