Published ahead of print on June 8, 2006, doi:10.1164/rccm.200505-693OC
© 2006 American Thoracic Society doi: 10.1164/rccm.200505-693OC
Two-Year Outcomes, Health Care Use, and Costs of Survivors of Acute Respiratory Distress SyndromeDepartment of Medicine, University Health Network; Departments of Critical Care Medicine and Anaesthesia, Sunnybrook and Women's College Health Sciences Centre; Departments of Anaesthesia, Critical Care Medicine, and Medicine, St. Michael's Hospital; Departments of Medicine and Anaesthesia, Mount Sinai Hospital; Interdepartmental Division of Critical Care Medicine, Department of Health Policy and Management Evaluation, Department of Public Health Sciences, and Institute of Medical Sciences, University of Toronto, Toronto; and Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Correspondence and requests for reprints should be addressed to Angela M. Cheung, M.D., Ph.D., FRCP(C), 200 Elizabeth Street, 7 Eaton North-221, Toronto, ON, M5G 2C4 Canada. E-mail: angela.cheung{at}uhn.on.ca Rationale: Little is known about the long-term outcomes and costs of survivors of acute respiratory distress syndrome (ARDS). Objectives: 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. Measurements: 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.
Key Words: acute respiratory distress syndrome • intensive care units • long-term survivors This article has been cited by other articles:
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