Long-term outcome of acute respiratory distress syndrome caused by severe acute respiratory syndrome (SARS): an observational study
ABSTRACT
Objective: We examined long-term outcome of pulmonaryfunction, exercise capacity and health-related quality of life(HRQoL) in patients with acute respiratory distress syndrome(ARDS) caused by severe acute respiratory syndrome (SARS).
Methods: 59 critically ill patients with ARDS caused by SARSbetween March and July 2003 were studied prospectively andfollowed up for 1 year. Thirty-six underwent pulmonaryfunction testing and a 6-minute walk test, and 35 underwentHRQoL evaluation by Short Form-36 questionnaire at 3, 6, and12 months after illness onset.
Results: Mean age was 47 (SD, 15.7) years. Median APACHEII score was 10 (interquartile range [IQR], 7-12). Only 47%required invasive mechanical ventilation. Median admissionand worst PaO2/FIO2 ratio were 142 (IQR, 94-177) mmHg and86 (IQR, 66-122) mmHg, respectively. Median stay in ICU andhospital were 9 (IQR, 5-20) and 31 (IQR, 20-54) days,respectively. Mortality was 24% at hospital discharge and at 1year. Mean lung volumes and spirometric measurements werenearly normal by 6 months. Except for diffusion capacityadjusted for haemoglobin concentration (DLCO) measured at12 months, there was no significant difference in pulmonaryfunction measurement between those who had mechanicalventilation and those who did not. The 6-minute walk distance(6MWD) improved from 3 to 6 months, with no furthersignificant change. Younger patients had near normal HRQoLby 6 months. Those aged over 40 years had impaired HRQoL atmultiple domains even at 12 months. At 12 months, forcedexpiratory volume in 1 second, forced vital capacity and6MWD correlated significantly with multiple SF-36 domainscores. DLCO correlated significantly only with domain scoresreflecting physical function.
Conclusions: The mortality of SARS-related ARDS is similar tothe mortality of ARDS from other causes. A substantial numberof patients with SARS-related ARDS survived without receivingmechanical ventilation. Patients had good recovery ofpulmonary function and HRQoL.
Crit Care Resusc 2006; 8: 302-308
