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One-Year Outcomes in Patients With Acute Respiratory Distress Syndrome Enrolled in a Randomized Clinical Trial of Helmet Versus Facemask Noninvasive Ventilation.


ABSTRACT: OBJECTIVES:Many survivors of acute respiratory distress syndrome have poor long-term outcomes possibly due to supportive care practices during "invasive" mechanical ventilation. Helmet noninvasive ventilation in acute respiratory distress syndrome may reduce intubation rates; however, it is unknown if avoiding intubation with helmet noninvasive ventilation alters the consequences of surviving acute respiratory distress syndrome. DESIGN:Long-term follow-up data from a previously published randomized controlled trial. PATIENTS:Adults patients with acute respiratory distress syndrome enrolled in a previously published clinical trial. SETTING:Adult ICU. INTERVENTION:None. MEASUREMENTS AND MAIN RESULTS:The primary outcome was functional independence at 1 year after hospital discharge defined as independence in activities of daily living and ambulation. At 1 year, patients were surveyed to assess for functional independence, survival, and number of institution-free days, defined as days alive spent living at home. The presence of ICU-acquired weakness and functional independence was also assessed by a blinded therapist on hospital discharge. On hospital discharge, there was a greater prevalence of ICU-acquired weakness (79.5% vs 38.6%; p = 0.0002) and less functional independence (15.4% vs 50%; p = 0.001) in the facemask group. One-year follow-up data were collected for 81 of 83 patients (97.6%). One-year mortality was higher in the facemask group (69.2% vs 43.2%; p = 0.017). At 1 year, patients in the helmet group were more likely to be functionally independent (40.9% vs 15.4%; p = 0.015) and had more institution-free days (median, 268.5 [0-354] vs 0 [0-323]; p = 0.017). CONCLUSIONS:Poor functional recovery after invasive mechanical ventilation for acute respiratory distress syndrome is common. Helmet noninvasive ventilation may be the first intervention that mitigates the long-term complications that plague survivors of acute respiratory distress syndrome managed with noninvasive ventilation.

SUBMITTER: Patel BK 

PROVIDER: S-EPMC6005726 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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One-Year Outcomes in Patients With Acute Respiratory Distress Syndrome Enrolled in a Randomized Clinical Trial of Helmet Versus Facemask Noninvasive Ventilation.

Patel Bhakti K BK   Wolfe Krysta S KS   MacKenzie Erica L EL   Salem Dhafer D   Esbrook Cheryl L CL   Pawlik Amy J AJ   Stulberg Megan M   Kemple Crystal C   Teele Megan M   Zeleny Erin E   Macleod Julia J   Pohlman Anne S AS   Hall Jesse B JB   Kress John P JP  

Critical care medicine 20180701 7


<h4>Objectives</h4>Many survivors of acute respiratory distress syndrome have poor long-term outcomes possibly due to supportive care practices during "invasive" mechanical ventilation. Helmet noninvasive ventilation in acute respiratory distress syndrome may reduce intubation rates; however, it is unknown if avoiding intubation with helmet noninvasive ventilation alters the consequences of surviving acute respiratory distress syndrome.<h4>Design</h4>Long-term follow-up data from a previously pu  ...[more]

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