One-Year Outcomes in Patients With Acute Respiratory Distress Syndrome Enrolled in a Randomized Clinical Trial of Helmet Versus Facemask Noninvasive Ventilation. Issue 7 (July 2018)

• Record Type: Journal Article
• Authors: Patel, Bhakti K.; Wolfe, Krysta S.; MacKenzie, Erica L.; Salem, Dhafer; Esbrook, Cheryl L.; Pawlik, Amy J.; Stulberg, Megan; Kemple, Crystal; Teele, Megan; Zeleny, Erin; Macleod, Julia; Pohlman, Anne S.; Hall, Jesse B.; Kress, John P.
• Is Part Of: Critical care medicine. Volume 46:Issue 7(2018)
• Publication Date: 2018-07
• Subjects: acute respiratory distress syndrome -- intensive care unit–acquired weakness -- early mobilization -- helmet -- noninvasive ventilation; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000003124
• Languages: English
• ISSNs: 0090-3493

Abstract

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. Abstract : Supplemental Digital Content is available in the text.