The long-lasting effects of the acute respiratory distress syndrome

ABSTRACT

Introduction

Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury common in critically ill patients and characterized by significant morbidity and mortality. It frequently manifests long-lasting effects beyond hospitalization, from cognitive impairment to physical weakness.

Areas covered

Several complications of ARDS have been identified in patients after hospital discharge. The authors conducted literature searches to identify observational studies, randomized clinical trials, systematic reviews, and guidelines. A summary of is presented here to outline the sequelae of ARDS and their risk factors with a focus on the limited but growing research into possible therapies. Long term sequelae of ARDS commonly identified in the literature include long-term cognitive impairment, psychological morbidities, neuromuscular weakness, pulmonary dysfunction, and ongoing healthcare utilization with reduced quality of life.

Expert opinion

Given the public health significance of long-term complications following ARDS, the development of new therapies for prevention and treatment is of vital importance. Furthering knowledge of the pathophysiology of these impairments will provide a framework to develop new therapeutic targets to fuel future clinical trials in this area of critical care medicine.

KEYWORDS:

• acute respiratory distress syndrome
• long-term outcomes

Article Highlights

• ARDS is a severe form of acute lung injury and critical illness, and its impact reaches beyond the immediate illness to impact survivors for years following hospitalization.

• ARDS is associated with ongoing mortality risk following discharge from the hospital that may be related to other complications of critical illness, such as muscular weakness.

• Patients who suffer from ARDS often develop a persistent form of cognitive dysfunction that can be severe and long-lasting. The strongest risk factor for this cognitive impairment is the development and duration of delirium during critical illness.

• In addition to cognitive impairment, ARDS patients can suffer from significant psychological morbidities, including anxiety, depression, and PTSD.

• One of the more debilitating impairments seen after ARDS is intensive care acquired weakness (ICU-AW), a broad term encompassing critical illness myopathy and polyneuropathy. These processes lead to muscle wasting and weakness that persists and is associated with greater long-term mortality following ARDS.

• ARDS survivors also experience greater use of healthcare resources and re-hospitalizations following their illness, which is coupled with a significant reduction in quality of life following their disease that may not improve to pre-illness levels.

Declaration of interest

LB Ware has received advisory board fees from Bayer, Quark, Merck and CSL Behring and research support from CSL Behring and Genentech. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors are supported by funding from the NIH, including 5K24 HL103836 received by LB Ware and research training support received by MF Mart (NIH 5T32 HL087738). Additional research funding support through the Vanderbilt University Medical Center Arthur and Lisa Wheeler Critical Care Research Fund is received by MF Mart.