Department of Medicine, Section of Pulmonary/Critical Care, University of Chicago, Chicago, IL.
Department of Medicine, Internal Medicine Residency Program, University of Chicago, Chicago, IL.
Crit Care Med. 2018 Jul;46(7):1078-1084. doi: 10.1097/CCM.0000000000003124.
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.
Long-term follow-up data from a previously published randomized controlled trial.
Adults patients with acute respiratory distress syndrome enrolled in a previously published clinical trial.
Adult ICU.
None.
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).
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.
急性呼吸窘迫综合征（ARDS）幸存者的长期预后较差，可能与“有创”机械通气期间的支持治疗措施有关。ARDS 患者应用头盔式无创通气可降低插管率；但尚不清楚避免使用头盔式无创通气而插管是否会改变 ARDS 幸存者的结局。
先前发表的随机对照试验的长期随访数据。
先前临床试验中纳入的 ARDS 成年患者。
成人 ICU。
无。
主要结局为出院后 1 年时的功能独立性，定义为日常生活活动和步行的独立性。在 1 年时，通过问卷调查评估功能独立性、生存情况以及机构无天数，即生存在家中的天数。出院时，由盲法治疗师评估 ICU 获得性肌无力和功能独立性。与面罩组相比，在出院时头盔组 ICU 获得性肌无力的发生率更高（79.5% vs. 38.6%；p = 0.0002），功能独立性更低（15.4% vs. 50%；p = 0.001）。83 例患者中的 81 例（97.6%）完成了 1 年随访。面罩组 1 年死亡率更高（69.2% vs. 43.2%；p = 0.017）。在 1 年时，头盔组患者更可能达到功能独立性（40.9% vs. 15.4%；p = 0.015），机构无天数更多（中位数，268.5[0-354] vs. 0[0-323]；p = 0.017）。
急性呼吸窘迫综合征行有创机械通气后，功能恢复不良较为常见。头盔式无创通气可能是减轻接受无创通气治疗的 ARDS 幸存者长期并发症的首个干预措施。
