Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Palermo, Italy -
Section of Anesthesia Analgesia Intensive Care and Emergency, Department of Biopathology and Medical Biotechnologies (DIBIMED), P. Giaccone Polyclinic, University of Palermo, Palermo, Italy.
Minerva Anestesiol. 2019 Sep;85(9):971-980. doi: 10.23736/S0375-9393.19.13095-7. Epub 2019 Jan 18.
Acute respiratory distress syndrome (ARDS) survivors are affected with long-term physical/mental impairments, with improvements limited mostly to the first year after intensive care (ICU) discharge. Furthermore, caregivers of ICU patients exhibit psychological problems after family-member recovery. We evaluated the long-term physical and mental recovery of ARDS survivors treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO), and the long-term psychological impact on their caregivers.
Single-center prospective evaluation of a retrospective cohort of 75 ARDS patients treated with VV-ECMO during a seven-year period (25.10.2009-11.08.2016). Primary outcomes were the 36-Item Short-Form Health-Survey (SF-36, patients only), and risks of depression, anxiety or post-traumatic stress disorder (PTSD), both for patients and their caregivers. We investigated correlations between outcomes and population characteristics.
Of 50 ICU-survivors, seven died later and five were not contactable. Among 38 living patients, 33 participated (87%, 31 with their caregiver) with 2.7 years of median follow-up. Physical and mental SF-36 component scores were 42 (inter-quartile range, IQR:22) and 52 (IQR:18.5), respectively. The worst domains of the SF-36 were physical-role limitations (25, IQR:100) and general-health perception (56, IQR:42.5). Psychological tests highlighted high risk of depression (39-42%, patients; 39-52%, caregivers), anxiety (42%, patients; 39%, caregivers), and PTSD (47%, patients; 61%, caregivers). Patient depression or anxiety scores were correlated to age and to the outcome reported by caregivers.
At almost three-year follow-up, ARDS survivors treated with VV-ECMO showed reduced health-related quality-of-life and high risk of psychological impairment, in particular PTSD. Caregivers of this population were at high psychological risk as well.
急性呼吸窘迫综合征（ARDS）幸存者存在长期的身体/精神障碍，在重症监护病房（ICU）出院后的第一年，这些障碍的改善情况最为明显。此外，在家庭成员康复后，ICU 患者的照顾者也会出现心理问题。我们评估了接受静脉-静脉体外膜肺氧合（VV-ECMO）治疗的 ARDS 幸存者的长期身体和精神恢复情况，以及对其照顾者的长期心理影响。
对 75 名 ARDS 患者进行单中心前瞻性评估，这些患者在 7 年期间（2009 年 10 月 25 日至 2016 年 11 月 8 日）接受 VV-ECMO 治疗。主要结局指标是 36 项简短健康调查问卷（SF-36，仅患者），以及患者和其照顾者的抑郁、焦虑或创伤后应激障碍（PTSD）风险。我们研究了结局与人口特征之间的相关性。
在 50 名 ICU 幸存者中，7 人后来死亡，5 人无法联系。在 38 名存活患者中，有 33 名（87%，31 名与照顾者一起）参与了随访，中位随访时间为 2.7 年。SF-36 生理和心理成分评分分别为 42（四分位距 IQR：22）和 52（IQR：18.5）。SF-36 最差的领域是生理角色受限（25，IQR：100）和一般健康感知（56，IQR：42.5）。心理测试显示，抑郁（39-42%，患者；39-52%，照顾者）、焦虑（42%，患者；39%，照顾者）和 PTSD（47%，患者；61%，照顾者）的风险很高。患者的抑郁或焦虑评分与年龄和照顾者报告的结果相关。
在近 3 年的随访中，接受 VV-ECMO 治疗的 ARDS 幸存者的健康相关生活质量下降，心理障碍风险高，尤其是 PTSD。该人群的照顾者也存在较高的心理风险。
