Interrelationships Among Workload, Illness Severity, and Function on Return to Work following Acute Respiratory Distress Syndrome

BackgroundDelayed return to work is common after acute respiratory distress syndrome (ARDS), but has undergone little detailed evaluation. We examined factors associated with the timing of return to work after ARDS, along with lost earnings and shifts in healthcare coverage.MethodsFive-year, multisite prospective, longitudinal cohort study of 138 2-year ARDS survivors hospitalised between 2004 and 2007. Employment and healthcare coverage were collected via structured interview. Predictors of time to return to work were evaluated using Fine and Grey regression analysis. Lost earnings were estimated using Bureau of Labor Statistics data.ResultsSixty-seven (49%) of the 138 2-year survivors were employed prior to ARDS. Among 64 5-year survivors, 20 (31%) never returned to work across 5-year follow-up. Predictors of delayed return to work (HR (95% CI)) included baseline Charlson Comorbidity Index (0.77 (0.59 to 0.99) per point; p=0.04), mechanical ventilation duration (0.67 (0.55 to 0.82) per day up to 5 days; p<0.001) and discharge to a healthcare facility (0.49 (0.26 to 0.93); p=0.03). Forty-nine of 64 (77%) 5-year survivors incurred lost earnings, with average (SD) losses ranging from US$38 354 (21,533) to US$43 510 (25,753) per person per year. Jobless, non-retired survivors experienced a 33% decrease in private health insurance and concomitant 37% rise in government-funded coverage.ConclusionsAcross 5-year follow-up, nearly one-third of previously employed ARDS survivors never returned to work. Delayed return to work was associated with patient-related and intensive care unit/hospital-related factors, substantial lost earnings and a marked rise in government-funded healthcare coverage. These important consequences emphasise the need to design and evaluate vocation-based interventions to assist ARDS survivors return to work.

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Ventilatory Ratio is a Valuable Prognostic Indicator in a Representative Observational Cohort of Patients with Acute Respiratory Distress Syndrome

10.21203/rs.3.rs-1037916/v1 ◽

2021 ◽

Author(s):

Emily R. Siegel ◽

Hanjing Zhuo ◽

Pratik Sinha ◽

Alexander I. Papolos ◽

Siyuan A. Ni ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Illness Severity ◽

Receiver Operating Curve ◽

Apache Iii ◽

Observational Cohort ◽

Respiratory Variables ◽

Receiver Operating

Abstract Background Estimating mortality risk is essential for prognostic enrichment. How various indices specific to respiratory compromise contribute to prognostication in patients with acute respiratory distress syndrome (ARDS) is not well-characterized in general clinical populations. The primary objective of this study was to identify variables specific to respiratory failure that add prognostic value to indicators of systemic illness severity. We tested the added benefit of respiratory variables in a representative observational cohort of patients with ARDS.Methods 50 patients with ARDS were enrolled in a single-center, prospective, observational cohort. We tested the contribution of respiratory variables (oxygenation index, ventilatory ratio [VR], and the radiographic assessment of lung edema score) to logistic regression models of 28-day mortality adjusted for indicators of systemic illness severity (the Acute Physiology and Chronic Health Evaluation [APACHE] III score or severity of shock as measured by the number of vasopressors required at baseline). We also compared a model utilizing APACHE III with one including baseline number of vasopressors using the areas under their receiver operating curves.ResultsVR significantly improved model performance by likelihood ratio testing when added to APACHE III (p = 0.04) or vasopressor number at baseline (p = 0.01). Adjusted for APACHE III, each 0.5-unit change in VR was associated with an odds ratio for 28-day mortality of 1.78 (95% CI = 0.78-3.23). The number of vasopressors required at baseline had similar prognostic discrimination to the multi-component APACHE III. A model including the number of vasopressors and VR (area under the receiver operating curve [AUROC] 0.77, 95% CI 0.64-0.90) was comparable to a model including APACHE III and VR (AUROC 0.81 (95% CI 0.68 – 0.93), p value for comparison = 0.58.) ConclusionsIn this observational cohort of patients with ARDS, the ventilatory ratio significantly improved discrimination for mortality when combined with indicators of severe systemic illness. Additionally, the number of vasopressors required at baseline and APACHE III had similar discrimination for mortality when combined with VR. The ventilatory ratio is easily obtained at the bedside and offers promise for both clinical prognostication and enriching clinical trial populations.

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Return to Work After Coronavirus Disease 2019 Acute Respiratory Distress Syndrome and Intensive Care Admission

Critical Care Medicine ◽

10.1097/ccm.0000000000005096 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Luca Carenzo ◽

Francesca Dalla Corte ◽

Ryan W. Haines ◽

Chiara Palandri ◽

Angelo Milani ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Return To Work ◽

Respiratory Distress ◽

Distress Syndrome ◽

Intensive Care Admission

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Acute Respiratory Distress Syndrome: Focus on Viral Origin and Role of Pulmonary Lymphatics

Biomedicines ◽

10.3390/biomedicines9111732 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1732

Author(s):

Eleonore Fröhlich

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Treatment Options ◽

Viral Origin ◽

Specific Effects ◽

Pulmonary Changes ◽

And Function

Acute respiratory distress syndrome (ARDS) is a serious affection of the lung caused by a variety of pathologies. Great interest is currently focused on ARDS induced by viruses (pandemic influenza and corona viruses). The review describes pulmonary changes in ARDS and specific effects of the pandemic viruses in ARDS, and summarizes treatment options. Because the known pathogenic mechanisms cannot explain all aspects of the syndrome, the contribution of pulmonary lymphatics to the pathology is discussed. Organization and function of lymphatics in a healthy lung and in resorption of pulmonary edema are described. A future clinical trial may provide more insight into the role of hyaluronan in ARDS but the development of promising pharmacological treatments is unlikely because drugs play no important role in lymphedema therapy.

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