Recovery from lung injury in survivors of acute respiratory distress syndrome: difference between pulmonary and extrapulmonary subtypes.

Abstract

To determine whether long-term outcome differs between acute respiratory distress syndrome (ARDS) resulting from pulmonary (ARDSp) and extrapulmonary (ARDSexp) causes. Observational study. Medical intensive care unit of a university hospital. Twenty-nine ARDS patients (16 ARDSp and 13 ARDSexp) who survived over 6 months after diagnosis. The two groups did not differ according to demographic data and severity indices on admission. The duration of ICU stay (median 21 days [interquartile range, 12-43 days] vs 12 [6.5-20] days, p=0.097) tended to be longer and total ventilation time (360 [96-700] h vs 144 [42.5-216] h, p=0.045) were longer in the patients with ARDSp. The ARDSp patients showed more severe abnormalities on thin-section computed tomography (CT), including ground-glass opacity (GGO; 6 [3-16] vs 0 [0-2.5], p=0.002), reticular density (12 [8-14] vs 5 [2-9], p=0.033) and the sum of all four patterns of lesion (20 [11-27] vs 5 [2-12], p=0.006). There were no between-group differences in Spitzer's Quality of Life index and the Chronic Respiratory Questionnaire. These results suggest that ARDSp would leave more severe lung sequelae than ARDSexp, but the clinical relevance of their difference is questionable.