Long-term survival in patients with severe acute respiratory distress syndrome and rescue therapies for refractory hypoxemia

Nita Khandelwal, Catherine L. Hough, Aasthaa Bansal, David L. Veenstra, Miriam Treggiari

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

OBJECTIVES:: To describe long-term survival in patients with severe acute respiratory distress syndrome and assess differences in patient characteristics and outcomes among those who receive rescue therapies (prone position ventilation, inhaled nitric oxide, or inhaled epoprostenol) versus conventional treatment. DESIGN:: Cohort study of patients with severe hypoxemia. SETTING:: University-Affiliated level 1 trauma center. PATIENTS:: Patients diagnosed with severe acute respiratory distress syndrome within 72 hours of ICU admission between January 1, 2008, and December 31, 2011. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Data were abstracted from the medical record and included demographic and clinical variables, hospital and ICU length of stay, discharge disposition, and hospital costs. Patient-level data were linked to the Washington State Death Registry. Kaplan-Meier methods and Cox's proportional hazards models were used to estimate survival and hazard ratios. Four hundred twenty-eight patients meeting study inclusion criteria were identified; 62 (14%) were initiated on a rescue therapy. PaO2/FIO2 ratios were comparable at admission between patients treated with a rescue therapy and those treated conventionally but were substantially lower by 72 hours in those who received rescue therapies (54 ± 17 vs 69 ± 17 mm Hg; p <0.01). For the entire cohort, estimated survival probability at 3 years was 55% (95% CI, 51-61%). Among 280 hospital survivors (65%), 3-year survival was 85% (95% CI, 80-89%). The relative hazard of in-hospital mortality was 68% higher among patients who received rescue therapy compared with patients treated conventionally (95% CI, 8-162%; p = 0.02). For long-term survival, the hazard ratio of death following ICU admission was 1.56 (95% CI, 1.02-2.37; p = 0.04), comparing rescue versus conventional treatment. CONCLUSIONS:: Despite high hospital mortality, severe acute respiratory distress syndrome patients surviving to hospital discharge have relatively good long-term survival. Worsening hypoxemia was associated with initiation of rescue therapy. Patients on rescue therapy had higher in-hospital mortality; however, survivors to hospital discharge had long-term survival that was comparable to other acute respiratory distress syndrome survivors.

Original languageEnglish (US)
Pages (from-to)1610-1618
Number of pages9
JournalCritical Care Medicine
Volume42
Issue number7
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Severe Acute Respiratory Syndrome
Adult Respiratory Distress Syndrome
Survival
Hospital Mortality
Survivors
Therapeutics
Hypoxia
Prone Position
Hospital Costs
Trauma Centers
Patient Admission
Epoprostenol
Proportional Hazards Models
Medical Records
Ventilation
Registries
Length of Stay
Nitric Oxide
Cohort Studies
Demography

Keywords

  • acute respiratory distress syndrome
  • critical care
  • refractory hypoxemia
  • rescue therapies

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Long-term survival in patients with severe acute respiratory distress syndrome and rescue therapies for refractory hypoxemia. / Khandelwal, Nita; Hough, Catherine L.; Bansal, Aasthaa; Veenstra, David L.; Treggiari, Miriam.

In: Critical Care Medicine, Vol. 42, No. 7, 2014, p. 1610-1618.

Research output: Contribution to journalArticle

Khandelwal, Nita ; Hough, Catherine L. ; Bansal, Aasthaa ; Veenstra, David L. ; Treggiari, Miriam. / Long-term survival in patients with severe acute respiratory distress syndrome and rescue therapies for refractory hypoxemia. In: Critical Care Medicine. 2014 ; Vol. 42, No. 7. pp. 1610-1618.
@article{f990df1db1974968991c0eecb0950c90,
title = "Long-term survival in patients with severe acute respiratory distress syndrome and rescue therapies for refractory hypoxemia",
abstract = "OBJECTIVES:: To describe long-term survival in patients with severe acute respiratory distress syndrome and assess differences in patient characteristics and outcomes among those who receive rescue therapies (prone position ventilation, inhaled nitric oxide, or inhaled epoprostenol) versus conventional treatment. DESIGN:: Cohort study of patients with severe hypoxemia. SETTING:: University-Affiliated level 1 trauma center. PATIENTS:: Patients diagnosed with severe acute respiratory distress syndrome within 72 hours of ICU admission between January 1, 2008, and December 31, 2011. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Data were abstracted from the medical record and included demographic and clinical variables, hospital and ICU length of stay, discharge disposition, and hospital costs. Patient-level data were linked to the Washington State Death Registry. Kaplan-Meier methods and Cox's proportional hazards models were used to estimate survival and hazard ratios. Four hundred twenty-eight patients meeting study inclusion criteria were identified; 62 (14{\%}) were initiated on a rescue therapy. PaO2/FIO2 ratios were comparable at admission between patients treated with a rescue therapy and those treated conventionally but were substantially lower by 72 hours in those who received rescue therapies (54 ± 17 vs 69 ± 17 mm Hg; p <0.01). For the entire cohort, estimated survival probability at 3 years was 55{\%} (95{\%} CI, 51-61{\%}). Among 280 hospital survivors (65{\%}), 3-year survival was 85{\%} (95{\%} CI, 80-89{\%}). The relative hazard of in-hospital mortality was 68{\%} higher among patients who received rescue therapy compared with patients treated conventionally (95{\%} CI, 8-162{\%}; p = 0.02). For long-term survival, the hazard ratio of death following ICU admission was 1.56 (95{\%} CI, 1.02-2.37; p = 0.04), comparing rescue versus conventional treatment. CONCLUSIONS:: Despite high hospital mortality, severe acute respiratory distress syndrome patients surviving to hospital discharge have relatively good long-term survival. Worsening hypoxemia was associated with initiation of rescue therapy. Patients on rescue therapy had higher in-hospital mortality; however, survivors to hospital discharge had long-term survival that was comparable to other acute respiratory distress syndrome survivors.",
keywords = "acute respiratory distress syndrome, critical care, refractory hypoxemia, rescue therapies",
author = "Nita Khandelwal and Hough, {Catherine L.} and Aasthaa Bansal and Veenstra, {David L.} and Miriam Treggiari",
year = "2014",
doi = "10.1097/CCM.0000000000000322",
language = "English (US)",
volume = "42",
pages = "1610--1618",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - Long-term survival in patients with severe acute respiratory distress syndrome and rescue therapies for refractory hypoxemia

AU - Khandelwal, Nita

AU - Hough, Catherine L.

AU - Bansal, Aasthaa

AU - Veenstra, David L.

AU - Treggiari, Miriam

PY - 2014

Y1 - 2014

N2 - OBJECTIVES:: To describe long-term survival in patients with severe acute respiratory distress syndrome and assess differences in patient characteristics and outcomes among those who receive rescue therapies (prone position ventilation, inhaled nitric oxide, or inhaled epoprostenol) versus conventional treatment. DESIGN:: Cohort study of patients with severe hypoxemia. SETTING:: University-Affiliated level 1 trauma center. PATIENTS:: Patients diagnosed with severe acute respiratory distress syndrome within 72 hours of ICU admission between January 1, 2008, and December 31, 2011. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Data were abstracted from the medical record and included demographic and clinical variables, hospital and ICU length of stay, discharge disposition, and hospital costs. Patient-level data were linked to the Washington State Death Registry. Kaplan-Meier methods and Cox's proportional hazards models were used to estimate survival and hazard ratios. Four hundred twenty-eight patients meeting study inclusion criteria were identified; 62 (14%) were initiated on a rescue therapy. PaO2/FIO2 ratios were comparable at admission between patients treated with a rescue therapy and those treated conventionally but were substantially lower by 72 hours in those who received rescue therapies (54 ± 17 vs 69 ± 17 mm Hg; p <0.01). For the entire cohort, estimated survival probability at 3 years was 55% (95% CI, 51-61%). Among 280 hospital survivors (65%), 3-year survival was 85% (95% CI, 80-89%). The relative hazard of in-hospital mortality was 68% higher among patients who received rescue therapy compared with patients treated conventionally (95% CI, 8-162%; p = 0.02). For long-term survival, the hazard ratio of death following ICU admission was 1.56 (95% CI, 1.02-2.37; p = 0.04), comparing rescue versus conventional treatment. CONCLUSIONS:: Despite high hospital mortality, severe acute respiratory distress syndrome patients surviving to hospital discharge have relatively good long-term survival. Worsening hypoxemia was associated with initiation of rescue therapy. Patients on rescue therapy had higher in-hospital mortality; however, survivors to hospital discharge had long-term survival that was comparable to other acute respiratory distress syndrome survivors.

AB - OBJECTIVES:: To describe long-term survival in patients with severe acute respiratory distress syndrome and assess differences in patient characteristics and outcomes among those who receive rescue therapies (prone position ventilation, inhaled nitric oxide, or inhaled epoprostenol) versus conventional treatment. DESIGN:: Cohort study of patients with severe hypoxemia. SETTING:: University-Affiliated level 1 trauma center. PATIENTS:: Patients diagnosed with severe acute respiratory distress syndrome within 72 hours of ICU admission between January 1, 2008, and December 31, 2011. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Data were abstracted from the medical record and included demographic and clinical variables, hospital and ICU length of stay, discharge disposition, and hospital costs. Patient-level data were linked to the Washington State Death Registry. Kaplan-Meier methods and Cox's proportional hazards models were used to estimate survival and hazard ratios. Four hundred twenty-eight patients meeting study inclusion criteria were identified; 62 (14%) were initiated on a rescue therapy. PaO2/FIO2 ratios were comparable at admission between patients treated with a rescue therapy and those treated conventionally but were substantially lower by 72 hours in those who received rescue therapies (54 ± 17 vs 69 ± 17 mm Hg; p <0.01). For the entire cohort, estimated survival probability at 3 years was 55% (95% CI, 51-61%). Among 280 hospital survivors (65%), 3-year survival was 85% (95% CI, 80-89%). The relative hazard of in-hospital mortality was 68% higher among patients who received rescue therapy compared with patients treated conventionally (95% CI, 8-162%; p = 0.02). For long-term survival, the hazard ratio of death following ICU admission was 1.56 (95% CI, 1.02-2.37; p = 0.04), comparing rescue versus conventional treatment. CONCLUSIONS:: Despite high hospital mortality, severe acute respiratory distress syndrome patients surviving to hospital discharge have relatively good long-term survival. Worsening hypoxemia was associated with initiation of rescue therapy. Patients on rescue therapy had higher in-hospital mortality; however, survivors to hospital discharge had long-term survival that was comparable to other acute respiratory distress syndrome survivors.

KW - acute respiratory distress syndrome

KW - critical care

KW - refractory hypoxemia

KW - rescue therapies

UR - http://www.scopus.com/inward/record.url?scp=84902547624&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902547624&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000000322

DO - 10.1097/CCM.0000000000000322

M3 - Article

VL - 42

SP - 1610

EP - 1618

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 7

ER -