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Randomized Controlled Trial
. 2018 Jul;46(7):1078-1084.
doi: 10.1097/CCM.0000000000003124.

One-Year Outcomes in Patients With Acute Respiratory Distress Syndrome Enrolled in a Randomized Clinical Trial of Helmet Versus Facemask Noninvasive Ventilation

Bhakti K Patel  1 , Krysta S Wolfe  1 , Erica L MacKenzie  2 , Dhafer Salem  3 , Cheryl L Esbrook  4 , Amy J Pawlik  4 , Megan Stulberg  4 , Crystal Kemple  4 , Megan Teele  4 , Erin Zeleny  4 , Julia Macleod  4 , Anne S Pohlman  1 , Jesse B Hall  1 , John P Kress  1
Affiliations
Randomized Controlled Trial

One-Year Outcomes in Patients With Acute Respiratory Distress Syndrome Enrolled in a Randomized Clinical Trial of Helmet Versus Facemask Noninvasive Ventilation

Bhakti K Patel et al. Crit Care Med. 2018 Jul.

Abstract

Objectives: 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.

Design: Long-term follow-up data from a previously published randomized controlled trial.

Patients: Adults patients with acute respiratory distress syndrome enrolled in a previously published clinical trial.

Setting: Adult ICU.

Intervention: None.

Measurements and main results: 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).

Conclusions: 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.

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Conflict of interest statement

Conflicts of interest

We declare that we have no relevant conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan Meier Analysis of One Year Survival
See this image and copyright information in PMC

Comment in

References

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