Sequelae of Acute Respiratory Distress Syndrome: Interest of Rehabilitation

Abstract

Case presentation: This clinical case presents the history of a woman hospitalized for acute respiratory distress syndrome (ARDS). A 62-year-old woman, with regular physical activity and no history of respiratory disease or smoking, was hospitalized for moderate ARDS with bilateral pneumonitis. Fourteen days later, she was discharged from the intensive care unit and received respiratory physical therapy. One month later, she experienced exertional dyspnea. A regression of alveolar condensation with persistent sequelae at the pulmonary bases was noted. Three months later, the patient continued daily physical activity with satisfactory tolerance. A reduction in alveolar-capillary transfer, inappropriate hyperventilation upon exercise, and impairment of gas exchanges at maximal effort, suggestive of pulmonary shunt, were demonstrated. At the 6-month evaluation, the patient displayed exertional dyspnea with residual bilateral basal consolidations. Six months later, the dyspnea had ceased. The persistence of bilateral basal interstitial syndrome associated with bronchial dilatation and pleural-based consolidations was noted, as well as a stable impaired alveolar-capillary diffusing capacity.

Discussion: Upon discharge from intensive care, pulmonary follow-up should be proposed to ARDS survivors. Moreover, pulmonary function testing at rest and exercise is advised as soon as possible to evaluate the respiratory sequelae. This will help to limit the severity of complications through adapted exercise rehabilitation and then regular physical activity.

Figure 1

The chest X-ray (in supine position) on admission showing bilateral alveolar-interstitial syndrome with bilateral lower lobe consolidations.

Figure 2

The chest X-ray (in standing position) showing the clear regression of alveolar condensation with some persistent sequelae at both pulmonary bases 1 month after ARDS.

Figure 3

The chest CT scan showing the persistence of a bilateral interstitial syndrome associated with bronchial dilatation and pleural-based consolidations 1 year after ARDS.