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Timothy A. Davidson, MD; Ellen S. Caldwell, MS; J. Randall Curtis, MD, MPH; Leonard D. Hudson, MD; Kenneth P. Steinberg, MD

JAMA. 1999;281:354-360.

Context  Health-related quality of life (HRQL) is reduced in patients who survive acute respiratory distress (ARDS), but whether this decline in HRQL is caused by ARDS or other aspects of the patient's illness or injury is unknown.

Objective  To determine if there are differences in the HRQL of ARDS survivors and comparably ill or injured controls without ARDS.

Design  Prospective, matched, parallel cohort study.

Setting  A 411-bed municipal medical and regional level I trauma center.

Patients  Seventy-three pairs of ARDS survivors and severity-matched controls with the clinical risk factors for ARDS of sepsis and trauma admitted between January 1, 1994, and July 30, 1996.

Main Outcome Measures  The HRQL of ARDS survivors and controls, assessed by generic and pulmonary disease–specific HRQL instruments (Medical Outcomes Study 36-Item Short Form Health Survey, Standard Form [SF-36] and St George's Respiratory Questionnaire [SGRQ], respectively).

Results  Clinically meaningful and statistically significant reductions in HRQL scores of ARDS survivors (n=73) were seen in 7 of 8 SF-36 domains and 3 of 3 SGRQ domains compared with matched controls (P<.001 for all reductions). The largest decrements in the HRQL were seen in physical function and pulmonary symptoms and limitations. Analysis of trauma-matched pairs (n=46) revealed significant reductions in 7 of 8 SF-36 domains (P.02) and 3 of 3 SGRQ domains (P.003). Analysis of sepsis-matched pairs (n=27) revealed significant reductions in 6 of 8 SF-36 domains (P.05) and 3 of 3 SGRQ domains (P.002).

Conclusions  Survivors of ARDS have a clinically significant reduction in HRQL that appears to be caused exclusively by ARDS and its sequelae. Reductions were primarily noted in physical functioning and pulmonary disease–specific domains.

Author Affiliations: Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle.

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