The acute respiratory distress syndrome (ARDS) is a life-threatening condition. In special situations, these critically ill patients must be transferred to specialized centers for escalating treatment. The aim of this study was to evaluate the quality of inter-hospital transport (IHT) of ARDS patients.We evaluated medical and organizational aspects of structural and procedural quality relating to IHT of patients with ARDS in a prospective nationwide ARDS study. The qualification of emergency staff, the organizational aspects and the occurrence of critical events during transport were analyzed.Out of 1234 ARDS patients, 431 (34.9%) were transported, and 52 of these (12.1%) treated with extracorporeal membrane oxygenation. 63.1% of transferred patients were male, median age was 54 years, and 26.8% of patients were obese. All patients were mechanically ventilated during IHT. Pressure-controlled ventilation was the preferred mode (92.1%). Median duration to organize the IHT was 165 min. Median distance for IHT was 58 km, and median duration of IHT 60 min. Forty-two patient-related and 8 technology-related critical events (11.6%, 50 of 431 patients) were observed. When a critical event occurred, the PaO2/FiO2 ratio before transport was significant lower (68 vs. 80 mmHg, p = 0.017). 69.8% of physicians and 86.7% of paramedics confirmed all transfer qualifications according to requirements of the German faculty guidelines (DIVI).The transport of critically ill patients is associated with potential risks. In our study the rate of patient- and technology-related critical events was relatively low. A severe ARDS with a PaO2/FiO2 ratio < 70 mmHg seems to be a risk factor for the appearance of critical events during IHT. The majority of transport staff was well qualified. Time span for organization of IHT was relatively short. ECMO is an option to transport patients with a severe ARDS safely to specialized centers. Trial registration NCT02637011 (ClinicalTrials.gov, Registered 15 December 2015, retrospectively registered).
Hintergrund: Das akute Lungenversagen des Erwachsenen (ARDS, „acute respiratory distress syndrome“) resultiert aus einer pulmonal oder extrapulmonal bedingten Schadigung des Lungenparenchyms. Die Betroffenen leiden oft unter einer eingeschrankten gesundheitsbezogenen Lebensqualitat (HRQoL, „health related quality of life“), psychischen und physischen Einschrankungen sowie andauernder Arbeitsunfahigkeit.
Methode: Diese systematische Ubersichtsarbeit untersucht die Literatur im Hinblick auf Determinanten von HRQoL und des Wiedereintritts in das Berufsleben (RtW, „return to work“). 24 Beobachtungsstudien mit einer statistischen Assoziation zwischen Determinanten und HRQoL oder RtW wurden eingeschlossen. Wegen der hohen Heterogenitat der Studien wurde auf eine statistische Aggregation der einzelnen Effektschatzer verzichtet; die Ergebnisse wurden deskriptiv zusammengefasst.
Ergebnisse: Insbesondere eine psychopathologische Symptomatik ist mit eingeschrankter Lebensqualitat verbunden. Hingegen fanden sich bei vielen versorgungs- und krankheitsbezogenen Determinanten kleine, nichtsignifikante Effekte auf HRQoL und RtW. Die Ein-Sekunden-Kapazitat ist durchweg positiv mit der HRQoL assoziiert. Ein durch Sepsis ausgelostes ARDS scheint im Vergleich zum ARDS anderer Genese ein Risikofaktor fur eine verminderte HRQoL zu sein. Hohe Heterogenitat zwischen den Studien und ein durchgangig hohes Risiko eines Selektionsbias erschweren eine Evidenzsynthese erheblich.
Schlussfolgerung: Die Identifikation von Determinanten eingeschrankter Lebensqualitat nach ARDS ist wesentlich fur klinisch relevante Interventionsmoglichkeiten. Uber verschiedene Studien hinweg wurden grosere signifikante Effekte nur dann beobachtet, wenn Determinanten mit engem inhaltlichem Bezug zu den Skalen der HRQoL-Instrumente auch zeitlich zusammen mit der HRQoL gemessen wurden.
ARDS is a common condition, with a prevalence of ∼10% in ICU patients.[1][1],[2][2] Due to a decrease in (in-hospital) mortality of ARDS, interest in long-term outcomes of survivors of ARDS, such as health-related quality of life or return to work, has increased during the past decades.[3][3]
Intensive care unit (ICU) patients have a high risk of developing complications when leaving the ICU for diagnostic procedures or therapeutic interventions. Our study examined the frequency of adverse events associated with magnetic resonance imaging (MRI) of intensive care patients and the extent of changes in therapy due to the MRI scan to weigh the risks associated with the scan against the potential benefits of an MR scan, using a change in therapy as an indicator of benefit.
Additional file 3: Excel File. Table 6. Linear Regression Analyses of Health-related Quality of Life after 3 months on Quality of Care. a adjusted for age, sex, severity of ARDS; b adjusted for age, sex, severity of ARDS, BMI, Education score, SAPS-II score, SOFA score, diagnosis of ARDS (participating vs. other ICU), self-reported physician-diagnosed mental disorder before ARDS diagnosis Notes: ARDS = acute respiratory distress syndrome; MCS-12 = mental component scale of short-form 12 questionnaire; PCS-12 = physical component scale of short-form 12 questionnaire.
Health services research (HSR) is of fundamental importance for the continuous improvement of preventive, diagnostic or therapeutic measures. The conduct of multi-centre HSR studies requires that ethical approval by Institutional review boards (IRB's) is obtained. We documented the effort, the complexity and the man power necessary to obtain secondary ethical approval for a national HSR in Germany ("Surviving the Acute Respiratory Distress Syndrome" [DACAPO-study]).Having obtained a primary ethical approval by the IRB of Regensburg University, the time, correspondence, necessity for amendments, corrections, or additional costs by 34 IRB's for 64 participating study centers was documented.The complete obtainment was found to be time consuming and associated with a high workload and man power. A time span of seven month was needed to receive votes from all IRB's. The median time span was 25,5 days (25 %/75 % percentile 13 and 42 days, respectively). Requirements in terms of corrections or amendments were inhomogeneous and frequent changes were necessary. There were additional fees for secondary votes of 4328,40 €. Total costs for the study center Regensburg were 21.193,40 € (2,6 % of the grant volume).Obtaining all ethical approvals for a multi-centre observational HSR study in Germany is complex and time consuming. Various and inhomogeneous formalities may delay the plan and realization of HSR. A Homogenization and simplification of the procedure of ethics votes should be discussed.
Einleitung Überlebende eines akuten Lungenversagens (acute respiratory distress syndrome [ARDS]) leiden oft noch Jahre nach Verlegung von der Intensivstation (ITS) an den langfristigen Folgen ihrer Erkrankung, z. B. im Hinblick auf eine geminderte gesundheitsbezogene Lebensqualität (health related quality of life [HRQoL]).Zur Rolle der sozialen Unterstützung und des subjektiven sozialen Status (SSS) als mögliche protektive Faktoren ist bisher noch wenig bekannt. Ziel dieser Studie ist es, den Zusammenhang zwischen sozialer Unterstützung, SSS und HRQoL zu betrachten.
Background Social support (SS) may contribute to the long-term recovery of critical illness survivors. This study focuses on survivors of the acute respiratory distress syndrome (ARDS) to investigate the causal relationship between SS and health related quality of life (HRQoL) and healthcare utilization in critically ill patients. Methods A cohort study with N=877 ARDS survivors in 61 ICUs was conducted in Germany, between 2014 and 2019. SS (F-SozU K-14) and HRQoL (Physical and Mental Component Scale: PCS, MCS of the SF-12) were assessed at 3, 6, 12, and 24 months after ICU discharge. Healthcare utilization was assessed after 12 and 24 months. To identify confounders and allow for causal inferences, a directed acyclic graph (DAG) was developed. Results Adjusted regression models demonstrated significant positive impact of SS on mental HRQoL after three months onward (all ßs >0.15, all p s <0.05). This influence increases over time. In contrast, the influence of SS on physical HRQoL and healthcare utilization remained inconclusive (only one significant association for physical HRQoL at 12 months: β=0.128, p<0.05, otherwise all p s >0.05). Conclusion Results indicate SS plays an important and unique role in the long-term recovery of survivors of critical illness in the mental area. It appears that the more distal mechanism of SS unfolds progressively over time, perhaps as the immediate sequelae of critical illness after discharge subside. In contrast, SS does not appear to exert a substantial causal impact on physical HRQoL and healthcare utilization.
