Clinical, Functional Outcomes and Quality of Life in Children Surviving ARDS

Abstract

Purpose: Patients with ARDS cause a significant morbidity & mortality. However, little is known about the long term outcomes of Pediatric ARDS. Thus, we decided to evaluate the clinical, functional outcomes and quality of life in survivors of Pediatric ARDS. Methods: Infants and children (aged 1 month - 15 years) with diagnosis of ARDS. who were discharged from PICU at King Chulalongkorn Memorial hospital from July, 2006 -December, 2007 were studied. They were followed at 6, 12, 18 months and 24 month after discharged. Their clinical & functional outcomes and quality of life (PedsQL TM) were compared with age, sex matched controlled children. Results 794 patients were admitted to PICU during studied period, there were 26 patients diagnosed with ARDS. Of 13 (13/26, 50%) survivors, 12 (11/13, 84.6%) were eligible for the study. The median age was 2.3 years. Most common causes were severe pneumonia and sepsis. The median of initial PaO2/FiO2 was at 106 mHg. The median duration of mechanical ventilator & PICU stay & hospital stay was 18, 19 & 40 days, respectively. All patients reported poor physical function, muscle weakness and fatique at the time of discharged. They returned to their normal growth velocity at 12 months follow-up. 3 cases (3/12, 25%) developed CLD and required supplement oxygen at discharged and one remain on oxygen at 1 year follow-up. Six-minute walk test demonstrated increasing in distance from a median of 338.5 m at 18 months to 430 m at 24 months. Although the six-minute walking distance was lower compared to normal controlled but no statistically significant. Conclusions: Survivors of Pediatric ARDS continue to have functional impairment and compromised health-related quality of life. However, it tended to improve overtime at 1 & 2 year follow-up. Clinical Implications: Pediatric ARDS cause significant functional impairment and reduction in quality of life. Clinicians, health-related personnel and caregivers should be awared of the long-term outcomes and find the way to improve.