Intensive Care Medicine

, Volume 32, Issue 8, pp 1115–1124 | Cite as

Quality of life after acute respiratory distress syndrome: a meta-analysis

  • David W. Dowdy
  • Mark P. Eid
  • Cheryl R. Dennison
  • Pedro A. Mendez-Tellez
  • Margaret S. Herridge
  • Eliseo Guallar
  • Peter J. Pronovost
  • Dale M. NeedhamEmail author
Systematic Review



To summarize long-term quality of life (QOL) and the degree of variation in QOL estimates across studies of acute respiratory distress (ARDS) survivors.


A systematic review of studies evaluating QOL in ARDS survivors was conducted. Medline, EMBASE, CINAHL, pre-CINAHL, and the Cochrane Library were searched, and reference lists from relevant articles were evaluated. Two authors independently selected studies reporting QOL in adult survivors of ARDS or acute lung injury at least 30 days after intensive care unit discharge and extracted data on study design, patient characteristics, methods, and results.

Measurements and results

Thirteen independent observational studies (557 patients) met inclusion criteria. Eight of these studies used eight different QOL instruments, allowing only qualitative synthesis of results. The five remaining studies (330 patients) measured QOL using the Medical Outcomes Study 36-Item Short Form survey (SF-36). Mean QOL scores were similar across these studies, falling within a range of 20 points for all domains. Pooled domain-specific QOL scores in ARDS survivors 6 months or later after discharge ranged from 45 (role physical) to 66 (social functioning), or 15–26 points lower than population norms, in all domains except mental health (11 points) and role physical (39 points). Corresponding confidence intervals were no wider than ± 9 points. Six studies all found stable or improved QOL over time, but only one found significant improvement beyond 6 months after discharge.


ARDS survivors in different clinical settings experience similar decrements in QOL. The precise magnitude of these decrements helps clarify the long-term prognosis for ARDS survivors.


Respiratory distress syndrome, adult Quality of life Critical illness Intensive care units Critical care Outcome assessment (health care) 



We thank Ramona Hopkins, PhD, and Gustav Schelling, MD, for providing data for use in this review.


  1. 1.
    Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824PubMedGoogle Scholar
  2. 2.
    Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD (2005) Incidence and outcomes of acute lung injury. N Engl J Med 353:1685–1693PubMedCrossRefGoogle Scholar
  3. 3.
    Bersten AD, Edibam C, Hunt T, Moran J (2002) Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian States. Am J Respir Crit Care Med 165:443–448PubMedGoogle Scholar
  4. 4.
    Milberg JA, Davis DR, Steinberg KP, Hudson LD (1995) Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983–1993. JAMA 273:306–309PubMedCrossRefGoogle Scholar
  5. 5.
    Abel SJ, Finney SJ, Brett SJ, Keogh BF, Morgan CJ, Evans TW (1998) Reduced mortality in association with the acute respiratory distress syndrome (ARDS). Thorax 53:292–294PubMedCrossRefGoogle Scholar
  6. 6.
    Carone M, Donner CF (2005) Impact of long-term ventilation on patients' health status. Chronic Respir Dis 2:29–33CrossRefGoogle Scholar
  7. 7.
    Angus DC, Carlet J (2003) Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med 29:368–377PubMedGoogle Scholar
  8. 8.
    Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, Needham DM (2005) Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med 31:611–620PubMedCrossRefGoogle Scholar
  9. 9.
    Needham DM, Dowdy DW, Mendez-Tellez PA, Herridge MS, Pronovost PJ (2005) Studying outcomes of intensive care unit survivors: measuring exposures and outcomes. Intensive Care Med 31:1153–1160PubMedCrossRefGoogle Scholar
  10. 10.
    Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:683–693PubMedCrossRefGoogle Scholar
  11. 11.
    Esteban A, Fernandez-Segoviano P, Frutos-Vivar F, Aramburu JA, Najera L, Ferguson ND, Alia I, Gordo F, Rios F (2004) Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings. Ann Intern Med 141:440–445PubMedGoogle Scholar
  12. 12.
    Fan E, Needham DM, Stewart TE (2005) Ventilatory management of acute lung injury and acute respiratory distress syndrome. JAMA 294:2889–2896PubMedCrossRefGoogle Scholar
  13. 13.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  14. 14.
    Parizkova R, Cerny V, Dostal P, Vasatko L, Hora P, Herold I, Novak I, Nalos D (2001) Monitoring quality of life in critically ill patients: a multicenter study. Anesteziol Neodkladna Pece 12:240–251Google Scholar
  15. 15.
    Davidson TA, Caldwell ES, Curtis JR, Hudson LD, Steinberg KP (1999) Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA 281:354–360PubMedCrossRefGoogle Scholar
  16. 16.
    Hayes JA, Black NA, Jenkinson C, Young D, Rowan KM, Daly K, Ridley S (2000) Outcome measures for adult critical care: a systematic review. Health Technol Assess 4:1–111PubMedGoogle Scholar
  17. 17.
    Hamel MB, Phillips RS, Davis RB, Teno J, Connors AF, Desbiens N, Lynn J, Dawson NV, Fulkerson W, Tsevat J (2000) Outcomes and cost-effectiveness of ventilator support and aggressive care for patients with acute respiratory failure due to pneumonia or acute respiratory distress syndrome. Am J Med 109:614–620PubMedCrossRefGoogle Scholar
  18. 18.
    Berlin J (1996) A. Randomized trial comparing masked/unmasked meta-analyses. AHCPR-97–20. Agency for Health Care Policy and Research, RockvilleGoogle Scholar
  19. 19.
    Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, Atkins D; Methods Work Group, Third US Preventive Services Task Force (2001) Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med 20:21–35PubMedCrossRefGoogle Scholar
  20. 20.
    Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012PubMedCrossRefGoogle Scholar
  21. 21.
    Berlin JA, Laird NM, Sacks HS, Chalmers TC (1989) A comparison of statistical methods for combining event rates from clinical trials. Stat Med 8:141–151PubMedCrossRefGoogle Scholar
  22. 22.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRefGoogle Scholar
  23. 23.
    Hopkins RO, Weaver LK, Collingridge D, Parkinson RB, Chan KJ, Orme JF (2005) Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med 171:340–347PubMedCrossRefGoogle Scholar
  24. 24.
    Schelling G, Stoll C, Vogelmeier C, Hummel T, Behr J, Kapfhammer HP, Rothenhausler HB, Haller M, Durst K, Krauseneck T, Briegel J (2000) Pulmonary function and health-related quality of life in a sample of long-term survivors of the acute respiratory distress syndrome. Intensive Care Med 26:1304–1311PubMedCrossRefGoogle Scholar
  25. 25.
    Weinert CR, Gross CR, Kangas JR, Bury CL, Marinelli WA (1997) Health-related quality of life after acute lung injury. Am J Respir Crit Care Med 156:1120–1128PubMedGoogle Scholar
  26. 26.
    Kim SJ, Oh BJ, Lee JS, Lim CM, Shim TS, Lee SD, Kim WS, Kim DS, Kim WD, Koh Y (2004) Recovery from lung injury in survivors of acute respiratory distress syndrome: difference between pulmonary and extrapulmonary subtypes. Intensive Care Med 30:1960–1963PubMedCrossRefGoogle Scholar
  27. 27.
    Cooper AB, Ferguson ND, Hanly PJ, Meade MO, Kachura JR, Granton JT, Slutsky AS, Stewart TE (1999) Long-term follow-up of survivors of acute lung injury: lack of effect of a ventilation strategy to prevent barotrauma. Crit Care Med 27:2616–2621PubMedCrossRefGoogle Scholar
  28. 28.
    Chatila W, Kreimer DT, Criner GJ (2001) Quality of life in survivors of prolonged mechanical ventilatory support. Crit Care Med 29:737–742PubMedCrossRefGoogle Scholar
  29. 29.
    McHugh LG, Milberg JA, Whitcomb ME, Schoene RB, Maunder RJ, Hudson LD (1994) Recovery of function in survivors of the acute respiratory distress syndrome. Am J Respir Crit Care Med 150:90–94PubMedGoogle Scholar
  30. 30.
    Combes A, Costa MA, Trouillet JL, Baudot J, Mokhtari M, Gibert C, Chastre J (2003) Morbidity, mortality, and quality-of-life outcomes of patients requiring > or  =  14 days of mechanical ventilation. Crit Care Med 31:1373–1381PubMedCrossRefGoogle Scholar
  31. 31.
    Granja C, Morujao E, Costa-Pereira A (2003) Quality of life in acute respiratory distress syndrome survivors may be no worst than in other ICU survivors. Intensive Care Med 29:1744–1750PubMedCrossRefGoogle Scholar
  32. 32.
    Ortiz CD, Jam Gatell MR (2003) Long term of quality of life and mortality in acute respiratory distress syndrome (ARDS) patients. Enferm Intensiva 14:88–95Google Scholar
  33. 33.
    Angus DC, Musthafa AA, Clermont G, Griffin MF, Linde-Zwirble WT, Dremsizov TT, Pinsky MR (2001) Quality-adjusted survival in the first year after the acute respiratory distress syndrome. Am J Respir Crit Care Med 163:1389–1394PubMedGoogle Scholar
  34. 34.
    Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson-Lohr V (1999) Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 160:50–56PubMedGoogle Scholar
  35. 35.
    Hopkins RO, Weaver LK, Chan KJ, Orme J (2004) Quality of life, emotional, and cognitive function following acute respiratory distress syndrome. J Int Neuropsychol Soc 10:1005–1017PubMedGoogle Scholar
  36. 36.
    Kapfhammer HP, Rothenhausler HB, Krauseneck T, Stoll C, Schelling G (2004) Posttraumatic stress disorder and health-related quality of life in long-term survivors of acute respiratory distress syndrome. Am J Psychiatry 161:45–52PubMedCrossRefGoogle Scholar
  37. 37.
    Orme J Jr, Romney JS, Hopkins RO, Pope D, Chan KJ, Thomsen G, Crapo RO, Weaver LK (2003) Pulmonary function and health-related quality of life in survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med 167:690–694PubMedCrossRefGoogle Scholar
  38. 38.
    Rothenhausler HB, Ehrentraut S, Stoll C, Schelling G, Kapfhammer HP (2001) The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: results of an exploratory study. Gen Hosp Psychiatry 23:90–96PubMedCrossRefGoogle Scholar
  39. 39.
    Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, Lenhart A, Heyduck M, Polasek J, Meier M, Preuss U, Bullinger M, Schuffel W, Peter K (1998) Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 26:651–659PubMedCrossRefGoogle Scholar
  40. 40.
    Stoll C, Haller M, Briegel J, Meier M, Manert W, Hummel T, Heyduck M, Lenhart A, Polasek J, Bullinger M, Schelling G (1998) Health-related quality of life. Long-term survival in patients with ARDS following extracorporeal membrane oxygenation (ECMO). Anaesthesist 47:24–29PubMedCrossRefGoogle Scholar
  41. 41.
    Stoll C, Rothenhausler HB, Kapfhammer HP, Schelling G (2000) Pulmonary function, quality of life, psychosocial and cognitive function after ARDS. J Anasth Intensivbehandl 7:212–215Google Scholar
  42. 42.
    Wehler M, Geise A, Hadzionerovic D, Aljukic E, Reulbach U, Hahn EG, Strauss R (2003) Health-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population. Crit Care Med 31:1094–1101PubMedCrossRefGoogle Scholar
  43. 43.
    Ridley SA, Chrispin PS, Scotton H, Rogers J, Lloyd D (1997) Changes in quality of life after intensive care: comparison with normal data. Anaesthesia 52:195–202PubMedCrossRefGoogle Scholar
  44. 44.
    Graf J, Koch M, Dujardin R, Kersten A, Janssens U (2003) Health-related quality of life before, 1 month after, and 9 months after intensive care in medical cardiovascular and pulmonary patients. Crit Care Med 31:2163–2169PubMedCrossRefGoogle Scholar
  45. 45.
    Herridge MS, Angus DC (2005) Acute lung injury—affecting many lives. N Engl J Med 353:1736–1738PubMedCrossRefGoogle Scholar
  46. 46.
    Pettila V, Kaarlola A, Makelainen A (2000) Health-related quality of life of multiple organ dysfunction patients one year after intensive care. Intensive Care Med 26:1473–1479PubMedCrossRefGoogle Scholar
  47. 47.
    Chrispin PS, Scotton H, Rogers J, Lloyd D, Ridley SA (1997) Short Form 36 in the intensive care unit: assessment of acceptability, reliability and validity of the questionnaire. Anaesthesia 52:15–23PubMedCrossRefGoogle Scholar
  48. 48.
    EuroQol Group (1990) EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 16:199–208CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • David W. Dowdy
    • 1
    • 2
  • Mark P. Eid
    • 2
  • Cheryl R. Dennison
    • 3
  • Pedro A. Mendez-Tellez
    • 4
  • Margaret S. Herridge
    • 5
  • Eliseo Guallar
    • 1
  • Peter J. Pronovost
    • 3
    • 4
    • 6
    • 7
  • Dale M. Needham
    • 8
    Email author
  1. 1.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.School of MedicineJohns Hopkins UniversityBaltimoreUSA
  3. 3.School of NursingJohns Hopkins UniversityBaltimoreUSA
  4. 4.Department of Anesthesiology/Critical Care MedicineJohns Hopkins UniversityBaltimoreUSA
  5. 5.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  6. 6.Department of SurgeryJohns Hopkins UniversityBaltimoreUSA
  7. 7.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  8. 8.Division of Pulmonary/Critical Care MedicineJohns Hopkins UniversityBaltimoreUSA

Personalised recommendations