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Das Leben nach ARDS

Life after ARDS

  • Leitthema
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Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Nach einem überlebten „acute respiratory distress syndrome“ (ARDS) leiden Patienten oftmals unter physischen und psychischen Langzeitfolgen. Dabei ist die Lungenfunktion der Überlebenden oft normal oder nur gering eingeschränkt, es besteht jedoch häufig eine Einschränkung der körperlichen Aktivität und Gehstrecke. Am auffälligsten ist jedoch die Vielzahl an depressiven Episoden, Angststörungen oder posttraumatischen Belastungsstörungen. Die Rate an kognitiven Störungen bei ARDS-Überlebenden beträgt 70–100 % bei Krankenhausentlassung, 46–80 % nach 1 Jahr und 20 % nach 5 Jahren, die Möglichkeit der Wiederaufnahme beruflicher Aktivität ist deutlich eingeschränkt. Aufgrund der vielfältigen Folgen müssen präventive Strategien entwickelt werden, um die hohe Prävalenz von persistierender körperlicher und psychischer Morbidität zu reduzieren. Neben einer konsequenten Prophylaxe und Therapie eines Delirs zeigen sich günstige Effekte für eine frühe und konsequente Mobilisierung und das Führen von Intensivtagebüchern.

Abstract

Patients who survive acute respiratory distress syndrome (ARDS) often suffer from long-term physical and psychological sequelae. Lung function is commonly only mildly reduced, whereas general physical activity and walking distance are often compromised. Most markedly, these patients have a high incidence of depression, anxiety, and posttraumatic stress disorder. The rate of cognitive dysfunction is as high as 70–100% at the time of hospital discharge, and remains 46–80% and 20% one year and five years post discharge, respectively. The possibility of returning to work is markedly limited. Because of these outcomes, preventative strategies must be identified to reduce the high prevalence of physical and psychological morbidity. Prevention and treatment of delirium as well as early and consequent mobilization and intensive care unit diaries are potentially beneficial.

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Literatur

  1. Baron R, Binder A, Biniek R, Braune S, Buerkle H, Dall P, Demirakca S, Eckardt R, Eggers V, Eichler I, Fietze I, Freys S, Frund A, Garten L, Gohrbandt B, Harth I, Hartl W, Heppner HJ, Horter J, Huth R, Janssens U, Jungk C, Kaeuper KM, Kessler P, Kleinschmidt S, Kochanek M, Kumpf M, Meiser A, Mueller A, Orth M, Putensen C, Roth B, Schaefer M, Schaefers R, Schellongowski P, Schindler M, Schmitt R, Scholz J, Schroeder S, Schwarzmann G, Spies C, Stingele R, Tonner P, Trieschmann U, Tryba M, Wappler F, Waydhas C, Weiss B, Weisshaar G (2015) Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version. Ger Med Sci 13:Doc19

    PubMed  PubMed Central  Google Scholar 

  2. Bein T, Bischoff M, Bruckner U, Gebhardt K, Henzler D, Hermes C, Lewandowski K, Max M, Nothacker M, Staudinger T, Tryba M, Weber-Carstens S, Wrigge H (2015) S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders : Revision 2015: S2e guideline of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI). Anaesthesist 64(Suppl 1):1–26

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, Ranieri M, Rubenfeld G, Thompson BT, Wrigge H, Slutsky AS, Pesenti A (2016) Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 315:788–800

    Article  CAS  PubMed  Google Scholar 

  4. Bienvenu OJ, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Shanholtz C, Husain N, Dennison CR, Herridge MS, Pronovost PJ, Needham DM (2012) Depressive symptoms and impaired physical function after acute lung injury: a 2-year longitudinal study. Am J Respir Crit Care Med 185:517–524

    Article  PubMed  PubMed Central  Google Scholar 

  5. Braune S, Kluge S (2013) ARDS – an update. Dtsch Med Wochenschr 138:1019–1022

    Article  CAS  PubMed  Google Scholar 

  6. Braune S, Sieweke A, Jarczak D, Kluge S (2017) Extracorporeal lung support. Med Klin Intensivmed Notfmed 112:426–436

    Article  CAS  PubMed  Google Scholar 

  7. Cameron JI, Chu LM, Matte A, Tomlinson G, Chan L, Thomas C, Friedrich JO, Mehta S, Lamontagne F, Levasseur M, Ferguson ND, Adhikari NK, Rudkowski JC, Meggison H, Skrobik Y, Flannery J, Bayley M, Batt J, dos Santos C, Abbey SE, Tan A, Lo V, Mathur S, Parotto M, Morris D, Flockhart L, Fan E, Lee CM, Wilcox ME, Ayas N, Choong K, Fowler R, Scales DC, Sinuff T, Cuthbertson BH, Rose L, Robles P, Burns S, Cypel M, Singer L, Chaparro C, Chow CW, Keshavjee S, Brochard L, Hebert P, Slutsky AS, Marshall JC, Cook D, Herridge MS (2016) One-year outcomes in caregivers of critically ill patients. N Engl J Med 374:1831–1841

    Article  CAS  PubMed  Google Scholar 

  8. Chan KS, Aronson Friedman L, Dinglas VD, Hough CL, Shanholtz C, Ely EW, Morris PE, Mendez-Tellez PA, Jackson JC, Hopkins RO, Needham DM (2017) Are physical measures related to patient-centred outcomes in ARDS survivors? Thorax. https://doi.org/10.1136/thoraxjnl-2016-209400

    Google Scholar 

  9. Cox CE, Docherty SL, Brandon DH, Whaley C, Attix DK, Clay AS, Dore DV, Hough CL, White DB, Tulsky JA (2009) Surviving critical illness: acute respiratory distress syndrome as experienced by patients and their caregivers. Crit Care Med 37:2702–2708

    Article  PubMed  PubMed Central  Google Scholar 

  10. Desai SR, Wells AU, Rubens MB, Evans TW, Hansell DM (1999) Acute respiratory distress syndrome: CT abnormalities at long-term follow-up. Radiology 210:29–35

    Article  CAS  PubMed  Google Scholar 

  11. Dinglas VD, Aronson Friedman L, Colantuoni E, Mendez-Tellez PA, Shanholtz CB, Ciesla ND, Pronovost PJ, Needham DM (2017) Muscle weakness and 5‑year survival in acute respiratory distress syndrome survivors. Crit Care Med 45:446–453

    Article  PubMed  Google Scholar 

  12. Dodoo-Schittko F, Brandstetter S, Apfelbacher C, Bein T (2017) Folgen kritischer Erkrankung und mögliche Interventionen. Anasthesiol Intensivmed Notfallmed Schmerzther 52:137–144

    Article  PubMed  Google Scholar 

  13. Dodoo-Schittko F, Brandstetter S, Blecha S, Thomann-Hackner K, Brandl M, Knuttel H, Bein T, Apfelbacher C (2017) Determinants of quality of life and return to work following acute respiratory distress syndrome. Dtsch Arztebl Int 114:103–109

    PubMed  PubMed Central  Google Scholar 

  14. Dodoo-Schittko F, Brandstetter S, Brandl M, Blecha S, Quintel M, Weber-Carstens S, Kluge S, Meybohm P, Rolfes C, Ellger B, Bach F, Welte T, Muders T, Thomann-Hackner K, Bein T, Apfelbacher C (2017) Characteristics and provision of care of patients with the acute respiratory distress syndrome: descriptive findings from the DACAPO cohort baseline and comparison with international findings. J Thorac Dis 9:818–830

    Article  PubMed  PubMed Central  Google Scholar 

  15. Senger D, Erbguth, F (2017) Critical-illness-Myopathie und -Polyneuropathie. Medizinische Klinik – Intensivmedizin und Notfallmedizin. https://doi.org/10.1007/s00063-017-0339-0

  16. Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, Adhikari NKJ, Amato MBP, Branson R, Brower RG, Ferguson ND, Gajic O, Gattinoni L, Hess D, Mancebo J, Meade MO, McAuley DF, Pesenti A, Ranieri VM, Rubenfeld GD, Rubin E, Seckel M, Slutsky AS, Talmor D, Thompson BT, Wunsch H, Uleryk E, Brozek J, Brochard LJ (2017) An official American Thoracic Society/European society of intensive care medicine/society of critical care medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 195:1253–1263

    Article  PubMed  Google Scholar 

  17. Gibelin A, Parrot A, Maitre B, Brun-Buisson C, Mekontso Dessap A, Fartoukh M, de Prost N (2016) Acute respiratory distress syndrome mimickers lacking common risk factors of the Berlin definition. Intensive Care Med 42:164–172

    Article  CAS  PubMed  Google Scholar 

  18. Herridge MS, Moss M, Hough CL, Hopkins RO, Rice TW, Bienvenu OJ, Azoulay E (2016) Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Med 42:725–738

    Article  PubMed  Google Scholar 

  19. Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE, Kudlow P, Cook D, Slutsky AS, Cheung AM (2011) Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 364:1293–1304

    Article  CAS  PubMed  Google Scholar 

  20. Holzgraefe B, Andersson C, Kalzen H, von Bahr V, Mosskin M, Larsson EM, Palmer K, Frenckner B, Larsson A (2017) Does permissive hypoxaemia during extracorporeal membrane oxygenation cause long-term neurological impairment?: A study in patients with H1N1-induced severe respiratory failure. Eur J Anaesthesiol 34:98–103

    Article  CAS  PubMed  Google Scholar 

  21. Hopkins RO, Weaver LK, Collingridge D, Parkinson RB, Chan KJ, Orme JF Jr. (2005) Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med 171:340–347

    Article  PubMed  Google Scholar 

  22. Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson LV (1999) Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 160:50–56

    Article  CAS  PubMed  Google Scholar 

  23. Jones C, Backman C, Capuzzo M, Egerod I, Flaatten H, Granja C, Rylander C, Griffiths RD (2010) Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial. Crit Care 14:R168

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kamdar BB, Huang M, Dinglas VD, Colantuoni E, von Wachter TM, Hopkins RO, Needham DM (2017) Joblessness and lost earnings after ARDS in a 1-year national multicenter study. Am J Respir Crit Care Med. https://doi.org/10.1164/rccm.201611-2327OC

    PubMed  Google Scholar 

  25. Kress JP, Hall JB (2014) ICU-acquired weakness and recovery from critical illness. N Engl J Med 370:1626–1635

    Article  CAS  PubMed  Google Scholar 

  26. Mikkelsen ME, Christie JD, Lanken PN, Biester RC, Thompson BT, Bellamy SL, Localio AR, Demissie E, Hopkins RO, Angus DC (2012) The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med 185:1307–1315

    Article  PubMed  PubMed Central  Google Scholar 

  27. Needham DM, Dinglas VD, Morris PE, Jackson JC, Hough CL, Mendez-Tellez PA, Wozniak AW, Colantuoni E, Ely EW, Rice TW, Hopkins RO (2013) Physical and cognitive performance of patients with acute lung injury 1 year after initial trophic versus full enteral feeding. EDEN trial follow-up. Am J Respir Crit Care Med 188:567–576

    Article  PubMed  PubMed Central  Google Scholar 

  28. Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes CG, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese SK, Canonico A, Hopkins RO, Bernard GR, Dittus RS, Ely EW (2013) Long-term cognitive impairment after critical illness. N Engl J Med 369:1306–1316

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM (2015) Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med 43:1121–1129

    Article  PubMed  Google Scholar 

  30. Pfoh ER, Wozniak AW, Colantuoni E, Dinglas VD, Mendez-Tellez PA, Shanholtz C, Ciesla ND, Pronovost PJ, Needham DM (2016) Physical declines occurring after hospital discharge in ARDS survivors: a 5-year longitudinal study. Intensive Care Med 42:1557–1566

    Article  PubMed  Google Scholar 

  31. 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 353:1685–1693

    Article  CAS  PubMed  Google Scholar 

  32. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373:1874–1882

    Article  PubMed  Google Scholar 

  33. Turnbull AE, Rabiee A, Davis WE, Nasser MF, Venna VR, Lolitha R, Hopkins RO, Bienvenu OJ, Robinson KA, Needham DM (2016) Outcome measurement in ICU survivorship research from 1970 to 2013: a scoping review of 425 publications. Crit Care Med 44:1267–1277

    Article  PubMed  PubMed Central  Google Scholar 

  34. Villar J, Blanco J, Anon JM, Santos-Bouza A, Blanch L, Ambros A, Gandia F, Carriedo D, Mosteiro F, Basaldua S, Fernandez RL, Kacmarek RM (2011) The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation. Intensive Care Med 37:1932–1941

    Article  PubMed  Google Scholar 

  35. Wilcox ME, Patsios D, Murphy G, Kudlow P, Paul N, Tansey CM, Chu L, Matte A, Tomlinson G, Herridge MS (2013) Radiologic outcomes at 5 years after severe ARDS. Chest 143:920–926

    Article  PubMed  Google Scholar 

  36. Wolters AE, Slooter AJ, van der Kooi AW, van Dijk D (2013) Cognitive impairment after intensive care unit admission: a systematic review. Intensive Care Med 39:376–386

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    B. Sensen, S. Braune, G. de Heer &  S. Kluge

  2. IV. Medizinische Klinik – Internistische Intensivmedizin und Notaufnahme, St. Franziskus-Hospital Münster, Münster, Deutschland

    S. Braune

  3. Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland

    T. Bein

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Correspondence to S. Kluge.

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Interessenkonflikt

S. Braune hat Vortragshonorare von der Firma Novalung erhalten. T. Bein ist Mitglied im Advisory Board der Firma Novalung und hat zudem Vortragshonorare von der Firma Novalung erhalten. S. Kluge ist Mitglied im Advisory Board der Firmen Gambro und Novalung, er hat zudem Vortragshonorare von den Firmen Gambro, Novalung und Sorin erhalten. B. Sensen und G. de Heer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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U. Janssens, Eschweiler

M. Joannidis, Innsbruck

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Sensen, B., Braune, S., de Heer, G. et al. Das Leben nach ARDS. Med Klin Intensivmed Notfmed 112, 605–611 (2017). https://doi.org/10.1007/s00063-017-0350-5

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