Long-term follow-up of survivors of acute lung injury: Lack of effect of aventilation strategy to prevent barotrauma

Objectives: To determine the effect of a ventilation strategy to prevent ba rotrauma on long-term outcome in survivors of acute lung injury. Design: Prospective blinded cohort analysis. Setting: Three university-affiliated medical-surgical intensive care units. Patients: A total of 28 survivors of acute lung injury, 1-2 yrs after diagn osis, from a multicenter prospective randomized controlled trial comparing pressure (peak inflation pressure less than or equal to 30 cm H2O) and volu me (tidal volume less than or equal to 8 mL/kg) limited ventilation to a co nventional (peak inflation pressure less than or equal to 50 cm H2O, tidal volume 10-15 mL/kg) ventilation strategy. Measurements and Main Results: Physicians blinded as to treatment group eva luated 20 of 28 survivors (treatment group, 7; control group, 13), Exercise tolerance in the 6-minute walk test was comparable to patients with chroni c respiratory disease and equivalent between groups (treatment group, 373 /- 171 m vs, control group, 375 +/- 129 m; p = .84). Pulmonary function tes ting showed reduced diffusing capacity (treatment group, 64 +/- 29% predict ed vs, control group, 74 +/- 14% predicted; p = .68) and normal volumes, fl ows, and blood gases, Two domains of disease-specific Health Related Qualit y of Life assessed by the Chronic Respiratory Questionnaire were worse for patients in the treatment group compared with the control group (Emotional Function 3.8 +/- 1.4 vs. 5.1 +/- 0.08; p = .05, Mastery 4.7 +/- 1.7 vs. 6.2 +/- 0.8; p = .03). There were no between-group differences in the scores o f the Spitzer Quality of Life Index (a generic Health Related Quality of Li fe instrument), although they were reduced (7.5 +/- 1.9) and comparable to patients with chronic disease. Conclusions: We found that 1-2 yrs after the onset of their illness, surviv ors of acute lung injury have reductions in quality of life and exercise to lerance which are similar to patients with chronic diseases. We were unable to show that a limited ventilation strategy improves either long-term pulm onary function or quality of life in survivors of acute lung injury.