Background
Acute respiratory syndrome (ARDS) is characterised by respiratory failure with either a direct pulmonary (e.g. pneumonia) or extra-pulmonary cause (e.g. sepsis) that requires treatment in intensive care including mechanical ventilation [
1]. Approximately 10% of all patients admitted to the ICU develop ARDS [
2]. This represents a considerable amount of patients. Further, cost associated with ARDS are very high. For instance, a study from the UK estimated mean societal cost over 1 year including initial ICU treatment cost at £ 44.077 [
3]. A US study estimated the median cost due to hospitalization post-discharge at $ 18.756 [
4].
With mortality estimated up to 45%, the focus of ARDS research has been on mortality for a long time. With decreasing mortality rates [
5] however, the interest in long-term outcomes such as mental health, return to work (RtW) and health-related quality of life (HRQoL) of ARDS patients increased [
6‐
10].
A multi-centre national study in the U.S. showed that nearly half of previously employed ARDS survivors were jobless at 12 months after ARDS and that this was accompanied by substantial lost earnings [
11]. If one aims at improving long-term outcome for these patients, it is important to shed light on possible determinants of outcomes such as HRQoL and RtW. We performed a systematic literature review [
12] summarising the existing evidence regarding the determinants of HRQoL or RtW in ARDS patients, including 24 highly heterogeneous observational studies. One of the main findings was that the core focus of published research was on clinical and care-related determinants (performance in pulmonary function testing, duration of ICU treatment etc.) which mainly showed small, non-significant effects on HRQoL and RtW. Despite the evident role of the care provided to patients with ARDS in the ICU, surprisingly, the role of quality of care (QoC) for long-term HRQoL and RtW has not been investigated thus far while ARDS mortality has been investigated in relation to university level of care [
13].
Against this background, the hypothesis underlying the study presented in this paper was that better QoC (defined by quality indicators) received during the acute ICU stay was associated with better HRQoL and a higher rate of RtW in survivors of ARDS. Thus, our aim was to identify QoC indicators predictive of HRQoL and RtW.
Acknowledgements
We are indebted to all the intensive care specialists and study nurses throughout Germany, who, with great commitment, recruited patients for the DACAPO study:
Johannes Bickenbach, Thorben Beeker, Tobias Schürholz, Jessica Pezechk (Aachen); Jens Schloer (Amberg); Ulrich Jaschinski, Ilse Kummer (Augsburg); Oliver Kuckein (Bamberg); Steffen Weber-Carstens, Anton Goldmann, Stefan Angermair, Krista Stoycheva, Jörg Brederlau, Nadja Rieckehr, Gabriele Schreiber, Henriette Haennicke (Berlin); Friedhelm Bach, Immo Gummelt, Silke Haas, Catharina Middeke, Ina Vedder, Marion Klaproth (Bielefeld); Michael Adamzik, Jan Karlik, Stefan Martini, Luisa Robitzky (Bochum); Christian Putensen, Thomas Muders, Ute Lohmer (Bonn); Rolf Dembinski (Bremen); Petra Schäffner, Petra Wulff-Werner (Deggendorf); Elke Landsiedel-Mechenbier, Daniela Nickoleit-Bitzenberger, Ann-Kathrin Silber (Dortmund); Maximilian Ragaller, Marcello Gama de Abreu, Alin Ulbricht, Linda Reisbach (Dresden); Kai Zacharowski, Patrick Meybohm, Simone Lindau, Haitham Mutlak (Frankfurt am Main); Alexander Hötzel, Johannes Kalbhenn (Freiburg); Christoph Metz, Stefan Haschka (Freising); Stefan Rauch (Göppingen); Michael Quintel, Lars-Olav Harnisch, Sophie Baumann, Andrea Kernchen (Göttingen); Sigrun Friesecke, Sebastian Maletzki (Greifswald); Stefan Kluge, Olaf Boenisch, Daniel Frings, Birgit Füllekrug, Nils Jahn, Knut Kampe, Grit Ringeis, Brigitte Singer, Robin Wüstenberg (Hamburg); Jörg Ahrens, Heiner Ruschulte, Andre Gerdes, Matthias Groß, Olaf Wiesner, Aleksandra Bayat-Graw (Hannover); Thorsten Brenner, Felix Schmitt, Anna Lipinski (Heidelberg); Dietrich Henzler, Klaas Eickmeyer, Juliane Krebs, Iris Rodenberg (Herford); Heinrich Groesdonk, Kathrin Meiers, Karen Salm, Thomas Volk (Homburg); Stefan Fischer, Basam Redwan (Ibbenbüren); Martin Schmölz, Kathrin Schumann-Stoiber, Simone Eberl (Immenstadt); Gunther Lenz, Thomas von Wernitz-Keibel, Monika Zackel (Ingolstadt); Frank Bloos, Petra Bloos, Anke Braune, Anja Haucke, Almut Noack, Steffi Kolanos, Heike Kuhnsch, Karina Knuhr-Kohlberg (Jena); Markus Gehling (Kassel); Mathias Haller, Anne Sturm, Jannik Rossenbach (Kempten); Dirk Schädler, Stefanie D’Aria (Kiel); Christian Karagiannidis, Stephan Straßmann, Wolfram Windisch, Thorsten Annecke, Holger Herff (Köln); Michael Schütz (Langen); Sven Bercker, Hannah Reising, Mandy Dathe, Christian Schlegel (Leipzig); Katrin Lichy (Ludwigsburg); Wolfgang Zink, Jana Kötteritzsch (Ludwigshafen); Marc Bodenstein, Susanne Mauff, Peter Straub (Mainz); Christof Strang, Florian Prätsch, Thomas Hachenberg (Magdeburg); Thomas Kirschning, Thomas Friedrich, Dennis Mangold (Mannheim); Christian Arndt, Tilo Koch (Marburg); Hendrik Haake, Katrin Offermanns (Mönchengladbach); Patrick Friederich, Florian Bingold, Michael Irlbeck, Bernhard Zwissler, Ines Kaufmann, Ralph Bogdanski, Barbara Kapfer, Markus Heim, Günther Edenharter (München); Björn Ellger, Daniela Bause (Münster); Götz Gerresheim (Neumarkt i.d.OPf); Dorothea Muschner, Michael Christ, Arnim Geise (Nürnberg); Martin Beiderlinden, Thorsten Heuter (Osnabrück); Alexander Wipfel (Passau); Werner Kargl, Marion Harth, Christian Englmeier, Thomas Bein, Sebastian Blecha, Dr. Kathrin Thomann-Hackner, Marius Zeder (Regensburg); Markus Stephan (Stuttgart); Martin Glaser (Traunstein); Helene Häberle (Tübingen); Hendrik Bracht, Christian Heer, Theresa Mast (Ulm); Markus Kredel, Ralf Müllenbach (Würzburg).
Further, we are grateful to previous members of the Regensburg DACAPO study team (medical documentation: Phillip Sebök, study physician: Kathrin Thomann-Hackner), to the members of the Advisory Board of the DACAPO-Study (Julika Loss, Bernhard Graf, Michael Leitzmann, Michael Pfeifer all Regensburg) and to our student assistants (Simon Bein, Vreni Brunnthaler, Carina Forster, Stefanie Hertling, Sophie Höhne, Carolin Schimmele, Elisa Valletta, Philipp Drewitz and Chiara Eberle). We are grateful to Arthur Slutsky, Toronto, for critically reviewing the intellectual content of an earlier version of this manuscript. Medical writing support was sought from topcorrect, Germany.
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