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Number of patients receiving extracorporeal lung assist devices (ELAD) on each day. (DOC 26 kb)

Selected patient-specific parameters on day 1 and day 3. (DOC 49 kb)

Full model of multivariate Cox regression analysis on factors influencing hospital mortality. (DOC 37 kb)

Number of patients in prone position on each day. IQR: 1d-2d. (DOC 25 kb)

Introduction We investigated health-related quality of life (HRQoL) and persistent symptoms of post-traumatic stress disorder (PTSD) in long-term survivors of acute respiratory distress syndrome (ARDS). We wished to evaluate the influence of PTSD on HRQoL and to investigate the influence of perceived social support during intensive care unit (ICU) treatment on both PTSD symptoms and HRQoL. Methods In ARDS patients we prospectively measured HRQoL (Medical Outcomes Study 36-Item Short Form; SF-36), symptoms of PTSD (Post-Traumatic Stress Syndrome 10-Questions Inventory; PTSS-10), perceived social support (Questionnaire for Social Support; F-Sozu) and symptoms of psychopathology (Symptom Checklist-90-R); and collected sociodemographic data including current employment status. Sixty-five (50.4%) out of 129 enrolled survivors responded, on average 57 ± 32 months after discharge from ICU. Measuring symptoms of PTSD the PTSS-10 was used to divide the ARDS patients into two subgroups ('high-scoring patients', indicating patients with an increased risk for developing PTSD, and 'low-scoring patients'). Results HRQoL was significantly reduced in all dimensions in comparison with age- and gender-adjusted healthy controls. Eighteen patients (29%) were identified as being at increased risk for PTSD. PTSD risk was significantly linked with anxiety during their ICU stay. In this group of patients there was a trend towards permanent or temporary disability, independent of the period between discharge from ICU and study entry. Perceived social support was associated with a reduction in PTSD symptoms (Pearson correlation; p < 0.05). Post-hoc test revealed a significant difference between 'high-scoring patients' and 'low-scoring patients' with respect to mental health, although they did not differ in physical dimensions. Conclusion HRQoL was reduced in long-term survivors, and was linked with an increased risk of chronic PTSD with ensuing psychological morbidity. This was independent of physical condition and was associated with traumatic memories of anxiety during their ICU stay. Social support might improve mental health and consequently long-term outcome including employment status.