• Bhakti K Patel, Krysta S Wolfe, Erica L MacKenzie, Dhafer Salem, Cheryl L Esbrook, Amy J Pawlik, Megan Stulberg, Crystal Kemple, Megan Teele, Erin Zeleny, Julia Macleod, Anne S Pohlman, Jesse B Hall, and John P Kress.
• Department of Medicine, Section of Pulmonary/Critical Care, University of Chicago, Chicago, IL.
• Crit. Care Med. 2018 Jul 1; 46 (7): 1078-1084.

ObjectivesMany survivors of acute respiratory distress syndrome have poor long-term outcomes possibly due to supportive care practices during "invasive" mechanical ventilation. Helmet noninvasive ventilation in acute respiratory distress syndrome may reduce intubation rates; however, it is unknown if avoiding intubation with helmet noninvasive ventilation alters the consequences of surviving acute respiratory distress syndrome.DesignLong-term follow-up data from a previously published randomized controlled trial.PatientsAdults patients with acute respiratory distress syndrome enrolled in a previously published clinical trial.SettingAdult ICU.InterventionNone.Measurements And Main ResultsThe primary outcome was functional independence at 1 year after hospital discharge defined as independence in activities of daily living and ambulation. At 1 year, patients were surveyed to assess for functional independence, survival, and number of institution-free days, defined as days alive spent living at home. The presence of ICU-acquired weakness and functional independence was also assessed by a blinded therapist on hospital discharge. On hospital discharge, there was a greater prevalence of ICU-acquired weakness (79.5% vs 38.6%; p = 0.0002) and less functional independence (15.4% vs 50%; p = 0.001) in the facemask group. One-year follow-up data were collected for 81 of 83 patients (97.6%). One-year mortality was higher in the facemask group (69.2% vs 43.2%; p = 0.017). At 1 year, patients in the helmet group were more likely to be functionally independent (40.9% vs 15.4%; p = 0.015) and had more institution-free days (median, 268.5 [0-354] vs 0 [0-323]; p = 0.017).ConclusionsPoor functional recovery after invasive mechanical ventilation for acute respiratory distress syndrome is common. Helmet noninvasive ventilation may be the first intervention that mitigates the long-term complications that plague survivors of acute respiratory distress syndrome managed with noninvasive ventilation.

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