OBJECTIVE: To determine the costs and long-term outcomes of acute respiratory distress syndrome (ARDS) in previously healthy adults. To determine whether treatment with inhaled nitric oxide affects these costs and outcomes. DESIGN: One-year follow-up of a randomized trial of inhaled nitric oxide. Hospital bills were collected, and follow-up was performed at hospital discharge, 6 months, and 1 year. SETTING: Forty-six U.S. centers. PATIENTS: Three hundred and eighty-five previously healthy adults with ARDS. INTERVENTIONS: Subjects were randomized to 5 ppm inhaled nitric oxide or placebo gas. MEASUREMENTS AND MAIN RESULTS: One-year survival was 67.8%, with no difference by treatment arm (67.3% vs. 68.3% for inhaled nitric oxide vs. placebo, p = .71). Hospital costs from enrollment to discharge were high and similar in the inhaled nitric oxide and placebo arms ($48,500 vs. $47,800, p = 0.8). There were also no differences in length of stay or Therapeutic Intervention Scoring System points. Almost half (43.4%) of subjects were discharged to another healthcare facility or to home with professional help, and 24.1% were readmitted in 6 months, with no differences between groups. At 1 year, survivors reported low quality of life with no differences by treatment arm (Quality of Well-Being score [range 0-1], 0.61 vs. 0.64 for inhaled nitric oxide vs. placebo, p = .11) and poor function with no differences by treatment arm (32.5% returned to </=5 points of baseline Activities of Daily Living [range 0-100], 63.3% returned to </=10 points, and the remaining 36.7% suffered a mean decrement of 27 points). CONCLUSIONS:ARDS, even in previously healthy adults, not only is followed by poor survival, quality of life, and function but also is associated with high costs of care and postdischarge resource use. Inhaled nitric oxide at 5 ppm had no effect on these outcomes.
RCT Entities:
OBJECTIVE: To determine the costs and long-term outcomes of acute respiratory distress syndrome (ARDS) in previously healthy adults. To determine whether treatment with inhaled nitric oxide affects these costs and outcomes. DESIGN: One-year follow-up of a randomized trial of inhaled nitric oxide. Hospital bills were collected, and follow-up was performed at hospital discharge, 6 months, and 1 year. SETTING: Forty-six U.S. centers. PATIENTS: Three hundred and eighty-five previously healthy adults with ARDS. INTERVENTIONS: Subjects were randomized to 5 ppm inhaled nitric oxide or placebo gas. MEASUREMENTS AND MAIN RESULTS: One-year survival was 67.8%, with no difference by treatment arm (67.3% vs. 68.3% for inhaled nitric oxide vs. placebo, p = .71). Hospital costs from enrollment to discharge were high and similar in the inhaled nitric oxide and placebo arms ($48,500 vs. $47,800, p = 0.8). There were also no differences in length of stay or Therapeutic Intervention Scoring System points. Almost half (43.4%) of subjects were discharged to another healthcare facility or to home with professional help, and 24.1% were readmitted in 6 months, with no differences between groups. At 1 year, survivors reported low quality of life with no differences by treatment arm (Quality of Well-Being score [range 0-1], 0.61 vs. 0.64 for inhaled nitric oxide vs. placebo, p = .11) and poor function with no differences by treatment arm (32.5% returned to </=5 points of baseline Activities of Daily Living [range 0-100], 63.3% returned to </=10 points, and the remaining 36.7% suffered a mean decrement of 27 points). CONCLUSIONS: ARDS, even in previously healthy adults, not only is followed by poor survival, quality of life, and function but also is associated with high costs of care and postdischarge resource use. Inhaled nitric oxide at 5 ppm had no effect on these outcomes.
Authors: Djillali Annane; Stephen M Pastores; Bram Rochwerg; Wiebke Arlt; Robert A Balk; Albertus Beishuizen; Josef Briegel; Joseph Carcillo; Mirjam Christ-Crain; Mark S Cooper; Paul E Marik; Gianfranco Umberto Meduri; Keith M Olsen; Sophia Rodgers; James A Russell; Greet Van den Berghe Journal: Intensive Care Med Date: 2017-09-21 Impact factor: 17.440
Authors: Oscar E Simonson; Dimitrios Mougiakakos; Nina Heldring; Giulio Bassi; Henrik J Johansson; Magnus Dalén; Regina Jitschin; Sergey Rodin; Matthias Corbascio; Samir El Andaloussi; Oscar P B Wiklander; Joel Z Nordin; Johan Skog; Charlotte Romain; Tina Koestler; Laila Hellgren-Johansson; Petter Schiller; Per-Olof Joachimsson; Hans Hägglund; Mattias Mattsson; Janne Lehtiö; Omid R Faridani; Rickard Sandberg; Olle Korsgren; Mauro Krampera; Daniel J Weiss; Karl-Henrik Grinnemo; Katarina Le Blanc Journal: Stem Cells Transl Med Date: 2015-08-18 Impact factor: 6.940
Authors: Margaret S Herridge; Marc Moss; Catherine L Hough; Ramona O Hopkins; Todd W Rice; O Joseph Bienvenu; Elie Azoulay Journal: Intensive Care Med Date: 2016-03-30 Impact factor: 17.440