Influence of quality of intensive care on quality of life/return to work in survivors of the acute respiratory distress syndrome: prospective observational patient cohort study (DACAPO)

Christian Apfelbacher, Susanne Brandstetter, Sebastian Blecha, Frank Dodoo-Schittko, Magdalena Brandl, Christian Karagiannidis, Michael Quintel, Stefan Kluge, Christian Putensen, Sven Bercker, Björn Ellger, Thomas Kirschning, Christian Arndt, Patrick Meybohm, Steffen Weber-Carstens, DACAPO study group, Thomas Bein, Johannes Bickenbach, Thorben Beeker, Tobias Schürholz, Jessica Pezechk, Jens Schloer, Ulrich Jaschinski, Ilse Kummer, Oliver Kuckein, Steffen Weber-Carstens, Anton Goldmann, Stefan Angermair, Krista Stoycheva, Jörg Brederlau, Nadja Rieckehr, Gabriele Schreiber, Henriette Haennicke, Friedhelm Bach, Immo Gummelt, Silke Haas, Catharina Middeke, Ina Vedder, Marion Klaproth, Michael Adamzik, Jan Karlik, Stefan Martini, Luisa Robitzky, Christian Putensen, Thomas Muders, Ute Lohmer, Rolf Dembinski, Petra Schäffner, Petra Wulff-Werner, Elke Landsiedel-Mechenbier, Daniela Nickoleit-Bitzenberger, Ann-Kathrin Silber, Maximilian Ragaller, Marcello Gama de Abreu, Alin Ulbricht, Linda Reisbach, Kai Zacharowski, Patrick Meybohm, Simone Lindau, Haitham Mutlak, Alexander Hötzel, Johannes Kalbhenn, Christoph Metz, Stefan Haschka, Stefan Rauch, Michael Quintel, Lars-Olav Harnisch, Sophie Baumann, Andrea Kernchen, Sigrun Friesecke, Sebastian Maletzki, Stefan Kluge, Olaf Boenisch, Daniel Frings, Birgit Füllekrug, Nils Jahn, Knut Kampe, Grit Ringeis, Brigitte Singer, Robin Wüstenberg, Jörg Ahrens, Heiner Ruschulte, Andre Gerdes, Matthias Groß, Olaf Wiesner, Aleksandra Bayat-Graw, Thorsten Brenner, Felix Schmitt, Anna Lipinski, Dietrich Henzler, Klaas Eickmeyer, Juliane Krebs, Iris Rodenberg, Heinrich Groesdonk, Kathrin Meiers, Karen Salm, Thomas Volk, Stefan Fischer, Basam Redwan, Martin Schmölz, Kathrin Schumann-Stoiber, Simone Eberl, Gunther Lenz, Thomas von Wernitz-Keibel, Monika Zackel, Frank Bloos, Petra Bloos, Anke Braune, Anja Haucke, Almut Noack, Steffi Kolanos, Heike Kuhnsch, Karina Knuhr-Kohlberg, Markus Gehling, Mathias Haller, Anne Sturm, Jannik Rossenbach, Dirk Schädler, Stefanie D'Aria, Christian Karagiannidis, Stephan Straßmann, Wolfram Windisch, Thorsten Annecke, Holger Herff, Michael Schütz, Sven Bercker, Hannah Reising, Mandy Dathe, Christian Schlegel, Katrin Lichy, Wolfgang Zink, Jana Kötteritzsch, Marc Bodenstein, Susanne Mauff, Peter Straub, Christof Strang, Florian Prätsch, Thomas Hachenberg, Thomas Kirschning, Thomas Friedrich, Dennis Mangold, Christian Arndt, Tilo Koch, Hendrik Haake, Katrin Offermanns, Patrick Friederich, Florian Bingold, Michael Irlbeck, Bernhard Zwissler, Ines Kaufmann, Ralph Bogdanski, Barbara Kapfer, Markus Heim, Günther Edenharter, Björn Ellger, Daniela Bause, Götz Gerresheim, Dorothea Muschner, Michael Christ, Arnim Geise, Martin Beiderlinden, Thorsten Heuter, Alexander Wipfel, Werner Kargl, Marion Harth, Christian Englmeier, Thomas Bein, Sebastian Blecha, Kathrin Thomann-Hackner, Marius Zeder, Markus Stephan, Martin Glaser, Helene Häberle, Hendrik Bracht, Christian Heer, Theresa Mast, Markus Kredel, Ralf Müllenbach, Phillip Sebök, Kathrin Thomann-Hackner, Julika Loss, Bernhard Graf, Michael Leitzmann, Michael Pfeifer, Simon Bein, Vreni Brunnthaler, Carina Forster, Stefanie Hertling, Sophie Höhne, Carolin Schimmele, Elisa Valletta, Philipp Drewitz, Chiara Eberle, Arthur Slutsky, Christian Apfelbacher, Susanne Brandstetter, Sebastian Blecha, Frank Dodoo-Schittko, Magdalena Brandl, Christian Karagiannidis, Michael Quintel, Stefan Kluge, Christian Putensen, Sven Bercker, Björn Ellger, Thomas Kirschning, Christian Arndt, Patrick Meybohm, Steffen Weber-Carstens, DACAPO study group, Thomas Bein, Johannes Bickenbach, Thorben Beeker, Tobias Schürholz, Jessica Pezechk, Jens Schloer, Ulrich Jaschinski, Ilse Kummer, Oliver Kuckein, Steffen Weber-Carstens, Anton Goldmann, Stefan Angermair, Krista Stoycheva, Jörg Brederlau, Nadja Rieckehr, Gabriele Schreiber, Henriette Haennicke, Friedhelm Bach, Immo Gummelt, Silke Haas, Catharina Middeke, Ina Vedder, Marion Klaproth, Michael Adamzik, Jan Karlik, Stefan Martini, Luisa Robitzky, Christian Putensen, Thomas Muders, Ute Lohmer, Rolf Dembinski, Petra Schäffner, Petra Wulff-Werner, Elke Landsiedel-Mechenbier, Daniela Nickoleit-Bitzenberger, Ann-Kathrin Silber, Maximilian Ragaller, Marcello Gama de Abreu, Alin Ulbricht, Linda Reisbach, Kai Zacharowski, Patrick Meybohm, Simone Lindau, Haitham Mutlak, Alexander Hötzel, Johannes Kalbhenn, Christoph Metz, Stefan Haschka, Stefan Rauch, Michael Quintel, Lars-Olav Harnisch, Sophie Baumann, Andrea Kernchen, Sigrun Friesecke, Sebastian Maletzki, Stefan Kluge, Olaf Boenisch, Daniel Frings, Birgit Füllekrug, Nils Jahn, Knut Kampe, Grit Ringeis, Brigitte Singer, Robin Wüstenberg, Jörg Ahrens, Heiner Ruschulte, Andre Gerdes, Matthias Groß, Olaf Wiesner, Aleksandra Bayat-Graw, Thorsten Brenner, Felix Schmitt, Anna Lipinski, Dietrich Henzler, Klaas Eickmeyer, Juliane Krebs, Iris Rodenberg, Heinrich Groesdonk, Kathrin Meiers, Karen Salm, Thomas Volk, Stefan Fischer, Basam Redwan, Martin Schmölz, Kathrin Schumann-Stoiber, Simone Eberl, Gunther Lenz, Thomas von Wernitz-Keibel, Monika Zackel, Frank Bloos, Petra Bloos, Anke Braune, Anja Haucke, Almut Noack, Steffi Kolanos, Heike Kuhnsch, Karina Knuhr-Kohlberg, Markus Gehling, Mathias Haller, Anne Sturm, Jannik Rossenbach, Dirk Schädler, Stefanie D'Aria, Christian Karagiannidis, Stephan Straßmann, Wolfram Windisch, Thorsten Annecke, Holger Herff, Michael Schütz, Sven Bercker, Hannah Reising, Mandy Dathe, Christian Schlegel, Katrin Lichy, Wolfgang Zink, Jana Kötteritzsch, Marc Bodenstein, Susanne Mauff, Peter Straub, Christof Strang, Florian Prätsch, Thomas Hachenberg, Thomas Kirschning, Thomas Friedrich, Dennis Mangold, Christian Arndt, Tilo Koch, Hendrik Haake, Katrin Offermanns, Patrick Friederich, Florian Bingold, Michael Irlbeck, Bernhard Zwissler, Ines Kaufmann, Ralph Bogdanski, Barbara Kapfer, Markus Heim, Günther Edenharter, Björn Ellger, Daniela Bause, Götz Gerresheim, Dorothea Muschner, Michael Christ, Arnim Geise, Martin Beiderlinden, Thorsten Heuter, Alexander Wipfel, Werner Kargl, Marion Harth, Christian Englmeier, Thomas Bein, Sebastian Blecha, Kathrin Thomann-Hackner, Marius Zeder, Markus Stephan, Martin Glaser, Helene Häberle, Hendrik Bracht, Christian Heer, Theresa Mast, Markus Kredel, Ralf Müllenbach, Phillip Sebök, Kathrin Thomann-Hackner, Julika Loss, Bernhard Graf, Michael Leitzmann, Michael Pfeifer, Simon Bein, Vreni Brunnthaler, Carina Forster, Stefanie Hertling, Sophie Höhne, Carolin Schimmele, Elisa Valletta, Philipp Drewitz, Chiara Eberle, Arthur Slutsky

Abstract

Background: Significant long-term reduction in health-related quality of life (HRQoL) is often observed in survivors of the acute respiratory distress syndrome (ARDS), and return to work (RtW) is limited. There is a paucity of data regarding the relationship between the quality of care (QoC) in the intensive care unit (ICU) and both HRQoL and RtW in ARDS survivors. Therefore, the aim of our study was to investigate associations between indicators of QoC and HRQoL and RtW in a cohort of survivors of ARDS.

Methods: To determine the influence of QoC on HRQoL and RtW 1 year after ICU-discharge, ARDS patients were recruited into a prospective multi-centre patient cohort study and followed up regularly after discharge. Patients were asked to complete self-report questionnaires on HRQoL (Short Form 12 physical component scale (PCS) and mental component scale (MCS)) and RtW. Indicators of QoC pertaining to volume, structural and process quality, and general characteristics were recorded on ICU level. Associations between QoC indicators and HrQoL and RtW were investigated by multivariable linear and Cox regression modelling, respectively. B values and hazard ratios (HRs) are reported with corresponding 95% confidence intervals (CIs).

Results: 877 (of initially 1225 enrolled) people with ARDS formed the DACAPO survivor cohort, 396 were finally followed up to 1 year after discharge. The twelve-month survivors were characterized by a reduced HRQoL with a greater impairment in the physical component (Md 41.2 IQR [34-52]) compared to the mental component (Md 47.3 IQR [33-57]). Overall, 50% of the patients returned to work. The proportion of ventilated ICU patients showed significant negative associations with both 12 months PCS (B = - 11.22, CI -20.71; - 1,74) and RtW (HR = 0,18, CI 0,04;0,80). All other QoC indicators were not significantly related to outcome.

Conclusions: Associations between ICU QoC and long-term HrQoL and RtW were weak and largely non-significant. Residual confounding by case mix, treatment variables before or during ICU stay and variables pertaining to the post intensive care period (e.g. rehabilitation) cannot be ruled out.

Trial registration: Clinicaltrials.govNCT02637011. (December 22, 2015, retrospectively registered).

Keywords: ARDS; Health-related quality of life; ICU; Quality of care; Return to work; Volume.

Conflict of interest statement

TB, CK, MQ, SK, CP, SB3, BE, TK, CA2, PM, and SWC are members of the German ARDS-Network. TB: received honoraria for lectures from Xenios Company, Germany. MQ: received honoraria for lectures from Maquet, Company, and Xenios Company, Germany. All other authors declare: no relationships/conditions/circumstances that present a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Patient flow. a For all patients who were lost to follow-up survival was assessed via local municipal population registries. b Written informed consent and patient data were transferred to the study centre with a delay of more than 12 months; thus, follow-up measurement was not possible within the scheduled follow-up period
Fig. 2
Fig. 2
SF-12 values of survivors of ARDS after 12 months (a). Probability of not returning to work (b)

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