Improving management of ARDS : uniting acute management and long-term recovery

© 2024. The Author(s)..

Acute Respiratory Distress Syndrome (ARDS) is an important global health issue with high in-hospital mortality. Importantly, the impact of ARDS extends beyond the acute phase, with increased mortality and disability for months to years after hospitalization. These findings underscore the importance of extended follow-up to assess and address the Post-Intensive Care Syndrome (PICS), characterized by persistent impairments in physical, cognitive, and/or mental health status that impair quality of life over the long-term. Persistent muscle weakness is a common physical problem for ARDS survivors, affecting mobility and activities of daily living. Critical illness and related interventions, including prolonged bed rest and overuse of sedatives and neuromuscular blocking agents during mechanical ventilation, are important risk factors for ICU-acquired weakness. Deep sedation also increases the risk of delirium in the ICU, and long-term cognitive impairment. Corticosteroids also may be used during management of ARDS, particularly in the setting of COVID-19. Corticosteroids can be associated with myopathy and muscle weakness, as well as prolonged delirium that increases the risk of long-term cognitive impairment. The optimal duration and dosage of corticosteroids remain uncertain, and there's limited long-term data on their effects on muscle weakness and cognition in ARDS survivors. In addition to physical and cognitive issues, mental health challenges, such as depression, anxiety, and post-traumatic stress disorder, are common in ARDS survivors. Strategies to address these complications emphasize the need for consistent implementation of the evidence-based ABCDEF bundle, which includes daily management of analgesia in concert with early cessation of sedatives, avoidance of benzodiazepines, daily delirium monitoring and management, early mobilization, and incorporation of family at the bedside. In conclusion, ARDS is a complex global health challenge with consequences extending beyond the acute phase. Understanding the links between critical care management and long-term consequences is vital for developing effective therapeutic strategies and improving the quality of life for ARDS survivors.

Medienart:	E-Artikel

Erscheinungsjahr:	2024
Erschienen:	2024

Enthalten in:	Zur Gesamtaufnahme - volume:28
Enthalten in:	Critical care (London, England) - 28(2024), 1 vom: 23. Feb., Seite 58

Sprache:	Englisch

Beteiligte Personen:	Latronico, Nicola [VerfasserIn] Eikermann, M [VerfasserIn] Ely, E W [VerfasserIn] Needham, D M [VerfasserIn]

Links:	Volltext

Themen:	ARDS Adrenal Cortex Hormones Chronic disability Hypnotics and Sedatives Journal Article Long-term outcome Post-intensive care syndrome Review

Anmerkungen:	Date Completed 26.02.2024 Date Revised 04.04.2024 published: Electronic Citation Status MEDLINE

doi:	10.1186/s13054-024-04810-9

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	NLM368858855