LUNG (PULMONARY) FUNCTION:
Most patients who survive ARDS have a remarkable degree of recovery
of lung function, given the severity of the initial injury. Recovery
time for each patient is variable. Patients recover at different
rates and have different end points. Complications from tracheal
injury and tracheal stenosis may be present which affect the rate
and degree of recovery. However, most patients recover the great
majority of lung function in the first three to six months. The
recovery period may extend up to a year and beyond. A few patients
experience a permanent decrease in lung function.
Surviving ARDS and Dealing with Post-ARDS Medical Issues. What
may be encountered or expected?
Lung function recovery is determined in part by how well the patient
is able to take a deep breath and how well oxygen is able to go from
the lungs into the bloodstream. This is measured by pulmonary
function tests and by pulse oximetry or arterial blood gas testing.
Patients may receive these tests at discharge from the hospital and
at three to six months after discharge.
During the first three months after discharge from the hospital,
some patients may feel short of breath, have a cough, produce
phlegm, and feel fatigued. Some may be required to use supplemental
oxygen for a period of time. Many patients experience hoarseness,
which is due to irritation from the endotracheal tube used while
they were on a ventilator. As the months go by, however, patients
may feel like they can take a deep breath more easily, walk farther
distances, or get tired less easily.
Some patients do not recover as well and may continue to experience
abnormal lung function for the rest of their life. Also, some
patients have underlying medical conditions which either prevent
full recovery or are the predominate cause of the ongoing abnormal
lung problems. Individuals might have COPD (Chronic Obstructive
Pulmonary Disease), emphysema, lung cancer, or a wide range of
pulmonary disorders and diseases.
STRENGTH and STAMINA: In addition to lung injury, other
residual effects of a critical illness can reduce strength and
stamina after hospital discharge. Depending in part on the length of
deep sedation and intentional paralysis, the body's muscles may
undergo significant atrophy and the individual may lose considerable
weight. To overcome these effects, many patients need extended
rehabilitation. Ideally, physical rehabilitation begins after
initial stabilization during mechanical ventilation with periodic
movement of legs, arms, neck, joints, and massaging muscles, to help
minimize atrophying and to help prevent joint "lock-up".
This depends on the medical status of the individual and the doctors
are in the best position to judge whether such intervention is
appropriate. Family members and friends might be able to assist with
this task under the guidance of the physicians and nurses and
considering the status of the patient. Never undertake doing this
without the guidance and instruction of medical personnel and the
approval of the doctors.
Physical rehabilitation should begin in
earnest as soon as possible after the end of mechanical ventilation
and continue after hospital discharge until full strength and stamina
are restored. A combination of aerobic exercise and weight training
can be tailored to the individual by a qualified physical therapist.
Not every patient is the same, and
the extent to which an individual may recover will be a function of
many factors, including the length of the coma/deep sedation, amount
of muscle atrophy, whether there was or was not joint
"lock-up", amount of weight loss, and the extent of damage
to lungs, vital organs, and body processes.
MEMORY and COGNITIVE AREAS: Research efforts are now being
extended to include the areas of emotional, cognitive and memory
loss. It is known that these conditions persist during the post-ARDS
period and research is being focused on the nature and impact of
these problems. Side-effects of many drugs used to treat the
underlying conditions and also to put a patient into a coma/deep
sedation might be to cause memory loss and perhaps later cognitive
problems. Also, depending on the extent of damage from low O2 Sat
levels, memory loss and later cognitive problems may also be a
function of physical impairment (e.g., brain damage). In many cases,
the memory loss and/or later cognitive problems may be significant,
but in time as recovery proceeds the memory loss and/or cognitive
problems usually begin to lessen. Many ARDS survivors report ongoing
memory loss and cognitive problems stretching sometimes six months
to a year or more after coming out of the coma/deep sedation.
EMOTIONAL ISSUES: This is another area that received little
attention for many years. Medical and professional advisors are
looking into these areas. The anecdotal information coming from ARDS
survivors is that there are a range of emotional and mental health
issues which they confront.
FEAR: Many ARDS survivors have a very deep fear of getting
ARDS again. There are currently no known studies or statistical data
on getting ARDS more than once. It is known that there are
individuals who have been diagnosed as having ARDS more than once.
There does not appear to be any medical reason why, given the right
set of circumstances, an individual's body would not react in a
similar manner more than once. Recovery from ARDS does not show any
creating of an immunity against getting ARDS again.
A second important element of fear is that of not being able to
breathe. This is one of the most powerful fears known. Individuals
who survive ARDS and then come down with various medical problems
such as colds, bronchitis, and other pulmonary conditions which
affect breathing, often report an intensification of the fear of not
being able to breathe.
GUILT and FEELING SORRY: Another fairly common emotion
experienced by ARDS survivors. Why did this happen? What did I do
wrong? Being sorry for putting family and friends through this
terrible experience. Usually this will, in time, slowly fade as the
recovery process proceeds. However, depending on the depth of the
guilt and feeling sorry, medical intervention might be warranted
especially when accompanied by depression.
DEPRESSION: Virtually all ARDS survivors report going some
period of depression. Sometimes, the depression is short-lived and
fades as recovery proceeds. Other times, the depression may be deep
and severe. The survivor, friends and family need to be aware of the
manifesting signs of depression in order that this may be confronted
and treated by medical intervention early if warranted. Some of the
indications of depression are not eating or exhibiting signs of
eating disorder, uncleanliness, sleeping a lot, no interest in doing
things the individual has always enjoyed, anger, short temper,
wanting to be left alone, not wanting to leave the house or bedroom,
work-related problems. Do not be afraid to speak with the doctors,
and to seek professional help from counselors, psychologists, and
psychiatrists. The earlier the intervention, the greater the chance
of combating the depression.
POST TRAUMATIC STRESS DISORDER (PTSD): This condition
embraces a wide range of emotional and mental health problems. This
area is being examined more closely. For more information on this
topic please see the Post ARDS section of the Learn About ARDS page
on this website.
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