Physical and psychological impairment in survivors of acute respiratory distress syndrome: a systematic review and meta-analysis

Br J Anaesth. 2022 Nov;129(5):801-814. doi: 10.1016/j.bja.2022.08.013. Epub 2022 Aug 26.


Background: Survivors of acute respiratory distress syndrome (ARDS) are at risk of long-term comorbidities. This systematic review and meta-analysis evaluated health-related quality of life (HRQoL), and physical and psychological impairments in ARDS survivors from 3 months to 5 yr follow-up after ICU discharge.

Methods: Systematic search of PubMed, AMED, BNI, and CINAHL databases from January 2000 to date. The primary outcome was HRQoL. Secondary outcomes included physical, pulmonary, and cognitive function, mental health, and return to work. A secondary analysis compared classical ARDS with severe acute respiratory syndrome coronavirus disease-2 (SARS-CoV-2) ARDS.

Results: Forty-eight papers met inclusion criteria including 11 693 patients; of those 85% (n=9992) had classical ARDS and 14% (n=1632) had SARS-CoV-2 ARDS. The 36-Item Short Form Health Survey (SF-36) physical component summary score mean (95% confidence interval [CI]) was 46 (41-50) at 3 months, 39 (36-41) at 6 months, and 40 (38-43) at 12 months. The SF-36 mental component summary mean score was 53 (48-57) at 3 months, 45 (40-50) at 6 months, and 44 (42-47) at 12 months. SF-36 values were lower than those found in the normal population up to 5 yr. The predictive distance walked in 6 min was 57% (45-69), 63% (56-69), and 66% (62-70) at 3, 6, and 12 months, respectively. Classical ARDS and SARS-CoV-2 ARDS showed no difference in HRQoL and physical function; however, patients with classical ARDS had higher incidence of anxiety and depression (P<0.001).

Conclusion: ARDS survivors can experience reduced HRQoL and physical and mental health impairment. These symptoms might not recover completely up to 5 yr after ICU discharge.

Systematic review registration: PROSPERO: CRD42021296506.

Keywords: ARDS; COVID-19; ICU-acquired comorbidity; SARS-CoV-2; acute respiratory distress syndrome; health-related quality of life; long-term outcomes.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • COVID-19* / complications
  • Humans
  • Quality of Life / psychology
  • Respiratory Distress Syndrome*
  • SARS-CoV-2
  • Survivors / psychology