Studies on monitoring hemodynamics and oxygen dynamics of adult respiratory distress syndrome secondary to high altitude pulmonary edema

To study monitoring hemodynamics and oxygen dynamics of adult respiratory distress syndrome (ARDS) secondary to high altitude pulmonary edema (HAPE),we performed clinic and laboratory studies in 8 patients who preliminarily developed high altitude cerebral edema (HACE) and then ARDS occurred at an altitude of 4 500 m. After an initial emergency treatment on high mountains,all the patients were rapidly transported to a hospital at a lower altitude of 2 808 m. The right cardiac catheterizations were carried out within 5 h after hospitalized. The monitoring hemodynamics and oxygen dynamics were studied via a thermodilution Swan-Gaze catheter. The results showed that before treatments at the beginning of monitoring,there presented a significant pulmonary artery hypertension with a decreased cardiac function,and a lower oxygen metabolism in all the 8 patients. However,after some effective treatments,including mechanical ventilation and using dexamethasone,furosemide,etc,four days later the result of a repeated monitoring showed that their pulmonary artery pressure had been decreased with an improved cardiac function with all the oxygen metabolic indexes increased significantly. Our studies suggested that performing monitoring hemodynamics in patients with ARDS secondary to HAPE will define the clinical therapeutic measures which will benefit the outcome.

Alveolar Hemorrhage and Acute Respiratory Distress Syndrome Associated with Pulmonary Cement Following Percutaneous Vertebroplasty with Polymethylmethacrylate

We report a rare complication of diffuse alveolar hemorrhage and respiratory failure following percutaneous vertebroplasty in a patient who has evidence of cement leakage. Cement injection was done two days prior to presentation and covered 2 vertebral levels for osteoporosis induced fractures.

Potential therapeutic application of adult stem cells in acute respiratory distress syndrome

Acute respiratory distress syndrome （ARDS） remains a poor prognosis in spite of the recent development of new therapeutic strategies. Cell-based therapy with stem cells has been considered as a promising way for the treatment of vital organ damage. Putative endogenous stern cells have been shown to be located within the adult lung in the basal layer of the upper airways, within or near pulmonary neuroendocrine cell rests, at the bronchoalveolar junction, as well as within the alveolar epithelium. These stem cells are hypothesized to be the source of lung regeneration and repair. But this mechanism seems to be insufficient alter lung injury. There is increasing excitement over the last few years with the suggestion that exogenous stem cells may offer new treatment options for ARDS. Exogenous stem cells have the ability to differentiate and function as both airway and lung parenchymal epithelial cells in both in vitro and in- creasingly in vivo experiments. However, there is great controversy concerning the repair effect of adult stem cells in lung injury. This review evaluates the advances in endogenous respiratory stem cells, and assesses the evidence for the use of stem cells in the repair of lung injury.

Clinical efficacy and safety of recruitment maneuver in patients with acute respiratory distress syndrome using low tidal volume ventilation： a multicenter randomized controlled clinical trial

Background The recruitment maneuver （RM） has been shown to improve oxygenation in some patients with acute respiratory distress syndrome. But there is a lack of standardization and lack of clinical studies to prove the improvement on clinical outcome. We conducted this study to evaluate the clinical efficacy and safety of the RM in patients with acute respiratory distress syndrome （ARDS） using Iow tidal volume ventilation.Methods We randomly assigned 110 patients with ARDS from 14 Chinese intensive care units （ICUs） at the tertiary teaching hospitals. Patients with PaO2 ≤200 mmHg at FiO2 1.0 and PEEP ≥10 cmH2O were included in the study.Patients were randomized into two groups： control group and RM group. The tidal volume was set to 6-8 mi per kilogram of predicted body weight （PBW） in both groups. RM was performed by continuous positive airway pressure （CPAP） of 40 cmH2O maintained for 40 seconds. RMs was conducted every eight hours for the first five days, or stopped within five days if the patient reached the weaning standard.Results One hundred and ten patients had completed the requirements for the primary study goals, 55 from the RM group and 55 control patients. Baseline characteristics remained similar in the two groups. In the RM group the PaO2/FiO2 was significantly increased compared to baseline at 120 minutes after RM on day one and day two （P=0.007and P=0.001）. There were no significant differences between the RM and control group in hospital mortality （41.8% vs.56.4%, P=0.13）, 28-day mortality （29.1% vs. 43.6%, P=0.11） and ventilator-free days at day 28 （10.8±10.1 vs. 7.4±10.0,P=0.08）. ICU mortality （32.7% vs. 52.7%, P=0.03）, the rate of survival with unassisted breathing for at least 48 consecutive hours at day 28 （58.2% vs. 36.2%, P=0.02）, and nonpulmonary organ failure-free days at day 28 （17.4±11.1vs. 13.0±12.0, P=0.03） favored the RM group. There was no significant difference in mean blood pressure and heart rate before RM and at 30, 60, 120 minutes after RM. There was no incidence of barotraumas.Conclusions RM was safe and useful for improving oxygenation in patients with ARDS who were ventilated with a low tidal volume, with a beneficial impact on their clinical outcome.

Retrospective analysis on acute respiratory distress syndrome in ICU

Objective： To assess the incidence, etiology, physiological and clinical features, mortality, and predictors of acute respiratory distress syndrome （ARDS） in intensive care unit （ICU）. Methods： A retrospective analysis of 5 314 patients admitted to the ICU of our hospital from April 1994 to December 2003 was performed in this study. The ARDS patients were identified with the criteria of the American- European Consensus Conference （ AECC ）. Acute physiology and chronic health evaluation Ⅲ （APACHE Ⅲ）, multiple organ dysfunction syndrome score （MODS score）, and lung injury score （LIS） were determined on the onset day of ARDS for all the patients. Other recorded variables included age, sex, biochemical indicators, blood gas analysis, length of stay in ICU, length of ventilation, presence or absence of tracheostomy, ventilation variables, elective operation or emergency operation. Resnits ： Totally, 131 patients （ 2. 5% ） developed ARDS, among whom, 12 patients were excluded from this study because they died within 24 hours and other 4 patients were also excluded for their incomplete information. Therefore, there were only 115 cases （62 males and 53 females, aged 22-75 years, 58 years on average ） left,accounting for 2. 2% of the total admitted patients. Their average ICU stay was （11.27±7.24） days and APACHE HI score was 17.23±7.21. Pneumonia and sepsis were the main cause of ARDS. The non-survivors were obviously older and showed significant difference in the ICU length of stay and length of ventilation as compared with the survivors. On admission, the non-survivors had significantly higher MODS and lower BE （base excess ）. The hospital mortality was 55. 7%. The main cause of death was multiple organ failure. Predictors of death at the onset of ARDS were advanced age, MODS≥8, and LIS ≥2.76. Conclusions： ARDS is a frequent syndrome in this cohort. Sepsis and pneumonia are the most common risk factors. The main cause of death is multiple organ failure. The mortality is high but similar to most recent series including severe comorbidities. Based on this patient population, advanced age, MODS score, and LIS may be the important prognostic indicators for ARDS.

Analysis of high risk factors related to acute respiratory distress syndrome following severe thoracoabdominal injuries

Objective: To investigate the high risk factors related to acute respiratory distress syndrome ( ARDS ) following serious thoracoabdominal injuries.Methods: The clinical data of 282 patients with serious thoracoabdominal injuries were retrospectively studied. Univariate and Cox multivariate regression analysis were used to determine the risk factors related to ARDS following serious thoracoabdominal injuries.Results: The incidence of ARDS was 31.9% (90/282) in patients with serious thoracoabdominal injuries.The mortality caused by ARDS was 37.8% (34/90). The univariate analysis and multivariate analysis demonstrated that the clinical conditions such as elder age, shock,dyspnea, abnormal arterial blood gas, hemopneumothorax,pulmonary contusion, flail chest, coexisting pulmonary diseases, multiple abdominal injury and high ISS score were the independent high risk factors related to ARDS.Conclusion: There are many high risk factors related to ARDS following severe thoracoabdominal injuries, which should be detected early and treated timely to decrease the incidence and mortality of ARDS.

Ginkgo biloba extract(EGb 761) attenuates lung injury induced by intestinal ischemia/reperfusion in rats:Roles of oxidative stress and nitric oxide

AIM： To investigate the effect of ginkgo biloba extract （EGb 761） on lung injury induced by intestinal ischemia/ reperfusion （ Ⅱ/R）. METHODS： The rat model of Ⅱ/R injury was produced by damping the superior mesenteric artery for 60 min followed by reperfusion for 180 min. The rats were randomly allocated into sham, Ⅱ/R, and EGb ＋Ⅱ/R groups. In EGb ＋Ⅱ/R group, EGb 761 （100 mg/kg per day） was given via a gastric tube for 7 consecutive days prior to surgery. Rats in Ⅱ/R and sham groups were treated with equal volumes of the vehicle of EGb 761. Lung injury was assessed by light microscopy, wet-todry lung weight ratio （W/D） and pulmonary permeability index （PPT）. The levels of malondialdehyde （MDA） and nitrite/nitrate （NO2/NO3）, as well as the activities of superoxide dismutase （SOD） and myeloperoxidase （MPO） were examined. Western blot was used to determine the expression of inducible nitric oxide synthase （iNOS）. RESULTS： EGb 761 markedly improved mean arterial pressure and attenuated lung injury, manifested by the improvement of histological changes and significant decreases of pulmonary W/D and PPT （P 〈 0.05 or 0.01）.Moreover, EGb 761 markedly increased SOD activity, reduced MDA levels and MPO activity, and suppressed NO generation accompanied by down-regulation of iNOS expression （P 〈 0.05 or 0.01）. CONCLUSION： The results indicate that EGb 761 has a protective effect on lung injury induced by Ⅱ /R, which may be related to its antioxidant property and suppressions of neutrophil accumulation and iNOS- induced NO generation. EGb 761 seems to be an effective therapeutic agent for critically ill patients with respiratory failure related to Ⅱ/R.

One disease, many faces-typical and atypical presentations of SARS-CoV-2 infection-related COVID-19 disease

Since the appearance of the novel coronavirus(severe acute respiratory syndrome-coronavirus-2)and related coronavirus disease 2019(COVID-19)in China in December 2019,a very high number of small and large patient series have been published in literature from around the world.Even though the classical presentation of COVID-19 is one with respiratory symptoms with or without pneumonia that can be self-limiting or evolve into severe respiratory distress syndrome with multiple organ failure,and secondary bacterial sepsis,a large body of evidence suggests a plethora of other types of clinical presentation.In this exhaustive review,we reviewed all of the published literature on COVID-19 to identify different types of clinical presentations affecting various organ systems,to provide an in-depth analysis that may prove useful for clinicians and health-workers on the frontline,battling the severe pandemic.

Protective Effect of Rhubarb on Endotoxin-Induced Acute Lung Injury

To approach the mechanism of lipopolysaccharide (LPS) in causing acute lung injury (ALI) and the protective effect of rhubarb and dexamethasone, lung specimens were examined with macroscopy, microscopy, electron microscopy and the biological markers of ALI including lung wet/dry weight, the rate of neutrophils and protein content in the pulmonary alveolar lavage fluid, pulmonary capillary permeability and pulmonary alveolar permeability index were observed. The mechanism of the ALI is mainly due to direct injury of alveolar epithelium and pulmonary vascular endothelium. Rhubarb and dexamethasone could significantly reduce the edema of the lung tissue, decrease the red blood cell exudation, neutrophil infiltration and plasma protein exudation in the alveoli and all the biological markers in comparison with the ALI model rats, indicating they have protective action on vascular endothelium and alveolar epithelium.

Actions of NO and INOS on Endotoxin Induced rat Acute Lung Injury and Effect of Rhubarb on Them

This study is to explore the actions of nitric oxide (NO) and inducible nitric oxide synthase (iNOS) on endotoxin (lipopolysaccharide, LPS) induced rat acute lung injury (ALI) and effect of Rhubarb on them. LPS was injected into the sublingual vein of male Wistar rats to prepare ALI animal models. The rats were divided into 4 groups: LPS, control, Rhubarb, and dexamethasone. Macroscopic and histopathological examinations of the lung specimens were performed and the biological indexes of lung, including wet weight/dry weight, the rate of neutrophils and protein content in the pulmonary alveolar lavage fluid, pulmonary vascular permeability and pulmonary alveolar permeability were observed. In the mean time, the contents of serum NO and the activities of lung tissue homogenate iNOS were measured. The results showed that in the LPS group, the injury and celluar infiltration in the pulmonary stroma and alveoli were more prominent than that in the control group. Lung wet weight/dry weight, the rate of neutrophils, protein content, pulmonary alveolar permeability, pulmonary vascular permeability were significantly increased (P<0.01); NO and iNOS were also markedly elevated (P<0.01). In the groups of dexamethasone and Rhubarb, the histopathological changes were significantly milder, and all the above biological indexes of lung injury and the contents of NO and the activities of iNOS were correspondingly decreased (P<0.05). The above data demonstrate that NO and the activities of iNOS play an important role in the onset of ALI; dexamethasone and Rhubarb interfering treatment can ameliorate lung injury and decrease the concentrations of NO and iNOS, showing that through inhibiting the levels of NO and the activities of iNOS, these 2 agents exert protective effect on ALI induced LPS.

Volumetric Overload Shocks: Why Is Starling’s Law for Capillary Interstitial Fluid Transfer Wrong? The Hydrodynamics of a Porous Orifice Tube as Alternative

Based on clinical and experimental work two new types of volumetric overload shocks are reported: volumetric overload shock type one and type two depending on the type of fluid causing their induction. Volumetric overload shock type one is induced by sodium-free fluids such as glycine, glucose, mannitol and sorbitol and is characterized with acute dilutional hyponatraemia. Volumetric overload shock type 2 is induced with sodium-based fluids normal saline and plasma substitutes used for resuscitation of the critically ill and has no serological marker. It presents with the multiple vital organs dysfunction or failure syndrome or the adult respiratory distress syndrome. Hypertonic sodium is an effective treatment when given early adequately. The underlying pathophysiology is discussed. An alternative to Starling’s law for the capillary interstitial fluid transfer is given. Hydrodynamic of a porous orifice tube akin to capillary with a surrounding Chamber akin to the interstitial fluid space demonstrated a rapid dynamic magnetic field-like fluid circulation between the surrounding chamber and the lumen of the G tube that represent an adequate replacement for Starling’s law.

Decreased expression of AQP1 and AQP5 in acute injured lungs in rats

OBJECTIVE: To determine if aquaporin1 (AQP1) and aquaporin5 (AQP5) are expressed in the alveolar capillary membrane in rats. Moreover, to investigate the alteration of AQP1 and AQP5 in acute injured lungs. METHODS: The distribution of AQP1 and AQP5 in alveolar capillary membrane were investigated by immunohistochemistry and immunoelectron microscopy with affinity-purified antibodies to human AQP1 and AQP5. To study the possibility that alveolar capillary membrane AQP1 and AQP5 undergo altered regulation, we established a rat model using alveolar instillation of lipopolysaccharide (LPS). RESULTS: Immunolabelling showed AQP1 was stained primarily in the microvascular endotheli a of normal lungs, while AQP5 was expressed in type I pneumocytes. Immunohisto chemical analysis showed a significant decrease in the expression of AQP1 and AQP5 in injured lungs at 4h-48h after LPS instillation. AQP1 protein was resumed partly at 24h after LPS instillation and steroid administration, whereas AQP5 was unchanged. CONCLUSION: The decreased expressions of AQP1 and AQP5 in injured lungs suggest that both of them may play a role in abnormal fluid transportation.

Protective effects of pretreatment with Radix Paeoniae Rubra on acute lung injury induced by intestinal ischemia/reperfusion in rats

Objective： To investigate the effect of pretreatment with Radix Paeoniae Rubra （RPR） on acute lung injury induced by intestinal ischemia/reperfusion in rats and its protective mechanism. Methods： Thirty-two Wistar rats were randomly divided into four groups： Sham-operation group, ischemla/ reperfusion group （I/R group ）, RPR-pretreatment group and hemin group. The model of intestinal ischemia/ reperfusion was established by clamping the superior mesenteric artery for 1 hour followed by 2-hour reperfusion. The effect of RPR on the expression of heme oxygenase-1 （HO-1） in lung tissues was detected by immunohistochemistry and morphometry computer image analysis. Arterial blood gas analysis, lung permeability index, malondialdehyde （MDA） and superoxide dismutase （SOD） contents in lungs were measured. The histological changes of lung tissue were observed under light microscope. Resalts： The expression of HO-1 in RPR-pretreatment group and hemin group was obviously higher than that in sham-operation group and I/R group （ P 〈 0.01 ）. The level of MDA and lung permeability index in RPR-pretreatment and hemin group were significantly lower than those in I/R group （P〈0.01 or P〈0.05）, while the activity of SOD in RPR-pretreatment and hemin group was obviously higher than that in I/R group （P〈0.01）. Under light microscope, the pathologic changes induced by I/R were significantly attenuated by RPR. Conclusion： Intestinal ischemia/reperfusion may result in acute lung injury and pretreatment with RPR injection can attenuate the injury. The protective effect of RPR on the acute lung injury is related to its property of inducing HO-1 expression and inhibiting lipid peroxidation.

Effect of radix paeoniae rubra on expression of p38 MAPK/iNOS/HO-1 in rats with lipopolysaccharide·induced acute lung injury

Objective: To investigate the effect of radix paeoniae rubra (RPR) on expression of p38 mitogen activated protein kinase ( MAPK )/iNOS/HO-1 in rats with lipopolysaccharide-induced acute lung injury and explore the molecular mechanism.Methods: Forty healthy male Wistar rats, weighing 200-250 g, aged 6-8 weeks (mean =7 weeks), provided by the Experimental Center, Medical College, Wuhan University, Wuhan, China, were employed in this study.Under anesthesia with 7% chloraldurat (5 ml/kg body weight) through intraperitoneal injection, the trachea of the rat was exposed and an arterial puncture needle pricked into the trachea via cricothyroid membrane. Then they were randomly divided into five groups: 8 rats receiving 1 ml normal saline through the puncture needle (Group A),8 receiving 1 ml lipopolysaccharide (LPS, 2.5 mg/kg,Group B), 8 receiving LPS and RPR (30 mg/kg, pumped through the femoral vein for 2 hours, Group C ), 8 receiving RPR 2 hours before dripping LPS ( Group D),and 8 receiving hemin (75 μmol/L through intraperitoneal injection) 18 hours before dripping LPS (Group E). After 6 hours of LPS dripping, blood samples were obtained through the carotid artery to perform blood gas analysis,then all the rats were exsanguinated to death and specimens of lung tissues were obtained. The pathomorphological changes of the lung tissues were observed. The expression of p38 MAPK/iNOS/HO-1, the neutrophil ratio, protein content in alveolar irrigating solution and malonaldehyde (MDA) content in the lung tissues were also detected.Results: Compared with Group A, the expression of p38 MAPK, iNOS and HO-1 markedly increased in Groups B, C, D, and E (P ＜0.01). But in Groups C, D, and E,the expression of p38 MAPK and iNOS were significantly lower than that of Group B, while expression of HO-1 was obviously higher than that of Group B ( P ＜ 0.05 ). The protein content, the ratio of neutrophils in bronchoalveolar lavage fluid ( BALF), the content of MDA and the activities of serum NO in Group B were significantly higher than those of Group A ( P ＜ 0.01 ). There was a significant decrease in the level of arterial bicarbonate and partial pressure of oxygen in Group B (P ＜ 0.01). Compared with Group B, these indexes of lung injury were significantly lower while the levels of arterial bicarbonate and partial pressure of oxygen increased significantly in Groups C, D,and E (P ＜ 0.05 or P ＜ 0.01 ). Under light microscope, the pathological changes induced by LPS were significantly attenuated by RPR and hemin.Conclusions: The high expression of MAPK plays an important role in lipopolysaccharide-induced acute lung injury. Protective effect of RPR on lipopolysaccharideinduced acute lung injury may be related to the inhibition of the abnormal high expression of p38 MAPK/iNOS/HO-1.

Serial analysis of gene expression in mice with lipopoly-saccharide-induced acute lung injury

Objective: To monitor the systemic gene expression profile in a murine model of lipopolysaccharide-induced acute lung injury. Methods: Acute lung injury was induced by intratracheal injection of lipopolysaccharide in 3 mice. Another 3 normal mice receiving same volume of normal saline were taken as the controls. The comprehensive gene expression profile was monitored by the recently modified long serial analysis of gene expression. Results: A total of 24 670 tags representing 12 168 transcripts in the control mice and 26 378 tags representing 13 397 transcripts in the mice with lung injury were identified respectively. There were 11 transcripts increasing and 7 transcripts decreasing more than 10 folds in the lipopolysaccharide-treated mice. The most overexpressed genes in the mice with lung injury included serum amyloid A3, metallothionein 2, lipocalin 2, cyclin-dependent kinase inhibitor 1A, lactate dehydrogenase 1, melatonin receptor, S100 calcium-binding protein A9, natriuretic peptide precursor, etc. Mitogen activated protein kinase 3, serum albumin, complement component 1 inhibitor, and ATP synthase were underexpressed in the lung injury mice. Conclusions: Serial analysis of gene expression provides a molecular characteristic of acute lung injury.

Changes in liquid clearance of alveolar epithelium after oleic acid-induced acu telung injury in rats

Objective:Impaired active fluid transport of al veolar epithelium may involve in the pathogenesis and resolution of alveolar ede ma. The objective of this study was to explore the changes in alveolar epithelia l liquid clearance during lung edema following acute lung injury induced by olei c acid. Methods:Forty-eight Wistar rats were randomly divided into si x groups, i.e., injured, amiloride, ouabain, amiloride plus ouabain and terbutal ine groups. Twenty-four hours after the induction of acute lung injury by intra venous oleic acid ( 0.25 ml/kg), 5% albumin solution with 1.5 μCi 12 5 I-labeled albumin (5 ml/kg) was delivered into both lungs via trachea. Alveo lar liquid clearance (ALC), extravascular lung water (EVLW) content and arterial blood gases were measured one hour thereafter. Results:At 24 h after the infusion of oleic acid, the rats dev eloped pulmonary edema and severe hypoxemia, with EVLW increased by 47.9 % and ALC decreased by 49.2 %. Addition of either 2×10 -3 M amiloride or 5× 10 -4 M ouabain to the instillation further reduced ALC and increased E VLW. ALC increased by approximately 63.7 % and EVLW decreased by 46.9 % wi th improved hypoxemia in the Terbutaline (10 -4 M) group, compared those in injured rats. A significant negative correlation was found between the incremen t of EVLW and the reduction of ALC. Conclusions:Active fluid transport of alveolar epithelium migh t play a role in the pathogenesis of lung edema in acute lung injury.

Changes in pulmonary vascular endothelial cells after acute lung injury induced by bone marrow extract injection in rabbits

Objective: To investigate the changes of the markers of pulmonary vascular endothelial cells (PVECs) after acute lung injury (ALI) induced by bone marrow extract (BME) injection in rabbits. Methods: Thirty one rabbits were randomized into control (CG, n=10) and experimental groups (EG, n=21). The rabbits in EG were injected with homogeneous bone marrow extract (0.35 ml/kg, 2 ml/h) at a slow and continuous rate through the jugular vein to establish the model of ALI. At 6 h after the injection, the number of circulating endothelial cells (CECs) in the blood, contents of granule membrane protein 140 (GMP 140), angiotensin converting enzyme (ACE) and endothelin 1 (ET 1) in the plasma and the content of GMP 140 in the pulmonary tissue were determined at various time intervals. Then the animals were killed and routine pathological examination and electron microscopy were performed to observe the changes in the pulmonary tissue. Results: The levels of plasma GMP 140, ACE, ET 1 and CECs were significantly increased in the early stage ( 0.5 h) and remained higher for 6 h. The marked increase of plasma GMP 140 (3.25 times) in the early stage was negatively correlated to PaO 2, but positively to other parameters. IHC staining showed that the GMP 140 on the surface of PVECs became weak. Conclusions: BME injection at slow and continuous rate can establish an acceptable model of ALI. Determination of plasma GMP 140 might be an important measure for the early surveillance and the evaluation of prognosis of ALI in clinical management of serious traffic accidents.

Health-related quality of life and stress-related disorders in COVID-19 ICU survivors:Are they worse than with other causes of ARDS?

Background:There are insufficient data regarding the impact of acute respiratory distress syndrome related to coronavirus disease 2019(C-ARDS)–caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)–on health-related quality of life(HRQoL)and the occurrence of stress-related disorders in coronavirus disease 2019(COVID-19)intensive care unit(ICU)survivors.The aim of this study is to assess HRQoL and the occurrence of stress-related disorders(acute stress disorder[ASD]and post-traumatic stress disorder[PTSD])in C-ARDS ICU survivors at 1 and 6 months following hospital discharge.Methods:This prospective observational study included 90 patients treated for C-ARDS between March and May 2020 in the ICU and discharged alive from the hospital.All patients included in the study were contacted by telephone 1 month and 6 months post-hospital discharge to assess the presence of symptoms of stress-related disorders and HRQoL using the 8-item Treatment Outcome Post-traumatic Stress Disorder scale(TOP-8)and 36-item Short Form survey(SF-36).We performed univariate analyses to evaluate differences between patients who developed stress and those who did not.We also compared SF-36 scores in our sample with data from the general Spanish population and from cohorts of non–C-ARDS and severe acute respiratory syndrome coronavirus-1(SARS-CoV-1)survivors.Results:There are 24.1%of patients showed symptoms of ASD;in 13.5%of cases the symptoms persisted 6 months later.Risk factors for the development of symptoms of ASD and PTSD are younger age,female sex,obesity,a previously diagnosed psychiatric disease and disease severity at ICU admission(P<0.05).HRQoL was greatly affected by C-ARDS;however,there was improvement on all scales of the SF-36 at the 6-month follow-up(P<0.05).The mean SF-36 score of our sample was higher than those previously reported in non–C-ARDS survivors(P<0.05)for physical functioning(78.0 vs.52.0),role functioning/physical(51.0 vs.31.0),bodily pain(76.1 vs.57.0),vitality(58.6 vs.48.0),social function(72.6 vs.63.0)and role emotional(77.4 vs.55.0),except on the general health scale.C-ARDS survivors also scored better than SARS-CoV-1 survivors on all scales except for body pain(P<0.05).Conclusions:The impact of C-ARDS on HRQoL is substantial,with frequent occurrence of PTSD symptoms.Patients are heavily affected in all areas of health in the first month of post-hospital discharge but show a dramatic improvement within 6 months,especially in terms of physical health.