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Interplay of physiology, social, familial and behavioural adaptation in the long-term outcome of ARDS
  1. Theodore J Iwashyna1,2,3,
  2. Timothy S Walsh4,5
  1. 1Department of Internal Medicine, Pulmonary and Critical Care Medicine, Ann Arbor, Michigan, USA
  2. 2Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
  4. 4Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
  5. 5Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Theodore J Iwashyna, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, Floor 3, Ann Arbor, MI 48109, USA; tiwashyn{at}umich.edu

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Discharge from a hospital after the intensive care unit (ICU) is challenging. Please do not mistake us—we agree many patients are happy to go home. In fact, most critical care survivors are desperate to leave the hospital, typically after a prolonged frightening hospital stay lasting weeks or longer. Unfortunately, most patients have not returned to their preillness physical status when they go home, and many face new cognitive or psychological disabilities that may just be emerging. Yet, constrained budgets, limited acute hospital beds and wide variation in formal rehabilitation mean many patients enter posthospital survivorship without coordinated support. No matter which health system cares for them, many survivors experience an unplanned rehospitalisation within a few months.1–4

Hospital discharge prior to full recovery may be inevitable, as recovery after many illnesses simply takes a really long time (or might never be complete). Data from the Women’s Health and Aging Study (all aged 65+) noted 33% of patients hospitalised for any reason had activity of daily living (ADL) recovery during the 6 months after hospitalisation, and another 14% in the 6 to 12-month interval.5 (See figure 1) A more acutely ill, younger cohort of critical care patients who required at least 7 days of mechanical ventilation experienced improvement in mean function over the first 6 months, but limited change thereafter.6 However, close inspection of these data reveals very wide variation between individuals between 6 and 12 months that are not apparent in population mean estimates. In light of these and related data, our community is rightly expending energy trying to treat this ‘post-intensive care syndrome (PICS),’7 or at least improve the health problems that our patients describe months or years after we discharge them from our ICUs.

Figure 1

Duration of recovery of function. (Left) Women’s Health and Aging …

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