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Acute Respiratory Distress Syndrome as a Precursor to Post–Intensive Care Syndrome

McPeake, Joanne, PhD, MSc*,†; Veith, Joshua, MD‡,§; Maley, Jason, MD; Mikkelsen, Mark E., MD, MSCE‡,§

doi: 10.1097/CPM.0000000000000295
Critical Care/Respiratory Care

More than 6 million patients are cared for in an intensive care unit annually in the United States, and millions more internationally. Acute respiratory failure (ARF) is a common indication for intensive care unit admission, one that afflicts more than half of critically ill patients. Acute respiratory distress syndrome (ARDS) is a severe, life-threatening form of ARF. With advances in care over the last 50 years, the majority of ARF and ARDS patients survive. The survivorship literature is largely one that describes functional impairments and reduced quality of life after critical illness. In this review article, we put forth the concept that ARDS is a precursor to post–intensive care syndrome, defined as new or worsening impairments in cognition, mental health, and/or physical health after critical illness. This “precursor” paradigm is suggested as a means to a better end for patients with ARDS, by detailing care provisions and strategies to optimize short-term and long-term outcomes.

*NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary

University of Glasgow, School of Medicine, Dentistry, and Nursing, Glasgow, Scotland

Division of Pulmonary, Allergy, and Critical Care Medicine

§Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Division of Pulmonary, Allergy, and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Disclosure: The authors declare that they have no conflicts of interest.

Address correspondence to: Mark E. Mikkelsen, MD, MSCE, Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Gates 05042, 3400 Spruce Street, Philadelphia, PA 19104. E-mail:

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