Katrina E. Hauschildt is an advanced fellow in health services research at the Veterans Affairs Center for Clinical Management Research and a research associate in the Pulmonary and Critical Care Division at the University of Michigan, Ann Arbor.
Claire Seigworth is research health science specialist at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, Michigan.
Am J Crit Care. 2021 May 1;30(3):221-229. doi: 10.4037/ajcc2021825.
Many patients confront physical, cognitive, and emotional problems after acute respiratory distress syndrome (ARDS). No proven therapies for these problems exist, and many patients manage new disability and recovery with little formal support. Eliciting patients' adaptations to these problems after hospitalization may identify opportunities to improve recovery.
To explore how patients adapt to physical, cognitive, and emotional changes related to hospitalization for ARDS.
Semistructured interviews were conducted after hospitalization in patients with ARDS who had received mechanical ventilation. This was an ancillary study to a multicenter randomized controlled trial. Consecutive surviving patients who spoke English, consented to follow-up, and had been randomized between November 12, 2017, and April 5, 2018 were interviewed 9 to 16 months after that.
Forty-six of 79 eligible patients (58%) participated (mean [range] age, 55 [20-84] years). All patients reported using strategies to address physical, emotional, or cognitive problems after hospitalization. For physical and cognitive problems, patients reported accommodative strategies for adapting to new disabilities and recuperative strategies for recovering previous ability. For emotional issues, no clear distinction between accommodative and recuperative strategies emerged. Social support and previous familiarity with the health care system helped patients generate and use many strategies. Thirty-one of 46 patients reported at least 1 persistent problem for which they had no acceptable adaptation.
Patients employed various strategies to manage problems after ARDS. More work is needed to identify and disseminate effective strategies to patients and their families.
许多急性呼吸窘迫综合征（ARDS）患者在出院后面临身体、认知和情绪方面的问题。目前尚无针对这些问题的有效治疗方法，许多患者在缺乏正式支持的情况下应对新的残疾和康复问题。了解患者在住院后对这些问题的适应情况，可能有助于发现改善康复的机会。
探讨 ARDS 住院患者如何适应与住院相关的身体、认知和情绪变化。
对接受机械通气的 ARDS 患者在出院后进行半结构化访谈。这是一项多中心随机对照试验的辅助研究。于 2017 年 11 月 12 日至 2018 年 4 月 5 日连续入选符合条件且幸存的、愿意接受随访且已在机械通气期间随机分组的患者，在出院后 9 至 16 个月进行访谈。
79 名符合条件的患者中有 46 名（58%）参与了研究（平均[范围]年龄为 55[20-84]岁）。所有患者均报告在出院后使用策略来解决身体、情绪或认知问题。对于身体和认知问题，患者报告了适应性策略，用于适应新的残疾，以及恢复性策略，用于恢复以前的能力。对于情绪问题，适应性和恢复性策略之间没有明显区别。社会支持和以前对医疗保健系统的熟悉程度帮助患者产生和使用了许多策略。46 名患者中有 31 名报告至少存在 1 个无法接受的持续性问题。
患者在 ARDS 后使用了各种策略来管理问题。需要进一步努力，以确定和向患者及其家属传播有效的策略。
