Among ARDS survivors, ICU readmission is linked to decline

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Takeaway

  • Survivors of acute respiratory distress syndrome (ARDS) experience worse physical decline after hospital readmissions that include an ICU stay vs readmissions that do not. 

Why this matters 

  • ARDS survivors often suffer long-term health problems and hospital readmissions.

Key results

  • 64% (n=84) experienced ≥1 readmission. Of those:
    • 42% (n=35) had ≥1 ICU stay;
    • 54% (n=45) had readmissions across multiple years.
  • On multivariate analysis, rate of physical decline did not differ after readmission without an ICU stay vs no readmission.
  • However, decline worsened after readmission with ICU stay vs no readmission (ORs): 
    • Strength: 2.59 (P=.01);
    • Exercise capacity: 4.99 (P<.001>
    • Self-reported physical function: 8.85 (P<.001>
  • Decline also worsened after hospital readmission with vs without ICU stay (ORs):
    • Strength: 2.32 (P=.06);
    • Exercise capacity: 3.00 (P=.03);
    • Self-reported function: 4.09 (P=.001).

Study design

  • Multisite, 5-year, longitudinal prospective cohort study.
  • Participants: 132 adults who had survived >2 years after ARDS.
  • At years 3, 4, and 5, researchers assessed outcomes in those readmitted to hospital and with vs without ICU stay. 
  • Outcome: rate of physical decline or death.
  • Funding: NIH; Johns Hopkins Institute for Clinical and Translational Research.

Limitations

  • Small study.
  • Study took place before hospitals adopted early-mobilization policies.