Patients who survive acute respiratory distress syndrome (ARDS) often leave a hospital intensive care unit with debilitating mental, physical, or cognitive problems that may limit their quality of life.

Now, a new study of 645 ARDS survivors by researchers at Intermountain Medical Center, Johns Hopkins University, and the University of Utah, has identified subgroups of ARDS survivors who suffer what’s been called post–intensive care syndrome, a collection of symptoms that can linger for years.

“A lot of work has been done around post–intensive care syndrome. We’re realizing the people who are surviving are often terribly wounded, and they have emotional and psychological distress as severe as combat veterans returning from war,” said Samuel M. Brown, MD, lead author of the study and director of the Center for Humanizing Critical Care at Intermountain Medical Center. “They may have profound weakness or shortness of breath or other important limitations to their quality of life after they survive.”

Results of the new study, were published in the journal Thorax.

Many ARDS survivors leave the hospital with an array of challenges that form post–intensive care syndrome. The survivors may live with long–term effects, including permanent lung damage and different degrees of physical, cognitive, and mental health problems. During the last quarter–century, the symptoms of post–intensive care syndrome have been increasingly recognized and understood. Critical care specialists say between half and two–thirds of ARDS survivors struggle with it after they’re released from the hospital, Dr. Brown said. Researchers at Intermountain Medical Center and Johns Hopkins University have been seeking common threads among survivors, focusing on combinations of impairments, including physical health, mental health, and brain function. The study builds on previous research by the team. Researchers say the threads within survivor subgroups may help them better identify factors that increase risk, and could potentially lead to tailored treatments to bolster patients’ recovery. In the study of ARDS survivors six months out of intensive care, the researchers found four different patient subgroups:

• those with mildly impaired physical and mental health (22% of patients)
• those with moderately impaired physical and mental health (39%)
• those with severely impaired physical health and moderately impaired mental health (15%)
• those with severe physical and mental health impairments (24%).

According to the research, physical and psychological injuries tend to go hand in hand. Cognitive impairment is independent of those two, however.

The study found people who have worse physical problems have worse symptoms of anxiety, depression, or post–traumatic stress disorder. The one exception was a small but distinct group (15% of all survivors) who had severe physical limitations, but only moderately severe mental health problems.

Researchers speculate that could mean those individuals already had some chronic physical challenges before developing ARDS and were more accustomed to living with physical limitations.