Objective: The financial burdens and subsequent related distress of medical care, referred to as financial toxicity, may limit access to beneficial treatments. However, financial toxicity after acute care is less described-but may be an important but underexplored mechanism preventing full recovery after critical illnesses such as Acute Respiratory Distress Syndrome (ARDS). We sought to identify the mechanisms by which financial toxicity manifested in patients with ARDS, protective factors against such toxicity, and the consequences of financial toxicity to survivors' lives following ARDS. Design:We conducted semi-structured interviews following patients' hospitalization and during recovery as an ancillary study to a multi-center RCT in ARDS. Patients were 9-16 months post randomization at the time of interview. Setting and participants:The ROSE trial examined the use of early neuromuscular blockade in mechanically ventilated patients with moderate/severe ARDS. We recruited consecutive surviving patients from 29 U.S. sites who were English speaking, consented to follow-up, and were randomized between 11/12/2017 and 4/5/2018 (N=79). Measurements and Main Results:We asked about patients' perceptions of financial burden(s) that they associated with ARDS hospitalization. 46 of 79 (58%) of eligible ARDS survivors participated (from 22 sites); their median age was 56 (IQR 46, 63). 31 of 46 reported at least one ARDS-related financial impact. Financial toxicity manifested via medical bills, changes in insurance coverage, and loss of employment income. Respondents reported not working prior to ARDS, using Medicaid or Medicare, or, conversely, generous work benefits as factors which may have limited financial burdens. Patients reported multiple consequences of ARDS-related Financial Toxicity After ARDS 4 financial toxicity, including harms to their mental and physical health, increased reliance on others, and specific material hardships.Conclusions: Financial toxicity related to critical illness is common and may limit patients' emotional, physical, and social recovery after ARDS hospitalization for at least a year.

Background 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. Objectives To explore how patients adapt to physical, cognitive, and emotional changes related to hospitalization for ARDS. Methods 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. Results 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. Conclusions Patients employed various strategies to manage problems after ARDS. More work is needed to identify and disseminate effective strategies to patients and their families.

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The coronavirus disease 2019 (COVID-19) pandemic continues, and healthcare workers (HCWs) are at increased risk of infection. 1 In addition to the morbidity associated with initial illness, persistent postviral symptoms, currently classified as postacute sequelae of COVID-19 (PASC), 2 also affect HCWs, causing further disruptions in their work, home, and social lives. 3 To further characterize PASC in this population, who are otherwise expected to be highly functional and in relatively good health, we sought to identify predictors and functional status of HCWs with persistent symptoms beyond 4 weeks after their initial COVID-19 diagnosis. Methods