Acute respiratory failure survivors’ needs throughout a year of recovery: A qualitative analysis using the Timing It Right framework

BACKGROUND: Although intensive care unit mortality is declining for the >1 million Americans who develop acute respiratory failure (ARF) annually, little evidence exists to guide care after hospital discharge and few studies have explored longitudinal care needs among survivors.

RESEARCH QUESTION: We conducted a qualitative study to identify barriers and facilitators to ARF survivor recovery utilizing the Timing It Right framework (TIR), which identifies longitudinal changing needs to develop dynamic, adaptable care plans across recovery trajectories.

STUDY DESIGN AND METHODS: After hospital discharge, we enrolled ARF survivors discharged from four University of Pennsylvania Health System hospitals from June 2022 through April 2023 who were mechanically ventilated for ≥24 hours into a longitudinal cohort study. We enrolled a subset of this cohort to conduct qualitative structured phone interviews at 3, 6, and 12 months regarding barriers and facilitators to recovery. We coded interview data and performed thematic analysis to identify unmet and met needs. Utilizing TIR recovery constructs, we sequentially mapped needs categorically and then across timepoints.

RESULTS: 32 patients participated in 59 interviews. Themes mapped to informational, instrumental, and emotional TIR recovery aspects across discharge preparation, transition to community, and long-term adjustment recovery phases. During discharge preparation, patients required rapport with inpatient clinicians and comprehensive information about the rehabilitation process. During transition to community, patients needed instrumental support, including increased touchpoints from healthcare professionals. As recovery continued, the mental and emotional burden of recovery became prominent.

INTERPRETATION: ARF survivors encountered evolving support needs throughout their recovery trajectories from informational needs during discharge preparation, to instrumental needs during transition to community, and emotional needs during long-term adjustment. Understanding needs trajectories is a critical first step towards developing guidance to mitigate unmet needs, and developing dynamic, adaptable care plans across recovery trajectories among ARF survivors.

National Heart, Lung, and Blood Institute

Jasmine A Silvestri, Craig Kwiatkowski, Erich M Dress, Taara V Prasad, Eric Ryu, Meeta Prasad Kerlin, Michael O Harhay, Tamar Klaiman, Rachel Kohn