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Two-Year Cognitive, Emotional, and Quality-of-Life Outcomes in Acute Respiratory Distress Syndrome

Dr. Hopkins and colleagues (1) have made an important contribution to our understanding of the relationship between critical illness and psychological and cognitive function. However, a major limitation of this study is the use of surrogate estimates as measures of premorbid neurocognitive function. While it is certainly plausible and perhaps probable that ARDS causes neurocognitive impairment, it is also possible that some degree of neurocognitive impairment was pre-existing (2), and even predisposed patients to ARDS. For example, substance abuse (alcohol and tobacco) may be a risk factor for ARDS and is also related to behavioral and psychological problems (3–5). Another possibility is that ARDS is an epiphenomenon. Making unnecessary assumptions about cause and effect may lead to important oversights in the understanding of complex patterns of illness (6).

Scott K. Aberegg

Johns Hopkins Medical Institutions, Baltimore, Maryland

FOOTNOTES

Conflict of Interest Statement: S.K.A. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Hopkins RO, Weaver D, Collingridge D, Parkinson RB, Chan KJ, Orme JF Jr. Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med 2005;171:340–347.[Abstract/Free Full Text]
2. Garland A, Dawson NV, Altmann I, Thomas CL, Phillips RS, Tsevat J, Desbiens NA, Bellamy PE, Knaus WA, Connors AF Jr, SUPPORT Investigators. Outcomes up to 5 years after severe, acute respiratory failure. Chest 2004;126:1897–1904.[Abstract/Free Full Text]
3. Iribarren C, Jacobs DR Jr, Sidney S, Gross MD, Eisner MD. Cigarette smoking, alcohol consumption, and risk of ARDS: a 15-year cohort study in a managed care setting. Chest 2000;117:163–168.[Abstract/Free Full Text]
4. Moss M, Bucher B, Moore FA, Moore EE, Parsons PE. The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults. JAMA 1996;275:50–54.[Abstract]
5. Coelho R, Rangel R, Ramos E, Martins A, Prata J, Barros H. Depression and the severity of substance abuse. Psychopathology 2000;33:103–109.[Medline]
6. Isaacs SL, Schroeder SA. Class — the ignored determinant of the nation's health. N Engl J Med 2004;351:1137–1142.[Free Full Text]

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