Vascular thrombosis after pediatric liver transplantation: Is prevention achievable?

BACKGROUND

Although ICU mortality is declining for the > 1 million Americans with 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: To ultimately develop dynamic, adaptable care plans across recovery trajectories, what are the barriers and facilitators to ARF survivor recovery?

STUDY DESIGN AND

METHODS

After hospital discharge, we enrolled survivors of ARF discharged from 4 University of Pennsylvania Health System hospitals from June 2022 through April 2023 who underwent mechanical ventilation 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 using the Timing It Right (TIR) framework, which identifies longitudinal changing needs. We coded interview data and performed thematic analysis to identify unmet and met needs. Using TIR framework recovery constructs, we sequentially mapped needs categorically and then across time points.

RESULTS

Thirty-two patients participated in 59 interviews. Themes mapped to informational, instrumental, and emotional TIR framework 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 health care professionals. As recovery continued, the mental and emotional burden of recovery became prominent.

INTERPRETATION: Survivors of ARF encountered evolving support needs throughout the recovery trajectory 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 toward developing guidance to mitigate unmet needs and developing dynamic, adaptable care plans across recovery trajectories among survivors of ARF.