The purpose of this observational study is to understand how adults who survive acute respiratory failure (ARF) and the people (usually family) who support ARF survivors after returning home think about the first 6 months of recovery. The study aims to find out if expectations about the recovery process after ARF are associated with mental health symptoms in both survivors and the survivor's care partners. Study participants will complete 3 surveys over 6 months. These surveys ask questions about participants' future expectations, feelings, and mood. Surveys can be completed online, over the phone, or on paper.

The overarching objectives of the Investigating Dyadic Expectations about ARF Survivorship (IDEAS) cohort study are to learn how expectations about ARF survivorship are related to dyadic mental health symptoms and dyadic coping. Specifically, the study aims are:

• Aim 1: To determine whether health expectations and self-efficacy after acute respiratory failure (ARF) are associated with mental health outcomes in survivor-care partner dyads.
• Aim 2: To assess whether concordant expectations within survivor-care partner dyads are associated with better dyadic coping (primary outcome) and exploratory secondary outcomes.

The term dyadic coping refers to the ways two people interact as the pair manage illness-related stressors. Concordant expectations within dyads, also called shared appraisal, refers to both members of a dyad being "on the same page", and is hypothesized to lead to better dyadic coping behaviors.

Patient Inclusion Criteria:

• ≥18 years old

• Meets study definition of ARF:

  • The study defines ARF as meeting 1 of the following 3:

    1. Mechanical ventilation via an endotracheal tube ≥24 consecutive hours OR
    2. Non-invasive ventilation (CPAP, BiPAP) ≥24 consecutive hours that is not for obstructive sleep apnea or other stable use OR
    3. High flow nasal cannula with fraction of inspired oxygen (FIO2)≥.5 and flow rate ≥ litres per minute (LPM) for ≥24 consecutive hours.

  • Occasional rest periods of ≤1 hour are not deducted from the calculation of consecutive hours. Patients who are intubated for mental status or airway obstruction are not eligible unless they have simultaneous ARF.

• Survival to hospital discharge to home

• Speaks or reads English or Spanish

• Identifies an adult who is expected to act as a primary care partner for at least the next 6 months.

Patient Exclusion Criteria:

• Pre-existing cognitive impairment (IQ-CODE >3.6)
• Residing in a medical institution at hospital discharge
• Receiving hospice care or life expectancy <6 months
• Homelessness or recent history of psychosis

Care Partner Inclusion Criteria:

• ≥18 years old
• Speaks or reads English or Spanish

Care Partner Exclusion Criteria:

• Pre-existing cognitive impairment (IQ-CODE >3.6)

The study team will enroll adults who were treated for ARF in ICUs at Johns Hopkins Hospital and Bayview Medical Center in Baltimore, Maryland.

Deidentified datasets and supporting information underlying publications will be shared at or prior to initial publication date.

At or prior to publication dates.

Datasets and associated metadata and documentation maintained by JHRDR is findable and identifiable through a digital object identifier (DOI) created by Johns Hopkins Data Services (JHRDR). Study data reposited in JHRDR will be available to the research community in perpetuity.