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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

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