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We investigated the impact of delirium on illness severity, psychological state, and memory in acute respiratory distress syndrome patients with very long ICU stay.Prospective cohort study in the medical-surgical ICUs of 2 teaching hospitals. Very long ICU stay (>75 days) and prolonged delirium (≥40 days) thresholds were determined by ROC analysis. Subjects were ≥18 years, full-code, and provided informed consent. Illness severity was assessed using Acute Physiology and Chronic Health Evaluation IV, Simplified Acute Physiology Score-3, and Sequential Organ Failure Assessment scores. Psychological impact was assessed using the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, and the 14-question Post-Traumatic Stress Syndrome (PTSS-14). Memory was assessed using the ICU Memory Tool survey.181 subjects were included. Illness severity did not correlate with delirium duration. On logistic regression, only PTSS-14 < 49 correlated with delirium (p = 0.001; 95% CI 1.011, 1.041). 49% remembered their ICU stay clearly. 47% had delusional memories, 50% reported intrusive memories, and 44% reported unexplained feelings of panic or apprehension.Delirium was associated with memory impairment and PTSS-14 scores suggestive of PTSD, but not illness severity.Prospective longitudinal cohort study of ARDS patients with very long ICU stay.Delirium duration did not correlate with illness severity, depression or anxiety.44% reported unexplained feelings of panic or apprehension.On logistic regression, only PTSS-14 < 49 significantly correlated with delirium duration (p = 0.001; 95% CI 1.011, 1.041).Significant memory impairment was observed. 49% remembered their ICU stay clearly, 47% had delusional memories, and 50% reported intrusive memories.