Document text
Principal Investigator: Leanne M Boehm
Organization: VANDERBILT UNIVERSITY
Fiscal Year: 2024
Award: $781,969
Funding agency: National Institute on Aging
Approximately 33-50% of intensive care unit (ICU) survivors develop long-term cognitive impairment – a well-established form of Alzheimer’s Disease Related Dementia (ADRD). ICU-acquired ADRD prevalence is especially high in acute respiratory distress syndrome and sepsis survivors, affecting up to 80%. This loss of cognition leads to loss of independence, employment, and quality of life and persists for months to years. ICU-acquired ADRD is part of a broader syndrome known as Post-Intensive Care Syndrome (PICS), including physical, mental, and socioeconomic impairments. ICU Recovery Clinics (ICU-RC) are a feasible and promising intervention to collaboratively address ICU-acquired ADRD and other PICS impairments, but in-person access is limited. There is a need to study efficacy of ICU-RCs with large cohorts using alternative delivery strategies to expand availability and reach. Older (age >=45) septic shock and/or acute respiratory failure patients are at a combined risk for ICU-acquired ADRD among other impairments, and the ideal population to first address this knowledge gap. The Vanderbilt ICU Recovery Center team has nearly 10 years of experience providing interdisciplinary, collaborative care to identify and treat ICU-acquired ADRD and other PICS impairments experienced by ICU survivors. We hypothesize that a collaborative telemedicine-delivered interdisciplinary ICU-RC intervention effectively identifies and improves long-term cognitive function, and as secondary outcomes, physical and mental health function, social integration, and self-management behaviors vs. a control condition with follow-up chosen by the discharge team. Therefore, in a sample of older septic shock and acute respiratory failure survivors, we aim to examine the efficacy of telemedicine ICU-RC services vs. control follow-up chosen by the discharge team in identifying and managing ICU-acquired ADRD and other PICS impairments (i.e., physical, mental health, social, self-management function) at 6 months after hospital discharge. We will address our hypothesis and aims by conducting a controlled trial of 202 patients randomized 1:1 with age stratification to telemedicine ICU-RC or control (101 per group). Telemedicine recipients will receive a minimum of 2 ICU-RC visits within 3 months of hospital discharge or return to home if discharged to another institution, with additional follow-up determined by the severity of PICS impairment. Our primary outcome is cognitive function (Aim 1) at 6 months using the MoCA-Blind and PROMIS Cognitive Function from the Long-term Core Outcome Measurement Set for ICU survivors. Our secondary outcomes are physical and mental health functioning (Aim 2) and social integration and self-management behaviors (Aim 3). In addition to 6-month measurements, we will assess pre-hospital function and 1-week post-discharge to assess discharge functional trajectories. This research will provide scientific justification for the continued development, implementation, and scaling of ICU recovery programs. Ultimately, such knowledge can improve the quality of life for millions of ICU survivors and family members by reducing ADRD burden.
Terms: <21+ years old><AD related dementia><ADRD><Acceleration><Active Follow-up><Acute respiratory failure><Address><Adult><Adult Human><Affect><Age><Alzheimer's and related dementias><Alzheimer's disease and related dementia><Alzheimer's disease and related disorders><Alzheimer's disease or a related dementia><Alzheimer's disease or a related disorder><Alzheimer's disease or related dementia><Alzheimer's disease related dementia><Amentia><Attention><Behavior><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Care Givers><Caregivers><Caring><Clinic><Clinic Visits><Clinical><Cognition><Cognitive><Cognitive Disturbance><Cognitive Impairment><Cognitive decline><Cognitive function abnormal><Cohort Studies><Complex><Concurrent Studies><Control Groups><Critical Illness><Critically Ill><Data><Dementia><Development><Disturbance in cognition><Employment><Evaluation><Family member><Financial Hardship><Goals><Health Care Utilization><Healthcare><Home><Hospitals><Impaired cognition><Impairment><Independent Living><Institution><Intensive Care><Intensive Care Units><International><Intervention><Intervention Strategies><Intervention Studies><Knowledge><Link><Long-Term Effects><Longterm Effects><Measurement><Measures><Mental Depression><Mental Health><Mental Hygiene><Methods><Modeling><Monitor><Morbidity><Morbidity - disease rate><O element><O2 element><Outcome><Outcome Measure><Oxygen><Patients><Persons><Population><Prevalence><Process><Provider><Psyche structure><Psychological Health><QOL><Quality of life><Randomized><Randomized, Controlled Trials><Recommendation><Recovery><Reporting><Research><Research Resources><Resources><Risk><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Sampling><Schedule><Self Management><Sepsis and ARDS><Septic Shock><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Severities><Site><Social Network><Societies><Specialist><Structure><Survivors><Syndrome><Technology><Telemedicine><Testing><Time><Travel><Unemployment><Visit><Work><active followup><acute respiratory distress syndrome caused by sepsis><adulthood><age stratification><ages><blind><care delivery><caregiver quality of life><clinical care><cognitive dysfunction><cognitive function><cognitive loss><cognitive skill><cohort><collaborative care><compare to control><comparison control><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><cost><dementia burden><depression><design><designing><determine efficacy><developmental><disability><effective intervention><efficacy analysis><efficacy assessment><efficacy determination><efficacy evaluation><efficacy examination><efficacy study><evaluate efficacy><evidence base><examine efficacy><experience><financial adversity><financial burden><financial distress><financial insecurity><financial strain><financial stress><follow up><follow-up><followed up><followup><health care><health care service use><health care service utilization><healthcare service use><healthcare service utilization><healthcare utilization><homes><hospital re-admission><hospital readmission><improved><indexing><intervention research><interventional research><interventional strategy><interventional study><interventions research><jobless><joblessness><measurable outcome><mental><out of work><outcome measurement><patient centered><patient oriented><peer><physical conditioning><physical health><primary outcome><programs><quality of life for caregivers><randomisation><randomization><randomized control trial><randomly assigned><re-admission><re-hospitalization><readmission><recovery services><recovery support services><rehospitalization><retired people><retired person><retiree><rural area><rural location><rural region><secondary outcome><sepsis ARDS><sepsis acute respiratory distress syndrome><sepsis and acute respiratory distress syndrome><sepsis associated acute respiratory distress syndrome><sepsis induced ARDS><sepsis induced acute respiratory distress syndrome><sepsis related acute respiratory distress syndrome><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social><social integration><socio-economic><socio-economically><socioeconomically><socioeconomics><standard of care><survivorship><telehealth><trial comparing><unemployed><uptake>