teleport pilot study

Conditions: Critical Illness; Acute Respiratory Distress Syndrome; Septic Shock

Summary: although more than 50% of survivors of critical illness experience one or more post-intensive care syndrome (pics) problems, there are still no validated interventions for the management of pics. the long-term goal of this study is to develop and refine in-person and telehealth strategies for the delivery of intensive care unit (icu) recovery care for the treatment of pics.

the overall objectives in this application are to (a) examine the feasibility of providing telehealth icu recovery care and (b) determine if icu recovery care is effective. the central hypothesis is that icu recovery care improves cognitive, mental health, and physical function of icu survivors by application of a patient-centered survivorship care plan with targeted interventions to address patient-specific cognitive, mental health, and physical dysfunctions. the rationale for this project is that a determination of the feasibility of telehealth and effectiveness of icu recovery care in general is likely to offer a strong scientific framework informing the development of new implementation strategies. we will test the central hypotheses by pursuing two specific aims: 1) test that telehealth icu recovery care is feasible, and 2) test the hypothesis that telehealth icu recovery care compared to standard of care conditions will be more effective for improvement in cognitive, mental health, physical, and global function at 6 months following hospital discharge. to address these aims, we will enroll patients treated for septic shock and acute respiratory distress syndrome in the medical and surgical icus at vanderbilt university medical center. study patients will be randomized 1:1 to either the telehealth icu recovery care or standard of care groups. we will conduct telehealth icu recovery care from the vanderbilt icu recovery center. this icu survivor clinic relies on the expertise of clinicians from critical care medicine, nursing, pharmacy, neuropsychology, rehabilitation, and case management to assess and manage pics. telehealth feasibility measures include appropriateness, acceptability, and implementability. following telehealth clinic participation at 3 weeks and 3 months after hospital discharge, we will assess participants for cognitive, mental health, physical, and global quality of life outcomes using trained, blinded research personnel at 6 months following hospital discharge. we incorporated promis patient-centered outcome measures into each patient outcome category. this research is significant because it is expected to provide scientific justification for the continued development and implementation of icu recovery care programs. ultimately, such knowledge has the potential to improve the quality of life for millions of icu survivors and their family members.

Eligibility criteria:
inclusion criteria: * index icu stay with a diagnosis of sepsis or acute respiratory distress syndrome projected to be discharged alive as these patients are at the highest risk for developing pics exclusion criteria: 1. no access to computer, electronic device (e.g., tablet, smartphone), and/or internet connection for virtual clinic visit, 2. primary care received outside of vumc network, 3. hospice care at discharge, 4. substance abuse or psychiatric disorder that prevents independent living, 5. blind, deaf, unable to speak english, or 6. severe dementia prior to index hospitalization

Keywords: post-intensive care syndrome