Addressing Post-Intensive Care Syndrome Among Survivors of Acute Lung Injury
Abstract
Acute Lung Injury (ALI) is a devastating pulmonary condition that requires treatment in an intensive care unit (ICU) with artificial respiration to keep the person alive. ALI affects approximately 200,000 people and results in 75,000 deaths annually in the United States and accounts for over $80 billion in healthcare expenditures. Clinical advances and research over the last 20 years have significantly reduced ALI mortality, with 70%-90% of patients eventually being discharged from the ICU. However, improved survival rates have often resulted in post-discharge problems, now termed the Post-Intensive Care Syndrome (PICS). This condition contains elements of psychological distress (especially post-traumatic stress disorder and risk for repeated hospitalizations) that are extremely common among wounded Warriors, Veterans, and other Service members. Our group and others have made several key observations: (1) PICS is common; (2) ICU aftercare is expensive and fragmented; (3) fragmented care is associated with morbidity and greater healthcare burdens; (4) some groups of people appear to be at greater risk than others; (5) aftercare and recovery activities help patients with congestive heart failure, a potentially analogous situation; (6) hospital readmission is a key target for interventions; and (7) some early evidence suggests potential interventions that may work. Despite the accumulation of data documenting the reality of specific functional impairments following ALI, the specific treatment needs of individuals with PICS are not well known. This application seeks to address the clinical and operational knowledge gap for ALI survivors by defining patterns of unmet needs, resource utilization, readmissions, and long-term functional outcomes among ICU survivors. We will employ a prospective, multi-center, observational study of outcomes and healthcare utilization among ALI survivors that are directly relevant to a military population. The study will enroll 200 patients at multiple civilian and Department of Veterans Affairs (VA) hospitals centers. We hypothesize that unmet needs in the first 1-4 weeks after hospital discharge will be associated with readmission or death after hospital discharge at 3 months, even after adjusting for the likelihood of having unmet needs. The Department of Defense, VA, and civilian population may realize substantial cost savings, improved patient outcomes, and decreased healthcare utilization through the successful completion of this work. This study will help to provide the evidence needed to improve future readiness and resilience, and to preserve the health and well-being of current Service members.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810814
Entities
People
- James E. Jackson
Organizations
- United States Army
- Vanderbilt University