Addressing Post-Intensive Care Syndrome Among Survivors of COVID (APICS-COVID)
Abstract
Acute Respiratory Distress Syndrome (ARDS) is a devastating condition that requires treatment in an intensive care unit (ICU) with artificial respiration to keep the afflicted individual alive. ARDS 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. A new cause of ARDS is pandemic COVID-19 disease, caused by a new coronavirus called SARS-CoV-2, which emerged in late 2019 and quickly spread across the globe. As of May 23, 2020, over 5 million cases of COVID-19 had been confirmed, with 1.6 million in the United States. Currently, COVID-19 continues to spread throughout the world causing a range of illness, from asymptomatic or mild symptoms to devastating lung injury (ARDS), multiorgan failure, and death. Clinical advances and research over the last 20 years have significantly reduced ARDS mortality, with 70%-90% of patients eventually being discharged from the ICU, currently the survival rate for patients with COVID-19 ARDS appears similar to prior cohorts of ARDS patients (if able to receive standard therapies). However, survivors often face post-discharge difficulties, now termed the Post Intensive Care Syndrome (PICS). This condition contains elements of psychological distress (especially post-traumatic stress disorder [PTSD] and risk for repeated hospitalizations) that are extremely common among wounded warriors, veterans, and other service members. PICS may be especially exacerbated by the COVID-19 pandemic, which has limited family interactions during hospitalization, increased isolation, and increased the use of sedative medication, all of which likely trigger worse PTSD among survivors. 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 ARDS, the specific treatment needs of individuals with PICS are not well known among patients with COVID-19 ARDS. Following up prior Department of Defense-funded research among patients with ARDS from January 2019 through July 2020, we will leverage preexisting research infrastructure to provide an unparalleled look at the outcomes and unmet needs of survivors of COVID-19. This application seeks to address the clinical and operational knowledge gap for ARDS survivors by defining patterns of unmet needs, resource utilization, readmissions, and long-term functional outcomes among ICU survivors, particularly those with COVID-19. We will employ a prospective, multi-center, observational study of outcomes and healthcare utilization among ARDS survivors that are directly relevant to a military population. The study will enroll 200 patients at multiple civilian and Veterans Administration 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, and we hypothesize that survivors of respiratory failure during the COVID-19 pandemic will differ from those enrolled in the APICS-01 cohort. The Department of Defense, Veterans Affairs Administration, 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, an
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110050
Entities
People
- Samuel M Brown
Organizations
- Intermountain Health
- United States Army