Telehealth-Enhanced Patient-Oriented Recovery Trajectory After Intensive Care

大约33-50%的重症监护室（ICU）幸存者会出现长期认知障碍，这是一种公认的阿尔茨海默病相关痴呆（ADRD）。重症监护病房获得性不良反应发生率在急性呼吸窘迫综合征和败血症幸存者中尤其高，影响高达80%。这种认知能力的丧失会导致独立性、就业和生活质量的丧失，并持续数月至数年。重症监护下获得性ADRD是重症监护后综合征（PICS）的一部分，包括身体、精神和社会经济障碍。ICU康复诊所（ICU- rc）是一种可行且有希望的干预措施，可以共同解决ICU获得性ADRD和其他PICS损伤，但亲自访问有限。有必要研究icu - rc在大型队列中使用替代递送策略的有效性，以扩大可获得性和覆盖范围。年龄较大（45岁）的感染性休克和/或急性呼吸衰竭患者在其他损伤中存在icu获得性ADRD的综合风险，是首先解决这一知识差距的理想人群。范德比尔特ICU康复中心团队有近10年的经验，提供跨学科的合作护理，以识别和治疗ICU幸存者获得性ADRD和其他PICS损伤。我们假设协作远程医疗提供的跨学科ICU-RC干预有效地识别和改善长期认知功能，作为次要结果，身心健康功能，社会整合和自我管理行为与出院团队选择的随访对照条件相比。因此，在老年感染性休克和急性呼吸衰竭幸存者的样本中，我们的目的是检查远程医疗ICU-RC服务与出院团队选择的对照随访在识别和管理icu获得性ADRD和其他PICS损伤（即身体、心理健康、社会、自我管理功能）方面的效果。我们将通过进行一项对照试验来解决我们的假设和目标，该试验将202例患者按年龄分层随机分为远程医疗ICU-RC或对照组（每组101例）。远程医疗接受者将在出院后3个月内至少接受2次ICU-RC访问，如果出院后转到其他机构，则返回家中，并根据PICS损伤的严重程度进行额外的随访。我们的主要结局是6个月时的认知功能（目标1），使用MoCA-Blind和PROMIS认知功能，来自ICU幸存者的长期核心结局测量集。我们的次要结果是身心健康功能（目标2）和社会融合和自我管理行为（目标3）。除了6个月的测量外，我们还将评估院前功能和出院后1周的功能轨迹。本研究将为ICU康复项目的持续发展、实施和规模化提供科学依据。最终，这些知识可以通过减少ADRD负担来改善数百万ICU幸存者和家庭成员的生活质量。

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.