Redefining Critical Illness Survivorship

As a doctor in an intensive care unit (ICU), I see critically ill patients of all ages, backgrounds and health histories.

Maybe the patient needs close monitoring after a major surgery. Maybe the patient was on a ventilator and contracted pneumonia or another serious infection. Or maybe the patient was perfectly healthy until injuries from a major car accident suddenly have them fighting for their lives. The point is that anyone can end up needing intensive care.

Patients admitted to the ICU have an increased risk of developing post-intensive care syndrome (PICS), or the health problems that remain after critical illness, such as drawn-out muscle weakness, issues with thinking and judgment, and other mental health problems.

I saw this firsthand among multiple survivors of critical illness–some of whom I knew personally.

This is what inspired me and my fellow clinician-researchers at the Indiana University Center for Aging Research, the Regenstrief Institute and IU School of Medicine to establish in 2011 the nation’s first collaborative care prototype clinic, Eskenazi Health Critical Care Recovery Center (CCRC). The clinic’s role is to provide specialized follow-up care for ICU survivors, such as supporting their extensive cognitive, psychological and physical recovery needs, after they are discharged from the hospital or rehabilitation facility.

Our clinic is also run by an ICU clinician, making Indiana one of very few places in the United States where ICU survivors may be able to continue care with their original ICU doctors typically don’t know what happens to their patients after they are discharged because, in traditional care models, those patients follow-up with their primary care physicians.

Since founding the clinic in 2011, our research team has received close to $7 million dollars in grants to study a variety of issues related to ICU patients and survivors, including virtual care models and novel assessment tools.

Most recently, we received a $3.48 million grant from the National Institute on Aging to develop and test the nation’s first cognitive training and physical exercise program to be delivered via telemedicine to ICU survivors who experienced delirium while in the hospital.

Delirium, which affects 70 percent of older ICU patients, is an acute brain failure resulting in confusion and long-term memory problems that can lead to dementia and long-term disability. Unfortunately not everyone can come to our clinic or have a cognitive or physical therapist come to their home. We are hopeful that a telemedicine, or virtual, program will help these patients get the care they need—from the convenience of their homes—to decrease their risk of dementia, anxiety and depressive symptoms and to enhance their physical function and quality of life.