As a nurse at Virginia Commonwealth University Medical Center’s Medical Respiratory Intensive Care Unit, VCU School of Nursing clinical assistant professor Tracye Proffitt met with a former ICU patient when he returned to the hospital a year after leaving to present to the nursing staff. “He talked about his memories of experiencing delirium in the ICU,” she said of the former patient who spent four weeks at the 27-bed unit that specializes in the care of critically ill adult patients with a range of respiratory and medical conditions.
The former patient spoke about experiencing new psychological symptoms after leaving the hospital, including feelings of depression, anxiety and post-traumatic stress. “He didn’t name the symptoms, but he talked about how he had always been laid back, and after he went home he was trying to micromanage everything and had delusional memories,” she said.
Proffitt recognized the patient’s experience as a condition clinically referred to as post-intensive care syndrome. “People who survive an illness requiring a stay at the intensive care unit sometimes experience health problems including cognitive impairment, physical weakness, and psychological symptoms such as depression, anxiety and post-traumatic stress,” she said. “Having one or more of those problems as a new or worsening symptom after being discharged from the ICU is what we call post-intensive care syndrome.”
Inspired to help people like the patient who she met with that day, Proffitt decided to study how post-intensive care syndrome symptoms are related. In August, she received funding from the VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research to support her research.
“Post-intensive care syndrome has been well-studied in the literature, but what is less studied is if and how the health problems are related to one another,” Proffitt said. “I think having related problems could make one problem or the other worse. For example, having cognitive impairment could compound depressive symptoms.” She also suspects that having more than one problem likely decreases people’s health-related quality of life.
Proffitt, who is pursuing a doctoral degree at VCU School of Nursing, plans to recruit 50 participants from the VCU Medical Center Medical Respiratory ICU to participate in a pilot study that she is leading investigating associations among post-intensive care syndrome symptoms. With support from the Wright Center Clinical Research Voucher Program, a funding mechanism that provides vouchers to researchers that are equivalent to up to $10,000 in clinical services for research, Proffitt will conduct her work at the VCU Medical Center Clinical Research Unit.
“By providing services at locations where patients already receive care in the health system, we hope to increase access to research, which will lead to better treatment for our patients,” said Mary Harmon, Ph.D., VCU Health Director of Clinical Research.
Located on the eighth floor of VCU Medical Center’s North Hospital, the Clinical Research Unit provides VCU Health clinicians and researchers with the physical space and support necessary to conduct clinical research. The unit includes exam rooms, interview spaces, clinical equipment and infusion chairs. It is staffed by experienced interdisciplinary nurses and technicians who are specially trained to carry out clinical research studies within a culture of patient safety, quality and compliance.
Proffitt expects the funding received from the Wright Center to aid her with recruiting participants. “It would be difficult to recruit people into the clinical trial if I had to ask them to meet at a place they were not already familiar with,” she said. “The Clinical Research Unit provides me with a consistent, guaranteed location where I can meet with the participants.”
Proffitt’s study aims to determine the associations among delirium, cognitive status, functional status, and psychological symptoms such as depression, anxiety and post-traumatic stress in adult ICU survivors at hospital discharge and one-month after hospital discharge. The Wright Center Voucher will cover the cost of using the Clinical Research Unit for the second visit, at which she will meet with participants in the unit’s outpatient exam rooms. “After a month, most patients will be back at home,” she said. “I wanted to have a space available to meet them at that would be familiar and easy to get to.”
She describes the current research as a descriptive study to learn about what ICU patients experience after leaving the intensive care unit, but eventually she would like to develop an intervention to try to prevent and treat problems associated with post-intensive care syndrome. She also hopes to disseminate her study findings at research conferences and through publications in peer-reviewed journals.
“I want to help the patients who we take care of in the intensive care unit have the best quality of life possible after leaving the hospital,” she said. “The support I received from the Wright Center will help me get the research off the ground.”