SCCM - Society of Critical Care Medicine

Vision Grant Winners

	2012- Selina Mary Parry B.Physio (Hons) PhD Candidate at the University of Heidelberg, Australia ICU Physiotherapist at Austin Health Heidelberg, Australia Topic: An Early Intervention to Prevent Muscle Weakness in Intensive Care: A Pilot Randomized Controlled Trial Abstract: The goal of this project is to investigate the benefits of functional electrical stimulation in addition to in-bed cycling on muscle mass, strength and physical function compared to standard care. This project combines both clinical and basic sciences to evaluate cellular and molecular mechanisms responsible for muscle mass and strength changes, together with measuring patient centered outcomes.

	2011 - Christopher Seymour, MD Assistant Professor Departments of Critical Care and Emergency Medicine University of Pittsburgh Pittsburgh, PA 15261 Topic: Tiered Regionalization of Critically Ill Patients during Out-of-Hospital Care: An Impact Analysis Abstract: Tiered regionalization of critical care may reduce variability in the quality of critical care and prevent thousands of avoidable deaths. As demonstrated among traumatically injured patients, out-of-hospital providers play a key role in early triage of high risk patients to referral centers for definitive care. A similar approach is feasible for non-injured patients, but little data exists to support pilot studies and demonstration projects. The goal of this proposal is to determine the impact on hospitals, patients, and EMS agencies of a tiered regionalization strategy that begins with out-of-hospital triage. We will perform an advanced simulation with a unique population-based cohort of linked EMS records and hospital discharge data. Our results will address important barriers to implementing a regionalized approach to intensive care.
	2010 - Theodore Iwashyna, MD, PhD Assistant Professor of Internal Medicine University of Michigan Health System Ann Arbor, MI 48109-5419 Topic: The Contribution of Functional Decline in Long-Term Costs of Severe Sepsis Abstract: This proposed work will inform practice, research and policy in important ways. Understanding long-term outcomes after severe sepsis is essential to allowing patients and families to make informed choices about their care in the ICU. Understanding the long-term consequences of severe sepsis may provide new and rich targets for emerging therapies, much as research on functional status after ARDS has done.

	2009 - Scott Halpern, MD, PhD Assistant Professor of Medicine & Epidemiology University of Pennsylvania School of Medicine Division of Pulmonary & Critical Care Medicine Philadelphia, PA 19104-6021 Topic: Effects of ICU Census on Rationing and Patient Survival Abstract: As the U.S. population ages and the output of critical care physicians and nurses plateaus, the demand for critical care is increasingly outpacing its supply. Intensivists face pressures to ration ICU services, and the time they have available to spend on each patient may be decreasing. This research explores how the increased demand for critical care may influence the withholding of potentially beneficial services and the survival of ICU patients. We will use the more than 150,000 patients admitted to 123 ICUs included in the Project IMPACT database to determine whether demand for critical care (as represented by ICU census) is associated with patients' probabilities of receiving potentially beneficial services or with their survival. We will also determine whether changes in survival are mediated by the withholding of examined services. The results will help increase public acceptance of rationing and will inform considerations of the optimal organization of critical care delivery.

	2008 - Jeremy Kahn, MD, MSc Instructor of Medicine University of Pittsburgh Philadelphia, PA 19104-2327 Topic: Attitudes Toward Regionalization of Adult Critical Care Abstract: Regionalization of critical care has been proposed as a strategy to expand access to high-quality critical care. No information about the perceptions of regionalization among national care providers currently exists. The goal of this project is to survey critical care practitioners and other stakeholders regarding their attitudes toward critical care regionalization. A validated survey instrument will be administered to critical care physicians, non-critical care physicians, ICU directors, and ICU nurse managers. The survey will uncover the important potential barriers to researching, designing, and implementing a regionalized system of intensive care.

	2007 - B. Robert Gibson, MD John Hopkins Bayview Medical Center Department of Surgery Baltimore, MD 21224-2735 Topic: The Efficacy of GLP-1 (7-36) Amide for Glycemic Control in Critically Ill Surgical Patients Abstract: This study will examine reduction or diminution in amount of insulin infusion required to maintain normal glycemic levels (80-110 mg/dl) in patients who are in surgical ICU when treated with the naturally occurring insulinotropic hormone glucagon-like-peptide (GLP-1). Additionally, we hypothesize that the number of hypoglycemic events will be totally eliminated or substantially reduced with GLP-1 administration.

Norma J. Shoemaker Winners

	2012 - Lisa Kohr, MSN, CPNP-AC, MPH, PhDc Children’s Hospital of Philadelphia Department of Cardiac Services Philadelphia, PA Topic: Promoting Physiologic Stability in High Risk Infants: A Cardiac ICU Environmental Care Bundle Abstract: The proposed interventional study will evaluate the impact of a nurse-managed intensive care unit environmental care bundle that includes cycled day-night lighting, noise reduction, and contained infant positioning on physiologic stability in neonates post cardiac surgery. This study will serve as the foundation for future multicenter randomized control trial to evaluate the effectiveness of an ICU environmental care bundle on improving clinical outcomes.

	2011 - Kate E. Klein, ACNP Nurse Practitioner Cleveland Clinic Cleveland, OH 44195 Topic: Detection of Delirium in the Neurological Intensive Care: Validity of 2 Tools and Neurointensive Examination for Delirium Screening and Monitoring Abstract: Delirium is a common and serious condition that affects 64-80% of ICU patients. This neurologic derangement is associated with death, longer ventilator days, increased length of stay and cognitive impairment at hospital discharge. Validated ICU delirium assessment scales are available, but investigation in delirium detection and management in patients with primary neurological injury (PNI) and critical illness is negligible. The purposes of this study are to examine if delirium can be detected in patients with primary neurological injury and to assess three methods of detecting delirium (two delirium scales and the neurointensivist's subjective impression) to determine if they are valid assessment tools for diagnosis and ongoing monitoring of delirium in patients treated in a NICU setting. Nurses are key personnel in providing ongoing care that prevents or minimizes the occurrence of delirium. A valid, reliable assessment tool for detecting delirium in patients with PNI will allow neuroscience nurses to provide nurse-directed delirium prevention and management strategies in critically ill patients treated in a medical or neuroscience ICU.

	2009 - Mary E. Lough, RN, MS, CNS, CCRN, CNRN Clinical Nurse Specialist University of California San Francisco, CA Topic: Epigenetic Contributions to Delirium in Mechanically Ventilated Patients Abstract: This study will explore whether an association exists between thiamine deficiency, delirium and biologically related candidate gene polymorphisms in critically ill mechanically ventilated ICU patients. This is a translational research study. The phenotype of thiamine deficiency is applied to physiologically stressed ICU patients, some of whom may be genetically vulnerable to metabolic disruption of cerebral glucose pathways (from low thiamine) with a consequent increase in delirium in ICU.

	2008 - Sheila A. Alexander, BSN, PhD Assistant Professor University of Pittsburgh Pittsburgh, PA 15261 Topic: Apolipoprotein E, Inflammatory Markers and delirium in ICU Patients Abstract: Delirium, a disturbance in consciousness with inattention accompanied by a change in cognition or perceptual disturbances, is a common occurrence in hospitalized patients in and out of the ICU. Factors increasing risk for the development of delirium include increasing age, metabolic disturbances, electrolyte imbalances, drug (alcohol) withdrawal, infection, seizures, dehydration, hyperthermia, head trauma, vascular disorders, intracranial space occupying lesions and other. Delirium in the ICU has been associated with prolonged ICU stay, prolonged hospital stay, and poorer outcome. Currently, there are no biomarkers available to predict delirium onset or duration in ICU patients. Recent research has identified a potential association between presence of the apolipoprotein E (APOE) 4 allele, a gene with known influence on neurologic recovery and disease, and delirium in ICU patients. The current study will explore the relationship between apoE 4 allele presence, serum APOE protein levels, serum cytokine levels (IL-1, IL-6, IL-8, and IL-10) and development and duration of delirium in ICU patients. Subjects will be identified upon admission to the ICU and consent obtained by a clinical nurse collaborating with the research team. Blood will be drawn upon enrollment and daily for the first 5 days of admission. DNA will be extracted from the first blood sample drawn. Serum will be extracted from each sample for apoE protein and cytokine quantification. Delirium will be assessed daily by the clinical nurse using the confusion assessment method-ICU (CAM-ICU). Chi-square analysis and repeat measures analysis of variance will be used to explore associations between APOE 4 allele presence and development/duration of delirium. Hierarchical linear and nonlinear modeling will be used to explore the relationship between APOE genotype, apoE protein level, and cytokine level and delirium development/duration. Identification of a genetic biomarker for individuals at risk for delirium would aid in focusing nursing care on individuals at risk and formation of individualized care to improve outcome. The results of the proposed study will inform future studies.