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Article ; Online: Meeting the Challenges of Establishing Intensive Care Unit Follow-up Clinics.

Butcher, Brad W / Eaton, Tammy L / Montgomery-Yates, Ashley A / Sevin, Carla M

American journal of critical care : an official publication, American Association of Critical-Care Nurses

2022 Volume 31, Issue 4, Page(s) 324–328

Abstract: Intensive care unit follow-up clinics are becoming an increasingly widespread intervention to facilitate the physical, cognitive, psychiatric, and social rehabilitation of survivors of critical illness who have post-intensive care syndrome. Developing ... ...

Abstract	Intensive care unit follow-up clinics are becoming an increasingly widespread intervention to facilitate the physical, cognitive, psychiatric, and social rehabilitation of survivors of critical illness who have post-intensive care syndrome. Developing and sustaining intensive care unit follow-up clinics can pose significant challenges, and clinics need to be tailored to the physical, personnel, and financial resources available at a given institution. Although no standard recipe guarantees a successful intensive care unit aftercare program, emerging clinics will need to address a common set of hurdles, including securing an adequate space; assembling an invested, multidisciplinary staff; procuring the necessary financial, information technology, and physical stuff; using the proper screening tools to identify patients most likely to benefit and to accurately identify disabilities during the visit; and selling it to colleagues, hospital administrators, and the community at large.
MeSH term(s)	Aftercare ; Critical Care/psychology ; Critical Illness/psychology ; Follow-Up Studies ; Humans ; Intensive Care Units ; Survivors/psychology
Language	English
Publishing date	2022-06-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1130987-8
ISSN	1937-710X ; 1062-3264
ISSN (online)	1937-710X
ISSN	1062-3264
DOI	10.4037/ajcc2022987
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Article ; Online: Patients Surviving Critical COVID-19 have Impairments in Dual-task Performance Related to Post-intensive Care Syndrome.

Morelli, Nathan / Parry, Selina M / Steele, Angela / Lusby, Megan / Montgomery-Yates, Ashley A / Morris, Peter E / Mayer, Kirby P

Journal of intensive care medicine

2022 Volume 37, Issue 7, Page(s) 890–898

Abstract: Objective: The purpose was to examine Dual Task (DT) performance in patients surviving severe and critical COVID-19 compared to patients with chronic lung disease (CLD). Secondarily, we aimed to determine the psychometric properties of the Timed Up and ... ...

Abstract	Objective: The purpose was to examine Dual Task (DT) performance in patients surviving severe and critical COVID-19 compared to patients with chronic lung disease (CLD). Secondarily, we aimed to determine the psychometric properties of the Timed Up and Go (TUG) test in patients surviving COVID-19. Design: Prospective, cross-sectional, observational study. Setting: Academic medical center within United States. Patients: Ninety-two patients including 36 survivors of critical COVID-19 that required mechanical ventilation (critical-COVID), 20 patients recovering from COVID-19 that required supplemental oxygen with hospitalization (severe-COVID), and 36 patients with CLD serving as a control group. Measurements and main results: Patients completed the TUG, DT-TUG, Short Physical Performance Battery (SPPB), and Six Minute Walk Test (6MWT) 1-month after hospital discharge. A subset of patients returned at 3-months and repeated testing to determine the minimal detectable change (MDC). Critical-COVID group (16.8 ± 7.3) performed the DT-TUG in significantly slower than CLD group (13.9 ± 4.8 s; Conclusion: The ability to maintain mobility performance in the presence of a cognitive DT is grossly impaired in patients surviving critical COVID-19. DT performance may subserve the understanding of impairments related to Post-intensive care syndrome (PICS) for survivors of critical illness.
MeSH term(s)	COVID-19/complications ; Critical Illness ; Cross-Sectional Studies ; Gait ; Humans ; Prospective Studies ; Task Performance and Analysis
Language	English
Publishing date	2022-01-24
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/08850666221075568
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 2158: Show issues

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Article ; Online: Post-intensive care syndrome and pulmonary fibrosis in patients surviving ARDS-pneumonia of COVID-19 and non-COVID-19 etiologies.

Sturgill, Jamie L / Mayer, Kirby P / Kalema, Anna G / Dave, Kinjal / Mora, Stephanie / Kalantar, Alborz / Carter, David J / Montgomery-Yates, Ashley A / Morris, Peter E

Scientific reports

2023 Volume 13, Issue 1, Page(s) 6554

Abstract: The purpose was to examine patient-centered outcomes and the occurrence of lung fibrotic changes on Chest computed tomography (CT) imaging following pneumonia-related acute respiratory distress syndrome (ARDS). We sought to investigate outpatient clinic ... ...

Abstract	The purpose was to examine patient-centered outcomes and the occurrence of lung fibrotic changes on Chest computed tomography (CT) imaging following pneumonia-related acute respiratory distress syndrome (ARDS). We sought to investigate outpatient clinic chest CT imaging in survivors of COVID19-related ARDS and non-COVID-related ARDS, to determine group differences and explore relationships between lung fibrotic changes and functional outcomes. A retrospective practice analysis of electronic health records at an ICU Recovery Clinic in a tertiary academic medical center was performed in adult patients surviving ARDS due to COVID-19 and non-COVID etiologies. Ninety-four patients with mean age 53 ± 13 and 51% male were included (n = 64 COVID-19 and n = 30 non-COVID groups). There were no differences for age, sex, hospital length of stay, ICU length of stay, mechanical ventilation duration, or sequential organ failure assessment (SOFA) scores between the two groups. Fibrotic changes visualized on CT imaging occurred in a higher proportion of COVID-19 survivors (70%) compared to the non-COVID group (43%, p < 0.001). Across both groups, patients with fibrotic changes (n = 58) were older, had a lower BMI, longer hospital and ICU LOS, lower mean RASS scores, longer total duration of supplemental oxygen. While not statistically different, patients with fibrotic changes did have reduced respiratory function, worse performance on the six-minute walk test, and had high occurrences of anxiety, depression, emotional distress, and mild cognitive impairment regardless of initial presenting diagnosis. Patients surviving pneumonia-ARDS are at high risk of impairments in physical, emotional, and cognitive health related to Post-Intensive Care Syndrome. Of clinical importance, pulmonary fibrotic changes on chest CT occurred in a higher proportion in COVID-ARDS group; however, no functional differences were measured in spirometry or physical assessments at ICU follow-up. Whether COVID infection imparts a unique recovery is not evident from these data but suggest that long-term follow up is necessary for all survivors of ARDS.
MeSH term(s)	Adult ; Humans ; Male ; Middle Aged ; Aged ; Female ; COVID-19/complications ; Pulmonary Fibrosis/complications ; Pulmonary Fibrosis/diagnostic imaging ; Retrospective Studies ; Pneumonia/complications ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/epidemiology
Language	English
Publishing date	2023-04-21
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-32699-x
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Article: Construct and criterion validity of muscle ultrasonography for assessment of skeletal muscle in patients recovering from COVID-19.

Mayer, Kirby P / Kosmac, Kate / Wen, Yuan / Parry, Selina M / Dhar, Sanjay / Foster, Sarah / Starck, Jonathan / Montgomery-Yates, Ashley A / Dupont-Versteegden, Esther E / Kalema, Anna G

Frontiers in physiology

2023 Volume 14, Page(s) 1231538

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2023-10-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564217-0
ISSN	1664-042X
ISSN	1664-042X
DOI	10.3389/fphys.2023.1231538
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Article ; Online: Nutrition in the intensive care unit and early recovery influence functional outcomes for survivors of critical illness: A prospective cohort study.

Jubina, Lindsey E / Locke, Alleyna / Fedder, Kelly R / Slone, Stacey A / Soper, Melissa K / Kalema, Anna G / Montgomery-Yates, Ashley A / Mayer, Kirby P

JPEN. Journal of parenteral and enteral nutrition

2023 Volume 47, Issue 7, Page(s) 888–895

Abstract: Background: Patients who are critically ill may receive suboptimal nutrition that leads to weight loss and increased risk of functional deficits.: Methods: Our overarching hypothesis is that nutrition in the intensive care unit (ICU) and the early ... ...

Abstract	Background: Patients who are critically ill may receive suboptimal nutrition that leads to weight loss and increased risk of functional deficits. Methods: Our overarching hypothesis is that nutrition in the intensive care unit (ICU) and the early recovery phase associates with functional outcomes at short-term follow-up. We enrolled adult patients who attended the University of Kentucky ICU recovery clinic (ICU-RC) from November 2021 to June 2022. Patients participated in muscle and functional assessments. Nutrition intake and status during the ICU stay were analyzed. The Subjective Global Assessment and a nutrition questionnaire were used to identify changes in intake, ongoing gastrointestinal symptoms, and patient's access to food at the ICU-RC appointment. Results: Forty-one patients enrolled with a median hospital length of stay (LOS) of 23 days. Patients with 0 days of nil per os (NPO) status throughout hospitalization had a shorter LOS (P = 0.05), were able to complete the five times sit-to-stand test (P = 0.02), and were less likely to experience ICU-acquired weakness (P = 0.04) at short-term follow-up compared with patients with ≥1 day of NPO status. Twenty (48%) patients reported changes in nutrition intake in early recovery compared with before hospitalization. Eight (20%) patients reported symptoms leading to decreased intake and four (10%) reported access to food as a barrier to intake. Conclusion: Barriers to nutrition exist during critical illness and persist after discharge, with almost half of patients reporting a change in intake. Inpatient nutrition intake is associated with functional outcomes and warrants further exploration.
MeSH term(s)	Adult ; Humans ; Critical Illness ; Prospective Studies ; Nutritional Status ; Intensive Care Units ; Length of Stay ; Survivors
Language	English
Publishing date	2023-07-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	800861-9
ISSN	1941-2444 ; 0148-6071
ISSN (online)	1941-2444
ISSN	0148-6071
DOI	10.1002/jpen.2538
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Article ; Online: Procalcitonin: A promising tool or just another overhyped test?

Paudel, Robin / Dogra, Prerna / Montgomery-Yates, Ashley A / Coz Yataco, Angel

International journal of medical sciences

2020 Volume 17, Issue 3, Page(s) 332–337

Abstract: Sepsis is the leading cause of death worldwide. Timely administration of antibiotics is recognized as the cornerstone in the management of sepsis. However, inappropriate use of antibiotics may lead to adverse effects and the selection of drug-resistant ... ...

Abstract	Sepsis is the leading cause of death worldwide. Timely administration of antibiotics is recognized as the cornerstone in the management of sepsis. However, inappropriate use of antibiotics may lead to adverse effects and the selection of drug-resistant pathogens. Microbiological cultures remain the gold standard to diagnose infection despite their low sensitivity and the intrinsic delay to obtain the results. Certain biomarkers have the benefit of rapid turnover, potentially providing an advantage in timely diagnosis leading to accurate treatment. Over the last few decades, there is an ongoing quest for the ideal biomarker in sepsis. Procalcitonin (PCT), when used alone or alongside additional clinical information, has shown to be a promising tool to aid in the diagnosis and management of patients with sepsis. In February 2017, the Food and Drug Administration (FDA) approved the use of PCT to guide antibiotic treatment in lower respiratory tract infections and sepsis. Despite a good negative predictive value for bacterial infection, the utility of PCT-guided antibiotic initiation is conflicting at best. On the other hand, the use of PCT-guided antibiotic discontinuation has shown to reduce the duration of antibiotic use, the associated adverse effects, and to decrease the overall mortality. The current review discusses the history and pathophysiology of procalcitonin, synthesizes its utility in the diagnosis and management of sepsis, highlights its limitations and compares it with other biomarkers in sepsis.
MeSH term(s)	Animals ; Anti-Bacterial Agents/therapeutic use ; Biomarkers/metabolism ; Humans ; Procalcitonin/metabolism ; Respiratory Tract Infections/drug therapy ; Respiratory Tract Infections/metabolism ; Sepsis/drug therapy ; Sepsis/metabolism
Chemical Substances	Anti-Bacterial Agents ; Biomarkers ; Procalcitonin
Language	English
Publishing date	2020-01-18
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	2151424-0
ISSN	1449-1907 ; 1449-1907
ISSN (online)	1449-1907
ISSN	1449-1907
DOI	10.7150/ijms.39367
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Article: Feasibility of Contrasting Brain Connectivity Patterns in Cognitive and Motor Cerebral Networks to Clinical Outcomes in Patients Surviving Acute Respiratory Failure: A Pilot Study.

Morelli, Nathan / Johnson, Nathan F / Cassity, Evan P / Kalema, Anna G / Morris, Peter E / Montgomery-Yates, Ashley A / Mayer, Kirby P

Cureus

2021 Volume 13, Issue 9, Page(s) e17785

Abstract: Background: There is a paucity of research regarding the feasibility and association of cerebral cortex function to patient outcomes after acute respiratory failure (ARF).: Purpose: To determine the feasibility of functional connectivity measures and ...

Abstract	Background: There is a paucity of research regarding the feasibility and association of cerebral cortex function to patient outcomes after acute respiratory failure (ARF). Purpose: To determine the feasibility of functional connectivity measures and examine the association of functional connectivity to a multifaceted battery of outcomes in survivors of ARF. Methods: Eight ARF patients (age:58±3.7, ICU days:10.4±8.6) completed functional magnetic resonance imaging (fMRI), cognitive, physical-function, anxiety, depression, and driving simulator tests at one month post-hospital discharge. Pearson's correlations assessed the relationship between functional connectivity within the default mode network (FPN), sensorimotor network (SMN), and frontoparietal network (FPN) to outcomes. Results: Low physical-function (r=0.75, p=0.03) and divided-attention (r=-0.86, p=0.03) during the driving simulator task correlated with low FPN connectivity. Low SMN connectivity demonstrated relationships to slower gait speed (r=0.82, p=0.01) and low short physical performance battery (SPPB) scores (r=0.81, p=0.01). Conclusions: fMRI is feasible to assess ARF patients' post-ICU limitations, as low post-ARF brain connectivity may be linked to low physical function, providing potential development of therapeutic interventions.
Language	English
Publishing date	2021-09-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.17785
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Article ; Online: ICU Recovery Clinic Attendance, Attrition, and Patient Outcomes: The Impact of Severity of Illness, Gender, and Rurality.

Mayer, Kirby P / Boustany, Heba / Cassity, Evan P / Soper, Melissa K / Kalema, Anna G / Hatton Kolpek, Jimmi / Montgomery-Yates, Ashley A

Critical care explorations

2020 Volume 2, Issue 10, Page(s) e0206

Abstract: Objectives: The primary purpose is to characterize patients attending ICU recovery clinic and then describe their trajectory of cognitive and emotional health in 1 year.: Design: Retrospective observational study to assess attendance, attrition, and ... ...

Abstract	Objectives: The primary purpose is to characterize patients attending ICU recovery clinic and then describe their trajectory of cognitive and emotional health in 1 year. Design: Retrospective observational study to assess attendance, attrition, and patient outcomes. Setting: ICU Recovery Clinic. Patients: Adult patients recently admitted to ICU for sepsis or acute respiratory failure and who were referred to clinic. Interventions: None. Measurements and main results: Thirty-eight patients (63%) attended ICU recovery clinic with a mean age of 53.2 ± 16 years (range, 20-82 yr), 42% female and mean Sequential Organ Failure Assessment scores at an ICU admission of 9.4 ± 2.9 participated in outcomes. Twelve patients (32%) were lost to follow up and 12 patients (32%) were transferred to different providers before the end of 1 year. Sequential Organ Failure Assessment scores were negatively associated with health-related quality of life at baseline ( Conclusions: Attendance and attrition in ICU recovery clinic are related to patient factors (living in rural area) and ICU factors. Data suggest different recovery trajectories exist based on gender, severity of illness, and self-reported outcomes.
Keywords	covid19
Language	English
Publishing date	2020-09-28
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000206
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Article ; Online: Safety and Feasibility of an Interdisciplinary Treatment Approach to Optimize Recovery From Critical Coronavirus Disease 2019.

Mayer, Kirby P / Parry, Selina M / Kalema, Anna G / Joshi, Rajan R / Soper, Melissa K / Steele, Angela K / Lusby, Megan L / Dupont-Versteegden, Esther E / Montgomery-Yates, Ashley A / Morris, Peter E

Critical care explorations

2021 Volume 3, Issue 8, Page(s) e0516

Abstract: Objectives: Examine the safety and feasibility of a multimodal in-person or telehealth treatment program, administered in acute recovery phase for patients surviving critical coronavirus disease 2019.: Design: Pragmatic, pre-post, nonrandomized ... ...

Abstract	Objectives: Examine the safety and feasibility of a multimodal in-person or telehealth treatment program, administered in acute recovery phase for patients surviving critical coronavirus disease 2019. Design: Pragmatic, pre-post, nonrandomized controlled trial with patients electing enrollment into one of the two recovery pathways. Setting: ICU Recovery Clinic in an academic medical center. Patients: Adult patients surviving acute respiratory failure due to critical coronavirus disease 2019. Interventions: Patients participated in combined ICU Recovery clinic and 8 weeks of physical rehabilitation delivered: 1) in-person or 2) telehealth. Patients received medical care by an ICU Recovery Clinic interdisciplinary team and physical rehabilitation focused on aerobic, resistance, and respiratory muscle training. Measurements and main results: Thirty-two patients enrolled with mean age 57 ± 12, 62% were male, and the median Sequential Organ Failure Assessment score was 9.5. There were no differences between the two groups except patients in telehealth pathway ( Conclusions: A multimodal treatment program combining care from an interdisciplinary team in an ICU Recovery Clinic with physical rehabilitation is safe and feasible in patients surviving the ICU for coronavirus disease 2019 acute respiratory failure.
Language	English
Publishing date	2021-08-19
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000516
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Article ; Online: Physical Therapy Management of an Individual With Post-COVID Syndrome: A Case Report.

Mayer, Kirby P / Steele, Angela K / Soper, Melissa K / Branton, Jill D / Lusby, Megan L / Kalema, Anna G / Dupont-Versteegden, Esther E / Montgomery-Yates, Ashley A

Physical therapy

2021 Volume 101, Issue 6

Abstract: Objective: The purpose of this case report is to provide the clinical presentation and physical therapist management for a patient with post-COVID syndrome. Secondarily, the report highlights the importance of assessing cognitive and emotional health in ...

Abstract	Objective: The purpose of this case report is to provide the clinical presentation and physical therapist management for a patient with post-COVID syndrome. Secondarily, the report highlights the importance of assessing cognitive and emotional health in patients with post-COVID syndrome. Methods (case description): A 37-year-old woman tested positive for SARS-CoV-2 and developed mild COVID-19 disease but did not require supplemental oxygen or hospitalization. The patient experienced persistent symptoms, including dyspnea, headaches, and cognitive fog. On day 62, they participated in an outpatient physical therapist evaluation that revealed deficits in exercise capacity, obtaining 50% of their age-predicted 6-minute walk distance. They had minor reductions in muscle strength and cognitive function. Self-reported quality of life was 50, and they scored above established cut-off scores for provisional diagnosis of posttraumatic stress disorder (PTSD). Results: The patient participated in biweekly physical therapist sessions for 8 weeks, which included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and mindfulness training. Metabolic equivalent for task levels increased with variability over the course of the program. The patient's muscle strength, physical function, and exercise capacity improved. 6-Minute walk distance increased by 199 m, equating to 80% of their age-predicted distance. Quality of life and PTSD scores did not improve. At evaluation after physical therapy, the patient was still experiencing migraines, dyspnea, fatigue, and cognitive dysfunction. Conclusion: This case report described the clinical presentation and physical therapist management of a person with post-COVID syndrome, a novel health condition for which little evidence exists to guide rehabilitation examination and interventions. Physical therapists should consider cognitive function and emotional health in their plan of care for patients with post-COVID syndromes. Impact: This case alerts physical therapists to post-COVID syndrome-which can include debilitating symptoms of decreased aerobic tolerance, anxiety, PTSD, and cognitive dysfunction-and to the role that therapists can play in assessing these symptoms and managing these patients.
MeSH term(s)	Adult ; COVID-19/complications ; COVID-19/therapy ; Cognitive Dysfunction/therapy ; Cognitive Dysfunction/virology ; Dyspnea/therapy ; Dyspnea/virology ; Female ; Humans ; Pandemics ; Physical Therapy Modalities ; Quality of Life ; SARS-CoV-2 ; Stress Disorders, Post-Traumatic/therapy ; Stress Disorders, Post-Traumatic/virology ; Surveys and Questionnaires ; Syndrome ; Walk Test
Language	English
Publishing date	2021-03-18
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	415886-6
ISSN	1538-6724 ; 0031-9023
ISSN (online)	1538-6724
ISSN	0031-9023
DOI	10.1093/ptj/pzab098
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