Researchers Look To Why Lung Injury Patients Often End Up Returning To Hospital

Mar 20, 2019, 6:44 PM | Updated: 6:46 pm

MURRAY, Utah — Researchers at Intermountain Healthcare are leading a national study to pinpoint complications and close a gap in care suffered by some patients recovering from acute lung injury. That’s a serious condition treated in the intensive care unit.

Doctors want to find out why too many of those patients end up back in the hospital.

The study*, funded by the U.S. Department of Defense, hopes to determine what is causing medical complications and high re-admission rates among those patients.

“I was conscious through all of these events but I still have no memory of them,” said Amanda Grow, who was an ICU patient at Intermountain Medical Center, a year ago.

Pregnant with her fourth child, she went into labor a couple of weeks early, and delivered a baby boy by C-section.

In the recovery room her health took a nose dive.

“My blood pressure was plummeting,” she said.

After some deliberation, a team of doctors and nurses was raced to the Shock\Trauma ICU.

“When they did an EKG on my heart, there was no blood left in my heart,” she said.

She was experiencing a rare childbirth complication and bleeding internally. Grow was given a massive blood infusion to save her life, and put in a medically-induced coma for six days.

“They just told my family we don’t know: it could go either way. She could die. She could live, we’re just not exactly sure.”

Among other problems, she had acute lung injury.

“My lungs had failed, and so I had a tube down my throat, and I was restrained on the bed,” she said, to keep her from unconsciously ripping the tube from her mouth.

She has foggy, nightmarish memories.

When she left the hospital after several weeks she emerged into a different reality. She was a patient not quite ready to make that transition, she said.

She had a nurse checking on her at home — but, for those who don’t?

“They’re just dropped back into life and they have to figure out how to navigate this totally different reality,” she said.

“That kind of storm in the intensive care unit leaves after effects in a person’s body,” said Samuel M. Brown, MD, director of the Center for Humanizing Critical Care at Intermountain Medical Center. “They can take months to even years to recover.”

Many patients, whose lives are saved in the ICU, are later re-admitted with complications related to the acute lung injury. As many as 50%.

The most common causes for acute lung injury: pneumonia, serious infections, and even battlefield injuries from bomb blasts, which is why the study is funded by the Department of Defense. Intermountain Medical Center and Vanderbilt University Medical Center are lead sites for the study.

They’ll work on the three-year study with Johns Hopkins University in Baltimore, Beth Israel Deaconess Medical Center in Boston, and the Veterans Affairs Medical Center in Salt Lake City. Researchers started enrolling patients last month.

“How do we, at a functional, simple, logistical level address the needs people have in the first few weeks after they leave the hospital?” he asked.

As Brown and his colleagues started talking more with patients and their families about their experience in aftercare, they realized the system didn’t always work well for the patient.

“They almost died, and they’re rebuilding a body and a life after almost having died, and it turns out they’re very fragile,” he said. “We realized that we had been abandoning these people.”

In the study, Dr. Brown hopes to zero-in on that gap between the care in the ICU and recovery after the hospital.

He wants to learn how to identify preventable re-admissions because many of the people they save in the ICU struggle when they leave, and the system isn’t helping them.

“How often do we try to pass the baton from the hospital based team to the outpatient team, and fail to follow through on the things that we all thought made sense as part of the recovery?” he asked. “How often are the patients running into unmet needs in the weeks after they leave the hospital? So, there is a moral impulse to why we’re doing it.”

*This work was supported by the U.S. Army Medical Research and Material Command, Congressionally Directed Medical Research Programs, through the Peer-Reviewed Medical Research Program, under Award No. W81XWH-18-1-0813. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.

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Researchers Look To Why Lung Injury Patients Often End Up Returning To Hospital