Journal of Critical Care
Volume 22, Issue 4 , Pages 275-284, December 2007

Intensive care unit exposures for long-term outcomes research: Development and description of exposures for 150 patients with acute lung injury☆

  • Dale M. Needham, MD, PhD

      Affiliations

    • Division of Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
    • Corresponding Author InformationCorresponding author. Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA. Tel.: +1 410 955 3467; fax: +1 410 955 0036.
    • ,
  • Weiwei Wang, MS Eng

      Affiliations

    • Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    • ,
  • Sanjay V. Desai, MD

      Affiliations

    • Division of Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
    • ,
  • Pedro A. Mendez-Tellez, MD

      Affiliations

    • Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
    • ,
  • Cheryl R. Dennison, ANP, PhD

      Affiliations

    • School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
    • ,
  • Jonathan Sevransky, MD

      Affiliations

    • Division of Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
    • ,
  • Carl Shanholtz, MD

      Affiliations

    • Division of Pulmonary/Critical Care Medicine, University of Maryland, Baltimore, MD 21201, USA
    • ,
  • Nancy Ciesla, PT

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD 21205, USA
    • ,
  • Kim Spillman, MPH

      Affiliations

    • Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    • ,
  • Peter J. Pronovost, MD, PhD

      Affiliations

    • Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
    • School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
    • Department of Surgery, Johns Hopkins University, Baltimore, MD 21205, USA

published online 26 June 2007.

Abstract 

Purpose

Long-term follow-up studies in critical care have described survivors' outcomes, but provided less insight into the patient/disease characteristics and intensive care therapies (“exposures”) associated with these outcomes. Such insights are essential for improving patients' long-term outcomes. This report describes the development of a strategy for comprehensively measuring relevant exposures for long-term outcomes research, and presents empiric results from its implementation.

Materials and Methods

A multistep, iterative process was used to develop the exposures strategy. First, a comprehensive list of potential exposures was generated and subsequently reduced based on feasibility, redundancy, and relevance criteria. Next, data abstraction methods were designed and tested. Finally, the strategy was implemented in 150 patients with acute lung injury with iterative refinement.

Results

The strategy resulted in the development of more than 60 unique exposures requiring less than 45 minutes per patient-day for data collection. Most exposures had minimal missing data and adequate reliability. These data revealed that evidence-based practices including lower tidal volume ventilation, spontaneous breathing trials, sedation interruption, adequate nutrition, and blood glucose of less than 6.1 mmol/L (110 mg/dL) occurred in only 23% to 50% of assessments.

Conclusions

Using a multistep, iterative process, a comprehensive and feasible exposure measurement strategy for long-term outcomes research was successfully developed and implemented.

Keywords: Respiratory distress syndrome, adult, Methodological study, Cohort studies, Prospective studies, Risk factors, Epidemiologic methods

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☆ This research received support from the National Institutes of Health (Acute Lung Injury SCCOR grant no. P050 HL 73994). Dr Needham is supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research. Drs Dennison and Sevransky are supported by Mentored Patient-Oriented Research Career Development Awards from the National Institutes of Health (K23 NR009193 and K23 GM071399, respectively). The funding bodies had no role in the study design, manuscript writing, or decision to submit the manuscript for publication.

PII: S0883-9441(07)00037-8

doi:10.1016/j.jcrc.2007.02.001

Journal of Critical Care
Volume 22, Issue 4 , Pages 275-284, December 2007

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