ABC + Post-Intensive Care Study Draft V 1.1 10.06.2021
Research type
Research Study
Full title
Anaemia & functional capacity, fatigue, daily activity, sleep and Circadian Rhythm Disruption among critical illness survivors
IRAS ID
286272
Contact name
Timothy Walsh
Contact email
Sponsor organisation
The University of Edinburgh
Duration of Study in the UK
1 years, 8 months, 1 days
Research summary
Summary of Research
With the advance of medical science and technology more and more critically ill patients survive. However, the majority of survivors have unwanted health-related issues for a long time after.
Generally, individuals after a serious illness who were treated in the Intensive Care Unit (ICU) have both low haemoglobin concentration (anaemia) and impaired physical capabilities with markedly retarded natural restoration pace. This adversely affects the individuals’ quality of life.
Recently in the UK, a multicentred clinical trial (ABC post-ICU trial) has begun, aiming to investigate the possible positive effects of the rapid anaemia correction by blood transfusion among critical illness survivors. As a side study to this trial at the single site (The Royal Infirmary Edinburgh), we plan to investigate the way how a different blood haemoglobin content (anaemia grade) affects exercise capacity, sedentary behaviour, quality of sleep, feeling of fatigue, and activities of daily living in patients after critical illness. Also, the feasibility of early bicycle-based cardiopulmonary capacity testing in hospitalized critical care survivors will be investigated.
We plan to recruit adults with capacity who have been successfully discharged from the ICU. The participants will be divided into three groups. The first, feasibility group is designed to include participants after a more severe illness, those who have been receiving mechanical lung ventilation no less than 72 hours. The second and the third group will include participants from both arms of the ABC post-ICU trial, control, and intervention.
Within the framework of the study, participants will be asked to fill in paper-based questionnaires regarding their feeling of fatigue and the activity of daily living two times, to wear a wrist-worn accelerometer device for as long as they can during day and night for approximately two months, even after hospital discharge. But, they could take it off whenever they want. And finally, close to the hospital discharge (10-20 days after ICU) participants will undertake a bicycle-based cardiopulmonary exercise test.
Summary of Results
We would like to sincerely thank all the participants who took part in this study. Your time, effort, and insights have been invaluable in helping us understand what recovery looks like after a serious illness.This research, titled “Anaemia and Functional Capacity, Fatigue, Daily Activity, Sleep, and Circadian Rhythm Disruption Among Survivors of Critical Illness,” was carried out by researchers at the University of Edinburgh in partnership with NHS Lothian.
Why We Did This Research?
Many people who survive a critical illness continue to face long-term physical and emotional challenges. These often include severe tiredness (fatigue), low energy, and difficulty carrying out everyday activities.We wanted to find out:
1) How people’s recovery changes over time; 2) How active they are; 3) How tired or low in energy they feel; 4) How their sleep and daily routines are affected; 5) We also wanted to test whether a wrist-worn activity monitor and a fitness test could be used safely and effectively to track recovery after a critical illness.Who took part?
We invited 55 adults who had recently left the Intensive Care Unit (ICU), which is the part of the hospital that looks after people who are seriously ill. Of those invited, 20 agreed to take part in our study.What We Measured?
Participants completed two short questionnaires: 1) The Barthel Index, which measures how well a person can perform daily activities; 2) The Visual Analogue Scale Fatigue, which measures severity of tiredness and energy depletion.
Both were completed during the first week after leaving intensive care and again before hospital discharge.
Participants were also asked to wear a wrist-worn activity monitor (accelerometer) to record movement and sleep for 60 days. Three participants completed an optional fitness test (bicycle-based cardiopulmonary exercise test). No safety issues were reported.What We Found?
• Most participants wore the wrist device for at least one week, and some for up to 52 days.
• Activity levels were very low in hospital, with participants walking fewer than 1,000 steps per day on average. Activity improved slowly after discharge.
• During their hospital stay, participants spent more than 75% of the day lying in bed. Sleep quality was poor, and many woke frequently at night. These problems often continued after returning home.
• Only a few participants were able to complete the fitness test, which suggests that this type of test may not be suitable for everyone soon after a serious illness.
• Most people found everyday tasks difficult soon after leaving intensive care but showed clear improvement by the time they were discharged from hospital.
• More than half of participants reported feeling very fatigued at first, though this improved by the time of discharge. However, about one third continued to experience very low energy levels.
• Those who felt more tired tended to be less active and had poorer sleep, although these associations were relatively weak.What This Means?
Our study shows that wrist-worn activity monitors can provide information about how movement and sleep change during recovery from critical illness. This could help healthcare teams understand patients’ needs better and support their recovery more effectively.Next, we hope to explore how this technology can be used in larger groups of patients and whether it can help guide rehabilitation plans or identify people who may need extra help during recovery.
REC name
East of Scotland Research Ethics Service REC 2
REC reference
21/ES/0051
Date of REC Opinion
25 Jun 2021
REC opinion
Further Information Favourable Opinion