Utilizing Technology for Optimization of Pain Management and Mobilization in High Risk Cardiac Surgical ICU Patients

NCT ID: NCT04146727

Last Updated: 2019-10-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

168 participants

Study Classification

OBSERVATIONAL

Study Start Date

2020-01-31

Study Completion Date

2021-06-30

Brief Summary

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The purpose of this project is to improve mobility in the perioperative period using activity trackers to augment current practice.

Delirium and poor functional status following ICU stays are intractable problems for which clear solutions do not exist. Digital health approaches have not been applied to these problems in the ICU setting and may represent a viable and unexplored intervention.

The program will involve the utilization of an activity tracker in ambulating patients. There will be two arms to the program. The first will involve the longitudinal study of ambulating lung transplant patients. Patients will be given an activity tracker at time of transplant which will continue throughout their care into their first month at home. The data will be collected to identify correlation between activity and clinical outcomes.

Detailed Description

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Early mobilization of patients, minimizing sedatives, maximizing pain control, optimizing sleep are strongly associated with decreased rates of delirium, decreased ICU length of stay, decreased hospital length of stay as well as improved functional status and quality of life at 1 year. Cardiac surgical patients that are at high risk of prolonged stay in the ICU due to the inherent nature of their disease (ie need for MCS (mechanical circulatory support) or lung transplantation) are most likely to benefit from a systematic aggressive approach to early mobilization. Technology such as activity trackers and virtual reality have been studied in general surgical populations but with limited data in the ICU and to date no studies in a cardiac surgical population. Activity trackers utilized in a multidisciplinary team to provide objective data to care teams and patients can be used to develop goal setting and patient motivation for teams, thereby improving mobility

Overall Goal: To evaluate whether quantitative information on post procedural ambulation in mechanical device patients, cardiac surgical patients and lung transplant patients can improve care teams ability to monitor and identify patients at high risk for complications and prolonged length of stay.

* The purpose of the research is to improve mobility in the perioperative period using Activity Trackers to augment current practice.
* Objective quantification and improvement in activity of post cardiac surgery patients might result in improved clinical outcomes, thereby making this tool a part of routine practice.

Patient Populations:

1. Lung transplant patients
2. Routine postoperative Cardiac surgical patients (elective cardiac surgical procedures including CABG and Valve replacement)
3. Device Patients (axillary patients pre-open heart transplantation (OHT). Post MCS patients)

Specific Aim 1: Create standardized trajectories for ambulation of study subject populations from time of index procedure to 30 days postoperatively Specific Aim 2: To determine if deviation from the standardized trajectory of postoperative ambulation predicts disposition (home, rehabilitation facility or SNF), length of stay, 30 day readmissions, intensive care unit (ICU) readmission, DVT, respiratory insufficiency (aspiration) Specific Aim 3: To determine if decline in ambulation over 48 hours for a given patient predicts outcomes including length of stay, readmission to an icu, readmission to hospital, deep vein thrombosis (DVT), respiratory insufficiency.

The purpose of this project is to improve mobility in the perioperative period using activity trackers to augment current practice.

Delirium and poor functional status following ICU stays are intractable problems for which clear solutions do not exist. Digital health approaches have not been applied to these problems in the ICU setting and may represent a viable and unexplored intervention.

The program will involve the utilization of an activity tracker in ambulating patients. There will be two arms to the program. The first will involve the longitudinal study of ambulating lung transplant patients. Patients will be given an activity tracker at time of transplant which will continue throughout their care into their first month at home. The data will be collected to identify correlation between activity and clinical outcomes.

The second part of the program will be within the intensive care unit. The daily step count will be recorded for all ambulatory patients that fall into one of the defined subject populations and have signed informed consent. Step counts will be displayed for the care teams as well as the patient. This will be utilized by team to continuously evaluate and modify physical mobility goals for the patient with earlier recognition of decreasing mobility which is associated with worse outcomes. The goals and progress for the patient will be displayed to the nursing staff and the patient which we hypothesize will increase motivation.

Our hypothesis is that these interventions will increase mobility, decrease ICU length of stay, optimize the ICU experience, and potentially increase in 6-month functional status.

Conditions

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Transplant; Failure, Heart Heart Failure, Congestive Lung Transplant Failure

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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ICU Duration

The total study duration is determined by their length of stay in the ICU.

No interventions assigned to this group

Transplant through 1 month at Home

Time from surgery through 1 month at home. Maximum duration is length of stay in the ICU plus 1 month at home.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

Patients that are at high-risk patients for one of the following interventions, will be considered for this study:

1. Axillary impella patients awaiting transplant, advanced MCS therapy or weaning
2. MCS patients post procedure including TAH, LVADs
3. Lung Transplant patients
4. Subjects \> 18 years of age.
5. Ability to provide informed consent and follow-up with protocol procedures

Exclusion Criteria

1. Non-ambulatory patients
2. Participation in an on-going protocol studying an experimental drug or device
3. Use of a walker, cane or wheelchair at baseline
4. Inability to wear the biosensor on the wrist
5. Any condition or other reason that, in the opinion of the Investigator or Medical Monitor, would render the subject unsuitable for the study
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cedars-Sinai Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Anahat Dhillon

Staff Physician II

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Anahat Dhillon, MD

Role: PRINCIPAL_INVESTIGATOR

Cedars-Sinai Medical Center

Locations

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Cedars-Sinai Medical Center

Los Angeles, California, United States

Site Status

Countries

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United States

Central Contacts

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Anahat Dhillion, MD

Role: CONTACT

Phone: 3104233300

Email: [email protected]

Tracey S Early, BS, MA

Role: CONTACT

Phone: 3104231231

Email: [email protected]

Facility Contacts

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Anahat Dhillion, MD

Role: primary

Tracey S Early, BS, MA

Role: backup

Other Identifiers

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pro000578722

Identifier Type: -

Identifier Source: org_study_id