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OACIS: Research Studies

Improving Long-Term Outcomes Research for Acute Respiratory Failure

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This project is funded by a NHLBI R24 grant for Investigator-Initiated Resource-Related Research Projects.  This project aims to assist researchers studying acute respiratory distress syndrome (ARDS)/acute respiratory failure (ARF) patients in designing trials that appropriately evaluate long-term patient outcomes, in order to facilitate research aimed at reducing the public health burden of health impairments after these critical illnesses.This  project includes:                                                   1)creation and dissemination of a national Web-based database of validated and                                   recommended survey instruments and clinical testing methods for evaluating ARDS/ARF                                     survivors’ long-term physical, cognitive, and mental health outcomes; 2) development and                                 dissemination of practical resources for maximizing retention of ARDS/ARF survivors in long-term,                 longitudinal research studies; and 3) evaluation, implementation and dissemination of statistical                               methods and programs for evaluating longitudinal functional outcomes in the presence of high                                 patient mortality (“censoring due to death”).

Principal Investigator: Dale Needham, MD, PhD
Grants: 1R24HL111895
Status: Active



Nutrition and EXercISe in Critical Illness (NEXIS)


This multi-centered randomized controlled trial investigates whether a novel early intervention combining Intravenous (IV) amino acids plus in-bed cycle ergometry exercise improves physical outcomes in critically ill patients. We hypothesize that this innovative approach will improve short-term physical functioning outcomes (primary outcome), as well as amino acid metabolism, body composition, and patient-reported                                       outcomes at 6-month follow-up.

Principal Investigators:Renee Stapleton,MD,PhD, Daren Heyland,MD,MScDale Needham,MD,PhD
Status: enrolling Identifier: NCT03021902
Selected Publications
             Additional Publications

BEhavioral Activation and ReHABilitation For Acute Respiratory Failure Survivors (BEHAB)


This pilot randomized controlled trial (RCT) investigates the feasibility of a combined behavioral activation – rehabilitation (BA-R) intervention in acute respiratory failure survivors. While our primary outcome is feasibility of the proposed pilot RCT, we will also evaluate, as secondary outcomes, whether BA-R will significantly lower depressive symptoms and reduce impairments in physical functioning.

Principal Investigator: Ann M Parker, MD
Status: Currently Recruiting Identifier: NCT03431493
Selected Publications
             Additional Publications

Functional Electrical Stimulation (FES) Assisted Cycle Ergometry for Early Rehabilitation of Critically Ill Patients

This multi-centered randomized controlled trial investigates whether Functional Electrical Stimulation-Assisted Cycle Ergometry (FES-Cycling) delivered early during critical illness in mechanically ventilated patients decreases intensive care unit-acquired weakness (ICU-AW). This trial’s main outcome measures include muscle strength, muscle mass and physical functioning. In a sub-group of patients, biochemical and histological changes in muscles will be evaluated via muscle biopsy. Participants also will receive 6-month follow-up to evaluate their physical, cognitive and mental health outcomes.

Principal Investigator: Dale Needham, MD, PhD
Status:  Cohort Follow-up Ongoing Identifier: NCT02214823
Recovery of Muscle after ALI (ROMA)

This study investigates changes and recovery in muscle electrophysiology and function during critical illness in order to understand mechanisms through which critical illness and ICU therapies contribute to long-term impairments in  muscle strength, physical function and quality of life. Participants are drawn from the ongoing NIH-funded ARDS Network randomized controlled trials and have long-term follow-up conducted as part of the ARDS Network Long-term Outcomes Study (ALTOS – see details above).

Principal Investigators:  Catherine (“Terri”) Hough, MD, MSc, and Dale Needham, MD, PhD
Status: Follow-up Complete Identifier:
ARDSNet Long Term Outcomes Study (ALTOS)


This study examines the long-term patient outcomes, at 6 and 12 months after enrollment into four NIH-funded ARDS Network clinical trials for acute lung injury/acute respiratory distress syndrome (ALI/ARDS) patients.  Long-term outcomes of interest include measures of physical, cognitive and mental health.  Participant evaluations are done via a battery of validated surveys by phone                                                       (estimated sample size = 900 from 41 hospitals at 11 study sites across United States)                                           and for a sub-set of participants, in-person evaluation is conducted (estimated sample size = 300 from 11 hospitals at 4 study sites).

Principal Investigators: Dale Needham, MD, PhD and Ramona Hopkins, PhD
Grants: RO1-HL091760, 3R01HL091760-02S1, N01-HR-56170, and Hopkins GCRC Grant # M01-RR00052
Status: Follow-up complete Identifier: NCT00719446


This study evaluates the effects of lower tidal volume ventilation and other aspects of critical illness and ICU care on the long-term physical and mental health outcomes of participants with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Follow-up evaluations are done at 3, 6, 12, 24, 36, 48 and 60 months after the diagnosis of ALI/ARDS.

Principal Investigators: Peter Pronovost, MD, PhD; Dale Needham, MD, PhD 
Status: Follow-up complete Identifier: NCT00300248
Selected Publications

              Additional Publications

Intensive Care Unit Sleep Quality and Neurocognitive Performance

The purpose of this study is to understand patients’ neurocognitive performance at discharge from the Medical Intensive Care Unit (MICU) and the potential effect of perceived sleep quality in the MICU on neurocognitive outcomes.

Principal Investigator: Dale Needham, MD, PhD, and Biren Kamdar, MD, MBA (Project leader)
Status: Completed Identifier: NCT01061242
This checklist was developed and used by Dr. Kamdar, Dr. Needham and collaborators as part of their Quality Improvement (QI) project for sleep in the Johns Hopkins Medical ICU (published in Critical Care Medicine.  2013; 41:800-809). This checklist describes the environmental modifications, non-pharmacologic sleep aids, and pharmacological guidelines implemented by ICU staff to improve and promote patient sleep in this QI project.


Use of Neuromuscular Electrostimulation (NMES) for Treatment or Prevention of ICU-Associated Weakness (NMES)

The purpose of this study is to investigate whether neuromuscular electrostimulation (NMES) will decrease ICU-associated weakness. The study is a randomized clinical trial to evaluate the efficacy of twice-daily NMES versus sham therapy, applied to the bilateral lower extremities, to reduce ICU-associated weakness in patients with acute respiratory failure.

Principal Investigator: Dale Needham, MD, PhD; Michelle Kho, PT, PhD (Project Leader), Alex Truong, MD, MPH (co-investigator)
Status: Completed Identifier: NCT00709124  

Glossary: Acute lung injury (ALI) is a less severe form of acute respiratory distress syndrome (ARDS). For more information on ALI and ARDS, please visit the National Heart, Lung, and Blood Institute website: link.



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