Background Sleep and circadian disruption (SCD) is common and severe in the ICU. On the basis of rigorous evidence in non-ICU populations and emerging evidence in ICU populations, SCD is likely to have a profound negative impact on patient outcomes. Thus, it is urgent that we establish research priorities to advance understanding of ICU SCD. Methods We convened a multidisciplinary group with relevant expertise to participate in an American Thoracic Society Workshop. Workshop objectives included identifying ICU SCD subtopics of interest, key knowledge gaps, and research priorities. Members attended remote sessions from March to November 2021. Recorded presentations were prepared and viewed by members before Workshop sessions. Workshop discussion focused on key gaps and related research priorities. The priorities listed herein were selected on the basis of rank as established by a series of anonymous surveys. Results We identified the following research priorities: establish an ICU SCD definition, further develop rigorous and feasible ICU SCD measures, test associations between ICU SCD domains and outcomes, promote the inclusion of mechanistic and patient-centered outcomes within large clinical studies, leverage implementation science strategies to maximize intervention fidelity and sustainability, and collaborate among investigators to harmonize methods and promote multisite investigation. Conclusions ICU SCD is a complex and compelling potential target for improving ICU outcomes. Given the influence on all other research priorities, further development of rigorous, feasible ICU SCD measurement is a key next step in advancing the field.

Background Uncontrolled asthma is a common highly-morbid condition with worse outcomes in low-income and minority patients in part due to barriers accessing and engaging with healthcare. We developed a patient advocate to educate about and assist with navigating access to care and provider-patient communication. Participants completed an End of Study Questionnaire (ESQ) which was analyzed to assess experience and engagement with the protocol. Objective This study uses qualitative analysis to evaluate participant experience with the Patient Advocate and control group interventions. Methods The ESQ aimed to prompt open-ended discussion of study experience. Questions were developed from patient focus groups about the patient advocate intervention (PAI), and were revised based on early responses. The questionnaire was administered after 12 months of study participation: 6 months of control or PAI, followed by 6-months of follow-up. Answers were evaluated using qualitative coding and a Grounded Theory analytical approach. Results 102 low-income and minority adults with moderate or severe asthma who have completed the study protocol at the time of publication (approximately one-third of total participants) found PAI and control group activities acceptable. Four themes emerged from both groups: 1) appreciation of interpersonal and educational interaction, 2) perception of improved healthcare adherence, 3) preparedness for physician appointments, 4) improved patient-provider communication. Attention from study personnel and review of asthma-related information was unanimously well-received and empowered patients’ active healthcare participation. Conclusion Patient engagement and empowerment were elicited by perceived education and personal attention. This study suggests a low-resource, feasible method to improve patient engagement.

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Provision of nutrition is universally considered a key element of supportive care in the intensive care unit (ICU). Despite this, there is a relative dearth of high-quality data, and where available, results are often conflicting. As we understand more about the process of recovery for critically ill patients, ICU nutrition might be better thought of as active therapy that can and should be tailored to the needs of patients in more dynamic ways. With the advent of the programmable feeding pump, continuous feeding modes have become the default manner in which patients are fed in many ICUs. In the modern ICU era, where the goal of critical care has shifted from mere survival to surviving and living well, non-continuous modes of feeding may have advantages related to fewer feeding interruptions, ICU mobilization, optimizing protein synthesis and autophagy, as well as restoring gastrointestinal physiology and the circadian rhythm. More research is desperately required to provide a framework in order to guide best nutrition practices for clinicians at the bedside.

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