Marc Moss, MD, and his colleagues have built a diverse research program that ranges from neuromuscular function, alcohol abuse and ARDS in critically ill patients to psychological distress among intensive care unit nurses.
Moss, who is the Department of Medicine Vice Chair for Clinical Research and the Roger S. Mitchell Professor of Medicine in the Division of Pulmonary Sciences and Critical Care Medicine, finds working in the intensive care unit “really rewarding. You work very long hard hours and very intensely care for patients sometimes for weeks, and you watch them get better.”
And as more critically ill patients get better and return home to daily living, many are limited by neuromuscular weakness that prevents them from resuming their normal activities. Improving quality of life after illness
Moss and his colleagues are trying to find new diagnostic methods to identify these weaknesses earlier, and working on ways to improve neuromuscular function when the patients go home. The group recently completed a clinical trial looking at different intensities of physical therapy for patients recovering from critical illnesses. The study raised some important new issues, Moss says. “We still need to better identify those patients who will truly benefit from a strategy of intensive physical therapy.”
Moss’s group also is studying patients who have problems with swallowing and aspiration after being on a ventilator, collaborating with University of Colorado Hospital Director of Rehabilitation Services Tim Wimbish and the speech language pathology team.
“As care in the intensive care unit has advanced, the long-term outcome of patients is becoming more of a focus,” says Moss. “We are learning to look beyond the immediate recovery and focus on their quality of life as they return to health.”Critical care and alcohol intervention
Moss is continuing work on ARDS (acute respiratory distress syndrome), which was first identified at CU in 1967. In conjunction with CU’s Department of Emergency Medicine, Moss received a seven-year grant to be a clinical site for an NIH consortium called the Prevention and Early Treatment of Acute Lung Injury.
Alcohol abuse is common in the intensive care unit. Up to 40 percent of patients have a pre-existing condition involving an alcohol abuse disorder, according to Moss. Patients who abuse alcohol are at increased risk of developing ARDS. Moss’s colleague Ellen Burnham, MD, is working to identify the reasons alcohol increases the lung’s susceptibility to ARDS, as well as interventions to treat and prevent ARDS. In addition to treating the diseases associated with alcohol abuse that land patients in the ICU, researchers are looking at ways to help them manage their dependence on alcohol. Brendan Clark, PhD, has a grant to try to create channels that help patients navigate through the medical system to find the support and care they need.Caring for the caregivers
Another area of research centers on critical care nurses who develop psychological distress. About eight years ago, Moss and colleague Meredith Mealer, PhD, found that many of these nurses were dealing with what he calls “really big problems.”
“If you look at what ICU nurses do – they work for 12 hours with someone who is critically ill. They interact with family members who are under tremendous stress, they care for very sick patients and unfortunately, some of their patients pass away,” Moss says.
Critical care nurses have increased prevalence of post-traumatic stress disorder, anxiety, depression and burnout syndrome. As a result, their turnover rate nationally is about 17 percent per year. Not only is that costly for hospitals, but it affects the quality of care as well.
Moss and Mealer are working with nurses to help them cope more effectively with these issues and try to increase their resilience, using practices like meditation, yoga, cognitive behavioral therapy, physical exercise or writing in journals.
Moss currently serves as vice president of the American Thoracic Society and will become president-elect in May 2016. He will serve as ATS president in the 2017-18 term.