Southampton Academy of Research

Dr Rebecca Cusack is a Consultant and Associate Professor in Critical Care Medicine at University Hospital Southampton and the University of Southampton. She holds a Research Leaders Programme (RLP) award.

Her research focuses on the rehabilitation of patients after a critical illness to help them return to living a normal life.

Improving patients’ recovery

Patients in the intensive care unit (ICU) are either critically ill, seriously injured, or have had major surgery. Many patients’ lives never return to normal.

They usually have problems with at least one organ. For example, they may have problems with their lungs, and need a ventilator to help them breathe.

Many of these patients need help to recover after intensive care, both physically and mentally. This is not just due to their illness or injury, but also because the stay itself can take its toll on their health.

“Patients lose about 20 percent of their muscle mass within the first week of being on a ventilator, which can result in significant weakness in addition to other physical problems,” Rebecca explains.

“And 20 to 40 percent of patients also have mental health problems after leaving ICU – mainly anxiety, depression or post-traumatic stress disorder.”

These patients need different types of rehabilitation, according to their specific needs, to help them recover. Rebecca is investigating ways to improve this rehabilitation, so more patients make a fuller recovery after leaving ICU.

Treating the whole patient

Rebecca aims to use her RLP award to accelerate the development of a long-term research project, bringing together several different aspects of health that are needed together to improve ICU patients’ recovery and wellbeing.

“One of the main reasons I applied is to have dedicated time to develop my research looking at different areas of a patient’s health with an aim to help recovery from a critical illness,” she says, “and having time to do this work will really transform the research I can deliver.”

Her aim is to use results from three preliminary studies to inform larger trials. Each of these preliminary studies will focus on a different aspect of a patient’s rehabilitation.

One, the EMPRESS study, is trying to prevent muscle loss and hasten their physical recovery. The second study will focus on early treatment of mental health problems to prevent long term difficulties.

A third study will look at the gut microbiome – the complex mix of bacteria that naturally live in our intestines, which are essential to health but negatively affected in all critically ill patients. It will investigate the specific problems this causes, and identify ways any negative effects could be prevented or treated.

To do this, Rebecca will need to form new collaborations and develop new skills. For example, she plans to collaborate with Professor Jonathan Swann and Dr Franklin Nobrega on the gut microbiome study. This will help her develop the skills required to work with the large data sets involved.

Better quality of life

The impact of not recovering properly from a stay in ICU can be huge. Rebecca says a lot of patients will lose their job, or their family will have to give up work to care for them.

They can become socially isolated, because issues with their physical or mental health prevent them from leaving the house.

“A lot of them never really recover from a serious illness,” she explains.

This also has a big impact on the NHS, with these patients visiting their GP and hospitals much more than other patients who have not required intensive care.

Rebecca hopes that her research will, ultimately, mean more patients who leave the ICU are able to fully recover and get the most out of life afterwards.