Optimizing a Mobile Mindfulness Intervention for ICU Survivors

INCLUSION CRITERIA

• Adult (age ≥18)
• Acute cardiorespiratory failure:
• Acute respiratory failure, defined as ≥1 of the following:
• mechanical ventilation via endotracheal tube for ≥12 hours
• non-invasive ventilation (CPAP, BiPAP) for ≥4 hours in a 24-hour period provided for acute respiratory failure in an ICU (not for obstructive sleep apnea or other stable use)
• high flow nasal cannula or face mask oxygen for ≥4 hours in a 24-hour period and / or
• Acute cardiac / circulatory failure, defined as ≥1 of the following:
• use of vasopressors for shock of any etiology for ≥1 hour
• use of inotropes for shock of any etiology for ≥1 hour
• use of pulmonary vascular vasoactive medications
• use of aortic balloon pump for cardiogenic shock for ≥1 hour
• Managed in an adult medical cardiac, trauma, surgical, or neurological ICU, stepdown unit, or monitored ward unit for ≥24 hours during the time inclusion criterion #2 is met.
• Cognitive status intact
• No history of pre-existing significant cognitive impairment (e.g., dementia) as per medical chart
• Absence of current significant cognitive impairment (impairment defined as ≥3 errors on the Callahan cognitive status screen)
• Decisional capacity present
• Absence of severe and/or persistent mental illness
• Treatment for severe and/or persistent mental illness (e.g., psychosis, bipolar affective disorder, schizoaffective disorder, schizoid personality disorder, schizophrenia [as per medical record], hospitalization for any psychiatric disorder) within the 6 months preceding the current hospital admission
• No endorsement of suicidality at time of admission or informed consent
• No active substance abuse within the 3 months preceding the current admission serious enough to limit completion of study procedures in the opinion of the site investigator.
• English fluency.

EXCLUSION CRITERIA (in hospital):

• Hospitalized within the preceding 3 months with life-threatening illness or injury.

Patients may be enrolled into the study if they had a hospitalization within the preceding 3 months that is determined to be non-serious. Non-serious admissions are defined as those admissions that are non-life threatening and/or potentially impacting patient's well-being long-term or likely to precipitate additional future admissions. Examples of non-life-threatening hospitalizations could be, but may not be limited to, admission for a bronchoscopy, admission for deep vein thrombosis, or admission to ED resulting in overnight stay for cardiac work-up.

• Admitted from a location other than home (e.g., nursing home, long-term acute care facility, inpatient rehabilitation facility)
• Anticipated or actual discharge to a location other than independent in a home setting (e.g., nursing home, long-term acute care facility, inpatient rehabilitation facility, home hospice)
• Complex medical care expected soon after discharge (e.g., planned surgeries, transplantation evaluation, extensive travel needs for hemodialysis, disruptive chemotherapy/radiation regimen)
• Unable to complete study procedures as determined by staff
• Lack of reliable smartphone with cellular data plan or wifi access

EXCLUSION CRITERIA (at T1, post-discharge):

• Low baseline psychological distress symptoms, defined as the absence of the following at T1: PHQ-9 score <5
• Failure to randomize within 2 month (60 days) post-discharge.