Eugene Wesley Ely

Eugene Wesley Ely Jr. is an American physician and professor of medicine as the Grant W. Liddle Endowed Chair at Vanderbilt University School of Medicine. He is conducting research as a geriatric intensivist in the Division of Pulmonary and Critical Care Medicine and the Center for Health Services Research at Vanderbilt University Medical Center. He is also the associate director of research at the Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), part of the U.S. Department of Veterans Affairs.

Ely's work is focused on aging, delirium, post-ICU dementia, and other disorders related to post-intensive care syndrome, a set of conditions common especially in elderly patients that develops during acute care hospitalization and could be caused by the treatments used in intensive care medicine. The diagnosis and treatment protocols developed by Ely and his research group have been validated by independent studies, translated into many languages, and adopted by hospitals around the world.

Ely attended Jesuit High School in Shreveport, Louisiana, where his mother Diana Lowe Ely was an English teacher and theater director of the high school. His father Eugene Wesley Ely was a mechanical engineer who worked for Ingersoll-Rand. After high school, Ely Jr. attended Tulane University in New Orleans, Louisiana, where he graduated summa cum laude with a bachelor's degree in Biology in 1985. He went on to attend the university's School of Public Health and Tropical Medicine, graduating with a public health master's degree in 1989. Ely earned his medical degree from the Tulane University School of Medicine later the same year.

After graduating from medical school, Ely began his residency at Bowman Gray School of Medicine (now known as Wake Forest School of Medicine). After three years as a resident, he continued at the hospital as a postdoctoral fellow until 1995.

Until 1998, Ely served as professor of internal medicine at the same medical school and medical director of its Chronic Lung Failure Clinic. In 1998, Ely trained in lung transplantation at Barnes-Jewish Hospital of the Washington University School of Medicine in St. Louis, Missouri before leaving Bowman Gray to serve as a professor of medicine at Vanderbilt University Medical Center. Since 1998, Ely has served as a pulmonologist, professor and researcher at Vanderbilt.

His research is focused on the diagnosis, causes, and management of delirium and other cognitive disorders developed during a patient's hospital stay, especially in geriatric patients. He founded and currently heads the ICU Delirium and Cognitive Impairment Study Group at Vanderbilt. Ely's group has been studying the long term effects of mechanical ventilation and sedation on patients in intensive care units (ICU). The group also publishes a website in an attempt to educate potential patients, families, doctors and other healthcare professionals about the effects and causes of delirium and post-intensive care syndrome (PICS). Ely is one of several physicians that encourages a reduction in the use of sedatives (especially benzodiazepines) to shorten patients’ time on mechanical ventilation during ICU treatment. With others at Vanderbilt, the team also developed an outpatient post-ICU clinic for patients at Vanderbilt. Ely was also a co-chair of the ICU Liberation Campaign of Society for Critical Care Medicine, which encourages the use of protocols to mitigate the effects of delirium and PICS. Together with Pratik Pandharipande, Ely co-directs the Critical Illness, Brain Dysfunction and Survivorship Center (CIBS Center) at Vanderbilt University Medical Center.

In 1996, while serving as chief resident at Bowman Gray, Ely and his colleagues published the findings of a study into the efficacy of a ventilator weaning protocol (called spontaneous breathing trials) in shortening the duration an ICU patient required assistance through mechanical ventilation as well as reducing complications and cost of care. The study published in The New England Journal of Medicine reported that "daily screening followed by spontaneous breathing trials in medical and coronary intensive care units reduced the duration of ventilation from a median of 6.0 to 4.5 [days]."

In 2001, Ely and Gordon Bernard were investigators on a study of the recombinant-form Activated Protein C (known as Drotrecogin alfa) and its possible efficacy in the treatment of sepsis. The same year, Ely and his ICU Delirium Study Group developed CAM-ICU based on an earlier Confusion Assessment Method (CAM) developed by Sharon Inouye. CAM-ICU is one of two commonly used methods to diagnose delirium in ICU patients. It has been validated in later independent studies, with a meta-analysis review of these studies showing high "pooled values for sensitivity and specificity of 80% and 95.9%, respectively." Also in 2001, Ely was awarded The American Federation for Aging Research's Paul B. Beeson Career Development Award. In 2002, Ely was appointed Associate Director of Research at the Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), part of the U.S. Department of Veterans Affairs.

In a 2004 study, Ely et al. reported that delirium predicted an increased risk of mortality in ICU patients. This has since been confirmed in at least two additional cohort studies. In 2006, Ely was inducted into the American Society for Clinical Investigation for his work demonstrating how "delirium is associated with a tripling of the risk of death within 6 months of ICU" hospitalization. In 2007, Ely, Pandharipande et al. published the results of the MENDS trial which investigated "the incidence and duration of delirium" when using the sedative dexmedetomidine compared to a benzodiazepine (specifically lorazepam). This and subsequent studies have resulted "in the recommendation to minimize the use of benzodiazepines in the most recent sedation guidelines."

In July 2007, Ely along with Timothy D. Girard and their colleagues presented the findings of a randomized clinical trial of a daily protocol of attempts at awakening the patient and allowing them to breathing independently. The 335-patient study presented at the International Conference of the American Thoracic Society reported that these daily tests, where the ICU patient was allowed to come out of sedation and breathe spontaneously without the use of a ventilator, resulted in the patients leaving the hospital an average of four days earlier. In 2010, Ely and Girard reported a correlation between the length of time the patient was affected by delirium and their cognitive outcome in the long-term. They developed a protocol named ABC which took earlier demonstrated attempts at ceasing sedation and paired it with concurrent attempts at a spontaneous breathing trial through the ventilator weaning method developed by him in 1996. Ely and his colleagues later extended the protocol, renamed ABCDEF Bundle, to include advice on the choice of sedation drugs, monitoring of delirium, early exercise, and encouragement of family participation.

In 2013, Ely was inducted into the Association of American Physicians. In October 2013, Ely, Pandharipande, and their team published the results of a study, sponsored by the National Institutes of Health and the Department of Veterans Affairs, about the long-term effects of ICU Delirium. The study reported that even after a one-year period, "34 percent of patients [affected by ICU Delirium] were still functioning on the same level as someone with moderate traumatic brain injury and 24 percent at the level of a person with mild Alzheimer's."

In 2018, he reported to the annual congress of the European Society of Intensive Care Medicine the results of the MIND-USA study into the efficacy of haloperidol and ziprasidone in the treatment of delirium. The antipsychotic drugs used for decades for the treatment of ICU delirium were found to be ineffective for that purpose, according to the study by Ely and his colleagues published in the NEJM.

During the Covid-19 pandemic, Ely warned that efforts to mitigate delirium had been erased by the disease. Covid-19 patients also show a higher prevalence of hospital delirium. As well as recommending the ABCDEF Bundle to lower the incidence of delirium in Covid-19 patients and prevent PICS, Ely and other researchers at the CIBS Center also initiated studies into the effects of delirium on Covid-19 patients and their increased "risk of developing long-term cognitive issues, depression and post-traumatic stress disorder."

Ely writes reflective opinion pieces and editorials about his personal experiences as a physician, which have been published in the Annals of Internal Medicine, JAMA, and The Wall Street Journal, among other periodicals. He participates in the ongoing debate on euthanasia and physician-assisted suicide through medical literature and international debates. He also wrote a CNN Opinion piece describing his own experiences with patients in palliative care who desired assisted suicide.

In May 2019, Ely wrote an opinion article published in USA Today, arguing against "death by donation", a practice currently illegal in the U.S. and Canada where a patient voluntarily donates their organs while still alive, subsequently leading to their death. In late June 2020, Ely wrote a Perspective article for The Washington Post describing the difficulties of treating Covid-19 patients while conducting ethical research into new treatment regimens for the disease and its effects including delirium.

Ely has three daughters with his wife Kim Ely, who also works at Vanderbilt University Medical Center. She is a surgical pathologist who graduated from Massachusetts Institute of Technology and like her husband attended Tulane University School of Medicine.

He is the president of the Nashville Guild of the Catholic Medical Association.

• Ely, E. Wesley;et al. (1996-12-19). "Effect on the Duration of Mechanical Ventilation of Identifying Patients Capable of Breathing Spontaneously". New England Journal of Medicine. 335 (25): 1864–1869. doi:10.1056/NEJM199612193352502. PMID 8948561.
• Ely, E. Wesley;et al. (2001-12-05). "Delirium in Mechanically Ventilated Patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU)". JAMA. 286 (21): 2703–10. doi:10.1001/jama.286.21.2703. PMID 11730446.
• Ely, E. Wesley;et al. (2003). "Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS)". JAMA. 289 (22): 2983–2991. doi:10.1001/jama.289.22.2983. PMID 12799407.
• Ely, E. Wesley (2004-04-14). "Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care Unit". JAMA. 291 (14): 1753–62. doi:10.1001/jama.291.14.1753. PMID 15082703.
• Pandharipande, Pratik P.; Ely, E. Wesley;et al. (2007-12-12). "Effect of Sedation With Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients". JAMA. 298 (22): 2644–2653. doi:10.1001/jama.298.22.2644. PMID 18073360.
• Girard, Timothy D.; Ely, E. Wesley;et al. (2008). "Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial". The Lancet. 371 (9607): 126–134. doi:10.1016/S0140-6736(08)60105-1. PMID 18191684.
• Pandharipande, P.P.; Ely, E. Wesley;et al. (2013-10-03). "Long-Term Cognitive Impairment after Critical Illness". New England Journal of Medicine. 369 (14): 1306–1316. doi:10.1056/NEJMoa1301372. PMC 3922401. PMID 24088092.
• Jackson, James C; Ely, E. Wesley;et al. (2014). "Depression, Posttraumatic Stress Disorder, and Functional Disability in Survivors of Critical Illness: results from the BRAIN ICU Investigation: A Longitudinal Cohort Study". The Lancet. Respiratory Medicine. 2 (5): 369–379. doi:10.1016/S2213-2600(14)70051-7. PMC 4107313. PMID 24815803.
• Girard, Timothy D.; Ely, E. Wesley;et al. (2018-12-27). "Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness". New England Journal of Medicine. 379 (26): 2506–2516. doi:10.1056/nejmoa1808217. PMC 6364999. PMID 30346242.