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Identifying and preventing ventilator induced diaphragm weakness in children

Identifying and preventing ventilator induced diaphragm weakness in children
识别和预防儿童呼吸机引起的膈肌无力
批准号:
10178072
负责人:
Robinder Khemani
金额:
$43.29万
依托单位国家:
美国
项目类别:
财政年份:
2017
资助国家:
美国
项目状态:
已结题
起止时间:
2017-08-15 至 2024-05-31

项目摘要

项目成果

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中文摘要
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英文摘要
Project Summary Nearly half of mechanically ventilated (MV), critically ill adults develop ventilator-induced respiratory muscle weakness (particularly of the diaphragm), which impairs successful weaning from MV, often leads to re- intubation, and is associated with higher post-ICU mortality. We have recently shown that respiratory muscle weakness is associated with extubation failure in critically ill children, but we still lack crucial information on the mechanisms and timing of this weakness, its importance for ventilator weaning, and its potential prevention through promoting more physiologic levels of patient effort of breathing during MV. Diaphragm weakness is most common in patients exposed to high levels of controlled ventilation. In children, we have shown that usual care ventilator management is frequently associated with minimal patient effort of breathing. To enhance patient effort, we developed a novel computer-based approach (Real-time Effort Driven ventilator management (REDvent)), which offers systematic recommendations to reduce controlled ventilation during the acute phase of MV, and uses real-time measures to adjust supported ventilator pressures such that patient effort of breathing remains in a normal range during the ventilator weaning phase. Through a Phase I clinical trial, we demonstrated that patients managed with REDvent spent fewer days on MV than historical controls, and bedside providers could easily implement REDvent. Our central hypothesis is that REDvent use will reduce ventilator-induced respiratory muscle weakness, leading to shorter time on MV by enhancing the patient’s capacity for effective, unsupported ventilation and by facilitating MV weaning. This application proposes a Phase II controlled clinical trial that will obtain comprehensive, serial assessments of respiratory muscle strength and architecture to understand the evolution of ventilator-induced respiratory muscle weakness in critically ill children, and test whether REDvent can preserve respiratory muscle strength and reduce time on MV. Three integrated yet independent Specific Aims are proposed: SA 1 will determine the clinical impact of REDvent by examining whether REDvent use for either acute or weaning phase ventilator management results in shorter MV weaning times compared to usual care; SA 2 will use a sophisticated, multi-modal approach to obtain a comprehensive view of respiratory muscle capacity, effort, load, and architecture to quantify the importance of respiratory muscle weakness on weaning outcomes in children, and identify when this weakness develops; SA 3 seeks to determine the independent effect of patient effort of breathing on the development of respiratory muscle weakness, after controlling for known or suspected risk factors for respiratory muscle weakness. Upon completion, this study will provide important information on the pathogenesis and timing of respiratory muscle weakness during MV in children, whether this weakness can be mitigated by promoting more normal patient effort during MV via the use of REDvent; forming the basis for a larger, Phase III multi-center study, powered for key clinical outcomes such as 28-day Ventilator Free Days.
期刊论文(16)
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会议论文
DOI: 10.1097/mcc.0000000000000688
发表时间: 2020-02
期刊: Current opinion in critical care
影响因子: 3.3
作者: [Khemani RG, Hotz JC, Sward KA, Newth CJL]
通讯作者: Newth CJL
Design and Rationale for Common Data Elements for Clinical Research in Pediatric Critical Care Medicine.
针对小儿重症监护医学临床研究的常见数据元素的设计和理由。
DOI: 10.1097/pcc.0000000000002455
发表时间: 2020-11
期刊: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
影响因子: --
作者: [Ward SL, Flori HR, Bennett TD, Sapru A, Mourani PM, Thomas NJ, Khemani RG]
通讯作者: Khemani RG
DOI: 10.1186/s13054-023-04754-6
发表时间: 2023-11-29
期刊: Critical care (London, England)
影响因子: --
作者: []
通讯作者:
DOI: 10.1097/ccm.0000000000004746
发表时间: 2021-03-01
期刊: Critical care medicine
影响因子: 8.8
作者: [Kyogoku M, Shimatani T, Hotz JC, Newth CJL, Bellani G, Takeuchi M, Khemani RG]
通讯作者: Khemani RG
共 8 条
    Patient Ventilator Asynchrony in Critically Ill Children
    Collaborative Pediatric Critical Care Research Network - Clinical Site
    • 批准号:
      10670231
    • 项目类别:
    • 资助金额:
      $8.75万
    • 财政年份:
      2021
    • 负责人:
      Robinder Khemani
    • 依托单位:
    Collaborative Pediatric Critical Care Research Network - Clinical Site
    • 批准号:
      10248815
    • 项目类别:
    • 资助金额:
      $9.02万
    • 财政年份:
      2021
    • 负责人:
      Robinder Khemani
    • 依托单位:
    Collaborative Pediatric Critical Care Research Network - Clinical Site
    • 批准号:
      10468846
    • 项目类别:
    • 资助金额:
      $8.75万
    • 财政年份:
      2021
    • 负责人:
      Robinder Khemani
    • 依托单位:
    海外基金