Circadian Diurnal Motor Synchrony and Delirium Amongst Older Cardiac Surgery ICU Patients

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The long term goal of this proposal is to determine the association of circadian rhythms with postoperative delirium in older adults admitted to the ICU after elective cardiac surgery. More than 250,000 older Americans undergo cardiac surgery every year which allows them to lead more functional and fulfilling lives, but if the procedure is complicated by delirium then the risk of functional or cognitive decline, discharge to a long-term care facility, and mortality increases substantially. Dr. Prin is a Critical Care Anesthesiologist dedicated to improving clinical outcomes after postoperative ICU admission for older adults and this NIA GEMSSTAR proposal is designed to provide her with the structured mentorship and training necessary to become a leader in perioperative aging research and critical care trials. She has developed a collaborative mentorship team led by Dr. Adit Ginde who is an Emergency Medicine Physician and national PI for the large multicenter PETAL network clinical trial with over 3,000 participants, with co-mentorship provided by Dr. Tobias Eckle (a national leader in the basic science of circadian rhythms) and Dr. John Devlin (an internationally recognized delirium researcher). Dr. Alex Kaizer, a biostatistician with expertise in novel and adaptive clinical trial design, will mentor Dr. Prin in trial methodology. This proposal leverages the collective expertise of an established mentorship team and the unique environment at the University of Colorado Anschutz Medical Center that incorporates a tertiary referral center for cardiac surgery in the setting of a large public research university. These ample resources will allow Dr. Prin to rigorously study the relationship of circadian rhythms with the incidence of delirium after cardiac surgery. Her global hypothesis is that disruption of circadian rhythmicity in the ICU environment drives the incidence of delirium. She will test this hypothesis by determining the association of diurnal motor activity patterns with delirium in a prospective observational cohort study (Aim 1) and preparing for a future clinical trial with an unblinded pilot trial of intense morning light for circadian motor activity patterns (Aim 2). These Specific Aims are designed to evaluate the association of circadian rhythms with delirium, which has not been established in critically ill human subjects. These studies require Dr. Prin to develop expertise in circadian research, delirium assessment tools, and clinical trial methodology. She will accomplish this with a focused Professional Development Plan including coursework on clinical trial design, neurocognitive assessments, and aging research. Completion of the proposed project will provide the necessary mentorship, training, and experience to allow Dr. Prin to become a leader in perioperative aging research to improve outcomes after postoperative ICU admission.