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

老年心脏手术 ICU 患者的昼夜节律运动同步性和谵妄

• 批准号: 10518974
• 负责人: Meghan Prin
• 金额: $ 12.6万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2023-02-20
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10518974
• 关键词: Acute Disease; Admission activity; Adverse event; Affect; Age; Aging; Alzheimer' s disease related dementia; American; Animal Model; Assessment tool; Attention; Award; Basic Science; Cardiac; Cardiac Surgery procedures; Caring; Circadian Dysregulation; Circadian Rhythms; Clinical; Clinical Trials; Clinical Trials Design; Clinical Trials Network; Cognition; Cognition Disorders; Cognitive; Cohort Studies; Colorado; Complication; Critical Care; Critical Illness; Cues; Data; Delirium; Development Plans; Early Mobilizations; Early identification; Elderly; Emergency Medicine; Enrollment; Environment; Etiology; Exposure to; Future; Goals; Health care facility; Homeostasis; Hospital Mortality; Hospitalization; Hour; Human; Human Volunteers; Impaired cognition; Incidence; International; Intervention; Laboratories; Lead; Light; Literature; Long-Term Care; Measures; Medical center; Medicare; Mentors; Mentorship; Methodology; Methods; Motor; Motor Activity; Movement; Neurocognitive; Operative Surgical Procedures; Outcome; Participant; Patients; Pattern; Periodicity; Perioperative; Phototherapy; Physicians; Population; Postoperative Complications; Postoperative Period; Procedures; Quality of life; Randomized Controlled Trials; Research; Research Personnel; Resources; Risk; Sample Size; Screening procedure; Sleep; Stress; Structure; Test Result; Testing; Time; Training; Universities; Work; Wrist; actigraphy; aging population; arm; bench to bedside; biomedical referral center; career; circadian; circadian pacemaker; circadian regulation; cognitive testing; cost; design; experience; faculty research; functional decline; functional outcomes; human subject; improved; improved outcome; innovation; mortality; mouse model; novel; pilot trial; postoperative delirium; primary outcome; prospective; randomized trial; recruit; restoration; screening; secondary outcome; standard care; tool; trial design

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.

这项建议的长期目标是确定昼夜节律与术后的关联。 择期心脏手术后住进ICU的老年人的精神错乱。超过25万美国老年人 每年接受心脏手术，使他们的生活更有功能和成就感，但如果 程序复杂，神志不清则有功能或认知功能衰退的危险，长期出院 护理设施，死亡率大幅增加。Prin博士是一名重症监护麻醉师，致力于 改善老年人术后ICU入院的临床结果和这项NIA GEMSSTAR 该提案旨在为她提供成为领导者所需的有组织的指导和培训 在围手术期衰老研究和重症监护试验中。她建立了一个协作性的导师团队，由 作者：Adit Ginde博士，他是急诊内科医生，也是大型多中心花瓣的国家PI 有3,000多名参与者的网络临床试验，由托拜厄斯·埃克勒博士(国家 昼夜节律基础科学的领导者)和约翰·德夫林博士(一种国际公认的精神错乱 研究人员)。亚历克斯·凯泽博士是一位生物统计学家，在新颖和适应性临床试验设计方面拥有专业知识，他将 在试验方法学中指导Prin博士。该建议充分利用了已建立的 科罗拉多大学安舒茨医学中心的导师团队和独特的环境 在一所大型公立研究型大学的背景下，纳入了心脏手术的第三转诊中心。 这些充足的资源将使Prin博士能够严格研究昼夜节律与 心脏手术后精神错乱的发生率。她的全球假说是昼夜节律性的破坏 ICU的环境导致了精神错乱的发生。她将通过确定 一项前瞻性观察队列研究中昼夜运动活动模式与精神错乱的关系(目标1) 以及为未来的临床试验做准备，这是一项针对昼夜节律运动的强烈晨光的非盲目试验 活动模式(目标2)。这些特定的目标旨在评估昼夜节律之间的联系。 患有精神错乱，这在病情危重的人类受试者中还没有得到证实。这些研究需要Prin博士 开发昼夜节律研究、精神错乱评估工具和临床试验方法学方面的专业知识。她会的 通过有重点的专业发展计划来实现这一点，包括临床试验设计的课程工作， 神经认知评估和衰老研究。拟建项目完成后，将提供 必要的指导、培训和经验使Prin博士成为围手术期老龄化领域的领导者 改善术后ICU预后的研究。