PREDICTORS OF POSTOPERATIVE ATELECTASIS PNEUMONIA

术后肺不张肺炎的预测因素

• 批准号: 2858064
• 负责人: JO A BROOKS-BRUNN
• 金额: $ 12.01万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-01-15 至 2001-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2858064
• 关键词: adult human (21+); atelectasis; behavioral /social science research tag; cardiovascular surgery; clinical research; disease /disorder proneness /risk; gastrointestinal surgery; health care model; hospital length of stay; human subject; model design /development; nursing models; pneumonia; postoperative complications; thoracic surgery

DESCRIPTION: (Adapted from investigator's abstract) Postoperative pulmonary complications (PPCs) are frequent and associated with increased morbidity, mortality, hospital length of stay and resource utilization. Atelectasis and pneumonia account for >80% of reported PPCs. The objective of this study is to develop predictive models for stratifying the risk of clinically significant atelectasis and/or pneumonia using readily accessible or existing clinical data in an adult abdominal and cardiothoracic surgical population. The long term goal is to develop predictive model(s) for use in the clinical setting to guide preoperative and postoperative pulmonary care. The primary aim of this study is to develop, compare and validate models to predict the risk of clinically significant atelectasis and/or pneumonia following abdominal or cardiothoracic procedures by assessing combinations of risk factors available at differing time periods during the surgical episode of care. Secondary aims are to compare the incidence of clinically significant atelectasis and/or pneumonia following abdominal and cardiothoracic procedures and postoperative length of stay between patients who develop these complications and those who do not. Four institutions will be utilized for data collection and the target population is adults who are undergoing elective abdominal or cardiothoracic procedures with general anesthesia. The target sample size is 1500 subjects over a three year period. Multi-criteria definitions will be used to measure the outcomes of clinically significant atelectasis and pneumonia as not to overestimate the incidence. The risk factors of interest are: increased age, impaired preoperative level of cognitive function, history of chronic lung disease, preexisting comorbid diseases, low or high body mass index (BMI), increased preoperative length of stay, smoking history, absence of preoperative respiratory education, high anesthesia physical risk status (ASA), increased duration of anesthesia, type and location of surgical procedure, incision direction and length, duration of intubation/mechanical ventilation in the postanesthesia period, pain management, postoperative mobility, administration of H2 blockers/antacids and presence of a nasogastric tube. Data will be collected on each subject prior to surgery and on a daily basis until hospital discharge. Logistic regression analysis will be used to examine the risk factors for univariate effects on clinically significant atelectasis and pneumonia and to develop and compare the multivariate models. Models will be evaluated for utility and goodness-of-fit. A split-sample technique will be used for model validation.

描述：（改编自研究者摘要）术后肺部 并发症（PPC）很常见，并且与发病率增加相关， 死亡率、住院时间和资源利用率。 肺不张 肺炎占报告 PPC 的 80% 以上。 此举的目的 研究的目的是开发预测模型来对临床风险进行分层 严重肺不张和/或肺炎，使用易于接近或 成人腹部和心胸外科手术的现有临床数据 人口。 长期目标是开发用于以下领域的预测模型： 指导术前和术后肺部护理的临床环境。 本研究的主要目的是开发、比较和验证模型 预测有临床意义的肺不张和/或肺炎的风险 通过评估组合来进行腹部或心胸手术 手术期间不同时间段可用的危险因素 护理的情节。 次要目标是比较临床上的发生率 腹部和腹部手术后出现明显的肺不张和/或肺炎 心胸外科手术和患者术后住院时间 哪些人会出现这些并发症，哪些人不会。 四大机构 将用于数据收集，目标人群是成年人 正在接受选择性腹部或心胸手术，一般 麻醉。 目标样本量是三年内 1500 名受试者 时期。 多标准定义将用于衡量结果 临床上显着的肺不张和肺炎，以免高估 发生率。 感兴趣的风险因素是：年龄增长、受损 术前认知功能水平、慢性肺部疾病史、 先前存在的合并症、体重指数 (BMI) 低或高、体重增加 术前住院时间、吸烟史、术前缺席 呼吸教育、高麻醉身体风险状态 (ASA)、增加 麻醉持续时间、手术类型和位置、切口 插管/机械通气的方向和长度、持续时间 麻醉后时期、疼痛管理、术后活动能力、 使用 H2 阻滞剂/抗酸剂并使用鼻胃管。 将在手术前和每天收集每个受试者的数据 直至出院。 逻辑回归分析将用于 检查单变量影响临床显着性的危险因素 肺不张和肺炎，并开发和比较多变量 模型。 将评估模型的实用性和拟合优度。 一个 分割样本技术将用于模型验证。