Cognitive Impairment in the ICU: Evaluation and Outcomes

描述(来自申请)：表格中的全球认知缺陷 精神错乱、昏迷或昏迷在老年ICU中极其常见和危险 病人。认知障碍与长期住院有关， 制度化和死亡。因为急性认知障碍 损害了患者脱离机械通气的能力和 可能是与长期神经心理后遗症相关的一个因素， 医生和护士需要能够识别出高风险的患者 认知障碍和了解护理的潜在可修改方面 这可能会减少认知障碍。意识被定义为有两个 成分：觉醒(清醒)和内容(专注)。唤醒，一个 精神功能的基本过程，在ICU患者中普遍被监测。 注意力，是由更复杂的神经相互作用产生的， 经常受到损害，但很少受到客观监测。没有经过验证的 可供护士或医生在床边使用的仪器以监测两者 机械通气患者的意识成分。我们建议 修改ICU中使用的现有仪器，以开发和 对大脑及其功能的机械监测系统进行验证 在ICU护理期间和之后使用呼吸机的患者(目标1)。一旦经过验证，我们就可以 确定老年ICU中急性认知障碍的患病率 患者及其与临床结果的关系(目标2)。这群人 患者将被用来确定与神经心理相关的因素 在入住ICU后6个月出现赤字(目标3)。这是建立在 候选人之前在ICU和老年学方面的工作，并扩展到 重要的新领域，即危重老年人的认知障碍 人。长期目标是改善老年ICU的健康状况 患者通过未来的研究，将寻求减少 认知障碍，以加强从机械通风中解放出来， 将这些观察结果纳入ICU常规监测，并改善 ICU后神经心理缺陷的认识与预防。至 为这个目标做准备，他提出的职业发展计划包括 老年认知评估、流行病学和生物统计学方面的培训， 心理测量学和研究方法，通过临床培训，课程工作， 和独立阅读。以及候选人的出版物记录和 成就，他将拥有丰富的学术环境，优秀的导师和 坚定的机构承诺，以确保他实现这些目标。

DESCRIPTION (From the application): Global deficits in cognition in the form of delirium, stupor, or coma are extremely common and hazardous in older ICU patients. Cognitive impairment is associated with prolonged hospital stays, institutionalization, and death. Because acute cognitive impairment compromises patients' ability to be removed from mechanical ventilation and may be a factor associated with long-term neuropsychological sequelae, physicians and nurses need to be able to identify patients at high risk for cognitive impairment and understand potentially modifiable aspects of care that may reduce cognitive impairment. Consciousness is defined as having two components: arousal (wakefulness) and content (attentiveness). Arousal, a basic process of mental function, is commonly monitored in ICU patients. Attentiveness, which results from more complex neurologic interactions, is often impaired yet rarely objectively monitored. There are no validated instruments available for bedside use by nurses or physicians to monitor both components of consciousness in mechanically ventilated patients. We propose to modify existing instruments for use in the ICU in order to develop and validate a system for monitoring the brain and its function in mechanically ventilated patients during and after ICU care (Aim 1). Once validated, we can determine the prevalence of acute cognitive impairments in elderly ICU patients and its association with clinical outcomes (Aim 2). This cohort of patients will be used to determine factors associated with neuro-psychological deficits at 6 months following the ICU stay (Aim 3). This builds on the candidate's previous work in the ICU and gerontology and extends into an important new area, which is cognitive impairment in critically ill older persons. The long-term goal is to improve health outcomes for elderly ICU patients through future studies which will seek to reduce the incidence of cognitive impairment, to enhance liberation from mechanical ventilation, to integrate these observations into routine ICU monitoring, and to improve the understanding and prevention of post-ICU neuropsychological deficits. To prepare for this goal, his proposed career development plan includes advanced training in geriatric cognitive assessment, epidemiology and biostatistics, psychometrics and research methodology through clinical training, course work, and independent reading. Along with the candidate's record of publications and achievement, he will have rich academic surroundings, excellent mentors and strong institutional commitment to ensure that he achieve these goals.