Outcomes of specific ventilator strategies

急性肺损伤(ALL)相对常见，并与显著的短期死亡率和长期发病率相关。尽管有证据表明，肺保护性传统呼吸机途径(CVLP)与降低28天死亡率有关，但CVLP的使用范围尚不清楚，我们对其使用障碍也知之甚少。此外，关于所有患者的长期死亡率和结果，或者CVLP是否改善了这些长期结果，我们知之甚少。为了改善ALL患者的预后，我们必须了解遵守CVLP的障碍、与ALL相关的长期死亡率和其他结果，以及可能与这些结果相关的一系列因素和其他治疗方法。这项研究将为我们对改进方法的理解增加重要的新知识 对所有患者的护理。我们建议评估以下两个具体目标：1.目的：评价CVLP在急性淋巴细胞白血病患者队列中的应用。1B.确定使用CVLP的患者、提供者和组织障碍。2.评估急性淋巴细胞白血病(ALL)患者CVLP呼吸机及其他护理措施与长期死亡率的关系。我们还将评估一个次要目标：评估CVLP和其他护理方面与广泛的患者结果之间的关联。为了评估这些目标，我们将在巴尔的摩大都市区的4家医院--6家重症监护病房(ICU)--进行一项队列研究。我们将评估接受特定医疗治疗的情况：CVLP、瘫痪、类固醇、抗生素和营养的使用；以及患者在ICU住院期间气管切开的时机。结果变量是：出院、6个月、1年和2年死亡率；以及生物功能障碍， 临床事件和患者报告的结果。我们将在ALL诊断后的出院时、1年和2年后评估综合临床研究中心的结果。我们将在6个月后通过电话调查评估结果。这项研究具有重要意义，因为它增加了关于使用CVLP策略的障碍、ALL患者的长期结果以及CVLP对这些结果的影响的新知识。此外，通过确定除CVLP外的与这些结果相关的药物治疗，我们将确定改善ALL患者护理的机会。该项目的各方面代表了与该SCCOR的其他项目和核心的合作努力，重点是呼吸机相关的肺损伤。

Acute Lung Injury (ALl) is relatively common and associated with significant short-term mortality and long-term morbidity. Despite evidence that a lung-protective conventional ventilator approach (CVLP) is associated with reduced 28 day mortality, it is unknown how widely CVLP is used, and we have a poor understanding of the barriers to its use. Moreover, little is known regarding the long-term mortality and outcomes in ALl patients or whether CVLP improves these long-term outcomes. To improve outcomes for patients with ALl, we must understand the barriers to compliance with CVLP, long-term mortality and other outcomes associated with ALl, and the constellation of factors and other therapies that may be associated with those outcomes. This study will add important new knowledge to our understanding of ways to improve the care of patients with ALl. We propose to evaluate the following 2 specific aims: 1a. To evaluate the use of CVLP as a care strategy in a cohort of patients with ALl. 1b. To identify patient, provider and organizational barriers to using CVLP. 2. To evaluate the association between CVLP ventilation and other aspects of care with long-term mortality in patients with ALl. We will also evaluate a secondary aim: to evaluate the association between CVLP and other aspects of care with a broad group of patient outcomes. To evaluate the aims, we will conduct a cohort study at 4 hospitals--6 intensive care units (ICUs)--in the Baltimore metropolitan area. We will evaluate exposure to specific medical therapies: use of CVLP, paralysis, steroids, antibiotics and nutrition; and timing of tracheotomy during patient ICU stay. Outcome variables are: discharge, 6 month, one year and 2 year mortality; and disorders of biologic functioning, clinical events and patient reported outcomes. We will evaluate outcomes in the General Clinical Research Center at discharge, 1 year and 2 years after diagnosis of ALl. We will evaluate outcomes at 6 months with phone survey. This study is significant as it adds new knowledge about barriers to using CVLP strategies, long-term outcomes of patients with ALl and the impact of CVLP on these outcomes. Moreover, by identifying medical therapies in addition to CVLP that are associated with these outcomes; we will identify opportunities to improve care of patients with ALl. Aspects of this project represent collaborative efforts with other projects and cores on this SCCOR focused on ventilator associated lung injury.