CPP Management Information Feedback and Nursing

描述（由申请人提供）：本研究假设可能存在最佳水平的脑灌注压（CPP）及其组成部分，颅内压（ICP）和全身动脉压（ABP），有助于预防或减少危重患者的继发性脑损伤。由于CPP可以受到护理护理的影响，如体位、吸痰等，目前正在测试护士在每分钟的基础上管理CPP的能力，以证明对晚期青少年和成人的短期和长期结果的可衡量改善的能力。在这一竞争的延续中，我们建议将观察扩展到尚未确定足够阈值的儿童，以检查生理波形的复杂性，以更好地了解可能导致临床结果差异的变化或更好地预测结果变化，并对这种技术改进进行成本分析。竞争延续的具体目标是：1)根据3个月、6个月和12个月的结果，确定16岁以下儿童的CPP阈值是否可以定义；2)描述成人和儿童的ICP和ABP复杂性和HRV与预测出院和6个月和12个月（儿童）预后的关系；3)估计监测CPP的儿童、青少年和成人整个生命周期的住院费用；4)估计质量调整生命年（QALY）对监测CPP的儿童、青少年和成人在整个生命周期中不同护理结果的价值。

DESCRIPTION (provided by applicant): This study is predicated on the assumption that there may be optimal levels of cerebral perfusion pressure (CPP) and its components, intracranial pressure (ICP) and systemic arterial blood pressure (ABP), that help prevent or reduce secondary brain injury in critically ill patients. Since CPP can be influenced by nursing care such as positioning, suctioning and the like, refining the ability for nurses to manage CPP on a minute-to-minute basis is currently being tested for the ability to demonstrate measurable improvement in short and long-term outcome for late adolescents and adults. In this competing continuation, we propose to extend the observation to children, for whom no adequate threshold has yet been determined, to examine complexity of physiologic waveforms to better understand the variations that may underlie clinical outcome differences or better predict outcome variation, and to conduct a cost-analysis of this improvement in technology. The specific aims of the competing continuation are to: 1) Determine if CPP threshold can be defined for children less than 16 years of age, based on 3, 6 and 12 month outcomes; 2) Characterize ICP and ABP complexity and HRV for both adults and children in relation to predicting outcome at discharge and 6 and 12 months (for children); 3) Estimate hospitalization cost across the life span for children, adolescents and adults monitored for CPP; 4) Estimate the value, in quality adjusted life years (QALY) for varying outcomes of care across the life span for children, adolescents and adults monitored for CPP. Computer interfaces that provide visual information about CPP will be allocated to beds in each of the pediatric intensive care units used for children ages 1-16 years with traumatic injury, in whom ICP and blood pressure monitoring has been instituted as part of medical management. Data regarding CPP and 3, 6 and 12-month functional outcome will be evaluated to determine if a threshold for CPP can be determined for differing grades of outcome (from death to very good physical and social function). Continuous ICP, ABP and electrocardiographic data from these children and from the adults in the parent study will be analyzed using a variety of non-linear approaches to determine waveform factors that are predictive of outcome. Hospital data regarding costs and charges during acute care hospitalization will be examined in both children and adults to determine if the use of the computer interface is associated with greater or lesser acute care costs. Finally, a survey of survivors of acute brain injury and of community peers will be conducted to estimate the value (in quality adjusted life years) placed on differing outcome states after both traumatic brain injury and aneurysmal subarachnoid hemorrhage.