Impact of Psychoactive Drugs on Delirium in ICU Patients

描述(由申请者提供)：这项以患者为导向的指导研究职业发展奖的长期目标是发展主要研究人员在观察性研究设计、量表开发和验证以及结果研究方面的技能和知识，重点是精神活性药物的使用及其对危重患者结果的影响。这项研究项目的主旨有三个方面：1)确定精神活性药物(镇静催眠药、麻醉剂和抗胆碱能药物)与ICU出院后持续性妄想的相关性。持续性妄想被定义为妄想，它存在于ICU中，也存在于ICU出院后。我们将检查单独和组合的药物，检查药物类别的影响，并检查接受药物的累积剂量的影响。2)确定与持续性精神错乱风险最高相关的主要药物或组合(称为高风险药物)。3)控制其他精神障碍危险因素(如痴呆症、疾病严重程度、侵入性操作、医疗合并症、侵入性操作和代谢异常)，我们将确定高风险药物对持续性精神错乱的独立贡献。申请者将通过在高度合格的导师的监督下完成良好整合的具体目标来实现长期目标，并由具有多学科ICU临床研究专业知识、精神错乱研究经验以及临床流行病学和生物统计学专家顾问协助的咨询委员会指导。申请者有一个重点课程，包括授课课程、参加研究研讨会和药理学培训，这些课程将补充她之前的公共卫生硕士课程。之所以选择这些研究项目，部分原因是它们将为申请者在ICU面向患者的研究中进一步过渡到独立调查者提供一个很好的培训工具。最终，我们希望这项工作将导致ICU药物治疗方面的具体干预措施的发展，这对美国400多万危重患者的护理至关重要。

DESCRIPTION (provided by applicant): The long-term objective of this Mentored Patient-Oriented Research Career Development Award is to develop the Principle Investigator's skills and knowledge in observational study design, scale development and validation and outcome studies focused on psychoactive drug use and its impact on outcomes in critically ill patients. The thrust of this research project is three-fold: 1) To determine the association of psychoactive (sedative-hypnotic, narcotic and anticholinergic) drugs with persistent delirium post-ICU discharge. Persistent delirium is defined as delirium, which is present in the ICU and is also present post-ICU discharge. We will examine the drugs individually and in combinations, examine the influence of drug class and examine the influence of cumulative dose of drug received. 2) To identify leading drugs or combinations (called HIGH RISK DRUGS) associated with the highest risk of persistent delirium. 3) Controlling for other delirium risk factors (e.g., dementia, illness severity, invasive procedures, medical comorbidities, invasive procedures, and metabolic abnormalities) we will determine the independent contribution of the HIGH RISK DRUGS to persistent delirium. The applicant will achieve the long-term objectives by completing the well-integrated specific aims under the supervision of a highly qualified mentor and guidance by an Advisory Committee with multidisciplinary ICU clinical research expertise, experience in delirium research, and assistance by expert consultants in clinical epidemiology and biostatistics. The applicant has a focused program of didactic courses, participation in research seminars and training in pharmacology that will complement her previous MPH curriculum. The research projects have been selected, in part because they will provide an excellent training vehicle for furthering the applicant's transition to an independent investigator in ICU patient-oriented research. Ultimately, we hope this work will lead to the development of specific interventions in ICU drug therapy vital to the care of more than four million critically ill patients in the United States.