LONG-TERM OUTCOMES OF SPECIFIC VENTILATOR STRATEGIES

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。急性肺损伤(ALI)相对常见，并与显著的短期死亡率相关。ALI的发病率估计为每100,000人中有75人(2000年)，历史上有40%的住院死亡率(Hudson 1998；Stewart 1998；Brochard 1998；Amato 1998；Brower 1999)。ALI网络的证据表明，使用常规呼吸机肺保护(CVLP)可将28天死亡率从40%降至31%(ARDS网络，2001)。尽管有这些证据，但关于ALI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，人们知之甚少。为了改善ALI患者的护理，我们需要更好地了解遵守CVLP的障碍、与ALI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治疗方法。这项观察性队列研究提供了一个独特的机会来确定ALI受试者的暴露和长期结果。暴露剂量将通过每天观察受试者在ICU接受的治疗(包括CVLP)和他们的医疗过程(例如，疾病的严重程度)来确定。将在ALI诊断后3、6、12和24个月观察结果，以评估以下类型的结果：生物功能障碍(例如，需要血液透析)、临床事件(例如，重复住院)和患者报告的结果(生活质量)。通过这一认识的提高，本研究将为改善ALI受试者的护理增加重要的新知识。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Acute Lung Injury (ALI) is relatively common and associated with significant short term mortality. The incidence of ALI is estimated to be 75 per 100,000 persons (Ware 2000) and historically has had 40% hospital mortality (Hudson 1998; Stewart 1998; Brochard 1998; Amato 1998; Brower 1999). Evidence from the ALI Network suggests that 28-day mortality can be reduced from 40% to 31% with the use of Conventional Ventilation Lung Protection (CVLP) (ARDS Network 2001). Despite this evidence, little is known regarding the long-term mortality and outcomes in ALI subjects or whether CVLP improves these long-term outcomes. To improve the care of subjects with ALI, we need to better understand the barriers to compliance with CVLP, the long-term mortality and other outcomes associated with ALI, and the therapies that may be associated with those outcomes. This observational cohort study presents a unique opportunity to identify exposures and long-term outcomes in ALI subjects. Exposures will be determined by daily observation of subjects' therapies received in the ICU (including CVLP) and their medical course (e.g., severity of illness). Outcomes will be observed at 3, 6, 12 and 24 months after diagnosis of ALI to assess the following categories of outcomes: disorders of biologic functioning (e.g., need for hemodialysis), clinical events (e.g. repeat hospitalization), and patient reported outcomes (quality of life). Through this improved understanding, this study will add important new knowledge of ways to improve the care of subjects with ALI.