Five Year Outcomes from Acute Lung Injury

急性肺损伤的五年结果

• 批准号: 8126292
• 负责人: Peter J. Pronovost
• 金额: $ 19.57万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-11 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8126292
• 关键词: Acute; Acute Lung Injury; Adrenal Cortex Hormones; Adult Respiratory Distress Syndrome; Anxiety; Blood capillaries; Caring; Cessation of life; Clinical Research; Cohort Studies; Critical Illness; Death Rate; Delirium; Diffuse; Epidemiology; Frequencies; Funding; Future; Goals; Grant; HIV Infections; Hypoxia; Incidence; Instruction; Intensive Care; Intensive Care Units; Intervention; Intervention Studies; Knowledge; Lead; Learning; Left; Longitudinal Studies; Lung; Mechanical ventilation; Medical; Mental Depression; Mental Health; Mental disorders; Mentors; Mid-Career Clinical Scientist Award (K24); Morbidity - disease rate; Muscle Weakness; Outcome; Patients; Persons; Physical Function; Post-Traumatic Stress Disorders; Prevalence; Psyche structure; Public Health; Quality of life; Recovery; Research; Research Design; Research Infrastructure; Research Proposals; Respiratory Failure; Risk Factors; Sampling; Sepsis; Severities; Survivors; Symptoms; Syndrome; United States National Institutes of Health; capillary; cohort; design; epidemiology study; experience; follow-up; functional status; improved; malignant breast neoplasm; mortality; nutrition; patient oriented research; physical conditioning; prospective; randomized trial; research study

DESCRIPTION (provided by applicant): Acute Lung Injury (ALI) is a syndrome characterized by acute, diffuse pulmonary capillary leak resulting in hypoxic respiratory failure. ALI imposes a significant public health burden with an incidence of 86 per 100,000 person years and a total number of deaths similar to breast cancer or HIV infection. Due to advances in medical care, the mortality rate for ALI has decreased from -70% to -40%. Patients who previously may have died now survive ALI; however, their recovery is often long and complicated. Research studying the long-term outcomes of these ALI survivors has become increasingly important. The present application is a third submission for a K24 award. The PI is a leader is patient -oriented research in critically ill patients especially those with ALI, and has an outstanding record of mentoring trainees. The goal of this proposal is to learn how existing ICU therapies can be used to minimize long-term physical and mental health morbidities and improve patients' functional status and quality of life after ALI. We propose to extend our existing NIH funded cohort study, which follows patients for 2 years after ALI, to allow 5-year follow-up. Specifically, we will study the epidemiology of muscle weakness, and symptoms of anxiety, depression and post-traumatic stress disorder at up to 5 years after ALI [Aims 1a and 2a] and the association of these sequelae with limitations in patients' physical function and quality of life. We will then determine the association of nutrition and corticosteroids in the ICU with long-term muscle weakness[Aim 1b]. We also will determine the association of delirium and corticosteroids in the ICU with long-term symptoms of post-traumatic stress disorder [Aim 2b]. A number of research opportunities exist for trainees. This research proposal describes a new cohort study of ALI patients who will be followed for 5 years. This research will provide new knowledge regarding the frequency of morbidities after ALI, their consequences for patients, and how nutrition, corticosteroids and delirium in the ICU may reduce or exacerbate these morbidities up to 5 years after ALI. The study will add to our infrastructure for trainees to participate in clinical research and to design future studies, including intervention studies, to improve outcomes in ALI patients. RELEVANCE (See instructions): Acute lung injury is a significant public health problem that can lead to death or long-term physical and mental illnesses. While death rates have been decreased by advances in medical care, the recovery period from ALI is long and patients are left with significant morbidity. This grant would research existing ICU therapies that could improve recovery and reduce long-term physical and mental health morbidities from ALI.

描述（由申请人提供）： 急性肺损伤（ALI）是一种以急性弥漫性肺毛细血管渗漏导致缺氧性呼吸衰竭为特征的综合征。 ALI 造成了巨大的公共健康负担，发病率为每 10 万人年 86 例，死亡总数与乳腺癌或 HIV 感染相似。由于医疗保健的进步，ALI的死亡率已从-70%下降到-40%。以前可能已经死亡的 ALI 患者现在幸存下来；然而，他们的恢复往往是漫长而复杂的。研究这些急性肺损伤幸存者的长期结果变得越来越重要。本申请是第三次提交 K24 奖项。 PI 是危重患者（尤其是急性肺损伤患者）以患者为导向的研究领域的领导者，并且在指导学员方面拥有出色的记录。该提案的目标是了解如何使用现有的 ICU 疗法来最大程度地减少长期身心健康发病率，并改善 ALI 后患者的功能状态和生活质量。我们建议延长现有的 NIH 资助的队列研究，该研究对 ALI 后的患者进行 2 年的随访，以允许 5 年的随访。具体来说，我们将研究 ALI 后长达 5 年的肌无力、焦虑、抑郁和创伤后应激障碍症状的流行病学[目标 1a 和 2a]，以及这些后遗症与患者身体功能和生活质量限制的关系。然后，我们将确定 ICU 中的营养和皮质类固醇与长期肌无力的关系[目标 1b]。我们还将确定 ICU 中谵妄和皮质类固醇与创伤后应激障碍长期症状的关系 [目标 2b]。实习生有许多研究机会。该研究提案描述了一项针对 ALI 患者的新队列研究，该研究将被跟踪 5 年。这项研究将提供有关 ALI 后发病频率、其对患者造成的后果，以及 ICU 中的营养、皮质类固醇和谵妄如何在 ALI 后 5 年内减少或加剧这些发病率的新知识。该研究将丰富我们的基础设施，让学员参与临床研究并设计未来的研究（包括干预研究），以改善 ALI 患者的治疗结果。相关性（参见说明）：急性肺损伤是一个重大的公共卫生问题，可能导致死亡或长期的身体和精神疾病。虽然医疗保健的进步降低了死亡率，但 ALI 的恢复期很长，并且患者的发病率很高。这笔赠款将用于研究现有的 ICU 疗法，这些疗法可以改善康复并减少 ALI 造成的长期身心健康发病率。