Minimally invasive techniques to measure upper airway obstruction in children

描述（由申请人提供）：在孩子最关键的时刻照顾他们是一种难以置信的荣幸。作为儿科重症护理从业人员，我们必须能够为这些儿童提供及时和基于证据的护理，并支持家庭的知识，一个人选择的治疗是基于证据和经验。然而，作为一个专业，我们只能通过严格的临床研究来建立基于证据的标准。致力于重症监护医学的职业生涯，我有责任为我的病人提供最高的、基于证据的护理，并通过开展研究来收集最佳实践的证据，帮助我们的专业发展。要做到这一点，我必须学习必要的技能，以促进我发展成为一个彻底和严谨的临床研究人员。虽然我在统计学和临床调查方面有本科和研究生水平的经验，但由于儿科疾病的“罕见”，需要对重症儿童进行多学科研究，才能得出有意义的结论。这对机械通气的儿童尤其重要，这是儿科重症监护中最常见但最多变的干预措施。寻求进行多中心机械通气试验，我必须掌握此类试验的设计和实施的知识和技能，并获得评估通气儿童试验潜在客观结果的专业知识。这份申请中详述的具体研究项目是我发展这些技能的第一步。通过动物模型验证上气道阻塞的微创措施，并将该措施应用于单部位机械通气儿童，希望掌握肺功能评估的相关技能。

DESCRIPTION (provided by applicant): It is an incredible privilege to take care of children at their most critical juncture. As pediatric critical care practitioners we must be able to provide timely and evidenced based care for these children, and support families with the knowledge that one's chosen treatment is based upon evidence and experience. However, as a specialty we can only create evidence based standards through rigorous clinical research. Committed to a career in intensive care medicine, it is my duty to provide my patients with the highest, evidence based care, and help our specialty grow by conducting studies to gather evidence for the best practices. To do this, I must learn the necessary skills to foster my development into a thorough and rigorous clinical researcher. While I have undergraduate and graduate level experience in statistics and clinical investigation, with the "rarity" of pediatric disease, multi-ite studies are needed to draw meaningful conclusions about critically ill children. This is particularly important for mechanically ventilated children-the most common yet most variable intervention in pediatric critical care. Seeking to conduct multi-center mechanical ventilation trials, I must equip myself with knowledge and skills about the design and implementation of such trials, and also gain expertise on evaluating potential objective outcomes for trials on ventilated children. The specific research project detailed in this application is the first step fr me to develop these skills. Using an animal model to validate a minimally invasive measure of upper airway obstruction and subsequently applying this measure to mechanically ventilated children at a single site, I hope to master skills related to the evaluation of pulmonary function, particularly upper airway obstruction. Upper airway obstruction is a complicating factor in ventilation trials because it prolongs length of mechanical ventilation. It is a bigger problem in children (compared to adults) as it is estimated on clinical grounds that 1/3 of all pediatric extubation failures result from upper airway obstruction. However, risk factors for and therapies targeting post-extubation airway obstruction are inconsistent, likely because clinical acumen to measure upper airway obstruction is lacking. Therefore, this project describes validating a minimally invasive technique to measure upper airway obstruction, initially in Rhesus Monkeys. It will then be applied in children to evaluate the accuracy of clinical stridor scales, and determine whether commonly applied therapeutics or supportive care impact resolution of airway obstruction, by demonstrating improvement in the objective, non-invasive measures. While this study will equip me with important skills to conduct clinical trials, I will get specifi experience with the nuances of multi-institutional trials through a series of meetings and activities with the NICHD Collaborative Pediatric Critical Care Research Network (CPCCRN) and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. These networks have undertaken many multi-center trials in critically ill children, and will help me learn the necessary skills to take a multi-center trial from an idea to reality.