Quantitative Monitoring and Control of Sedation and Pain in the ICU Environment

ICU 环境中镇静和疼痛的定量监测和控制

• 批准号: 8616877
• 负责人: Michael Brandon Westover
• 金额: $ 19.46万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8616877
• 关键词: Absence of pain sensation; Address; Adrenergic Agonists; Affect; Analgesics; Behavior assessment; Boston; Brain; Cardiac; Cardiovascular system; Caring; Characteristics; Clinical; Computer Simulation; Computer software; Conscious; Critical Illness; Data; Delirium; Development Plans; Dexmedetomidine; Dose; Drug Delivery Systems; Drug Kinetics; Electromyography; Environment; Exhibits; Feedback; General Hospitals; Goals; Health Care Costs; Individual; Infusion procedures; Institution; Intervention; Intravenous; Knowledge; Lung; Massachusetts; Measurable; Measurement; Measures; Medical; Medicine; Mental Depression; Mentors; Mentorship; Methods; Modeling; Monitor; Morbidity - disease rate; Movement; Neurologist; Neurosciences; Opiates; Outcome; Pain; Patients; Performance; Pharmaceutical Preparations; Pharmacodynamics; Physiologic Monitoring; Physiological; Physiology; Population; Positioning Attribute; Process; Research; Research Personnel; Research Proposals; Resources; Science; Sedation procedure; Signal Transduction; Statistical Models; Stream; Stress; Structure; System; Techniques; Technology; Testing; Time; Titrations; Tube; Ventilator; Ventilator Weaning; Work; bench to bedside; career; career development; clinical care; clinical practice; didactic education; healthy volunteer; improved; neurophysiology; novel; patient oriented research; pharmacodynamic model; physiologic model; programs; psychological distress; public health relevance; relating to nervous system; remifentanil; response; sedative; signal processing; skills

DESCRIPTION (provided by applicant): Dr. M. Brandon Westover is a practicing Neurologist and clinical electroencephalographer at Massachusetts General Hospital (MGH), whose goal is to become an independent investigator with expertise in biomedical signal processing and pharmacodynamics as they relate to sedation and analgesia in critically ill patients. His career development plan leverages the resources of a world-class environment by bringing together an out-standing team of investigators centered at a leading academic institution in Boston, Massachusetts General Hospital. Dr. Westover has already obtained preliminary results demonstrating the feasibility of a research plan that combines pharmacokinetic/pharmacodynamic (PK/PD) modeling with real-time automated processing of EEG and other physiological signals to quantitatively monitor and provide closed-loop control of sedation and analgesia in ICU patients. Under the mentorship of Dr. Emery Brown, and co-Mentors Dr. Sydney Cash and Dr. Patrick Purdon, Dr. Westover proposes: 1) To determine which features of the EEG and other physiological signals systematically relate with levels of sedation and analgesia in ICU patients, 2) To determine the full range and variability of pharmacodynamic responses in ICU patients receiving combinations of two specific intravenous sedative-analgesic medications, namely dexmedetomidine and remifentanil, and 3) To investigate whether a closed-loop drug delivery system, which integrates knowledge about population-level PK/PD characteristics of dexmedetomidine and remifentanil with real-time physiological feedback about an individual's level of pain and level of consciousness, can achieve more precise control of sedation-analgesia than is possible under current clinical practices. The overall goal is to develop an understanding of how to objectively and quantitatively monitor pain and sedation in the ICU setting, and to use this understanding to reduce the now pervasive problem of morbidity due to over- and under-dosing of sedative-analgesic drugs. Bringing together cutting-edge technology and a team with relevant expertise, this project will open new avenues for optimizing care and improving outcomes for a broad range of ICU patients. This well-defined patient-oriented research proposal, in concert with mentorship and a structured didactic curriculum, will provide Dr. Westover with the skills that are essential to develop an independent career in clinical neurophysiological research at the cutting edge of science.

描述（由申请人提供）：M. Brandon Westover 博士是马萨诸塞州总医院 (MGH) 的一名执业神经科医生和临床脑电图学家，他的目标是成为一名独立研究者，拥有生物医学信号处理和药效学方面的专业知识，因为这些知识与危重患者的镇静和镇痛有关。他的职业发展计划利用了世界一流环境的资源，汇集了以波士顿领先学术机构马萨诸塞州综合医院为中心的优秀研究团队。 Westover博士已经获得了初步结果，证明了一项研究计划的可行性，该研究计划将药代动力学/药效学（PK/PD）建模与脑电图和其他生理信号的实时自动处理相结合，以定量监测并提供ICU患者镇静和镇痛的闭环控制。在 Emery Brown 博士以及共同导师 Sydney Cash 博士和 Patrick Purdon 博士的指导下，Westover 博士建议：1) 确定 EEG 和其他生理信号的哪些特征与 ICU 患者的镇静和镇痛水平系统相关，2) 确定接受两种特定静脉镇静镇痛药物组合的 ICU 患者药效学反应的全面范围和变异性，即 3) 研究将右美托咪定和瑞芬太尼群体水平 PK/PD 特征的知识与个体疼痛水平和意识水平的实时生理反馈相结合的闭环给药系统是否能够实现比当前临床实践更精确的镇静镇痛控制。总体目标是了解如何在 ICU 环境中客观、定量地监测疼痛和镇静，并利用这种理解来减少目前普遍存在的因镇静镇痛药物剂量过多或不足而导致的发病率问题。该项目汇集了尖端技术和具有相关专业知识的团队，将为优化护理和改善广大 ICU 患者的治疗结果开辟新途径。这项明确的以患者为导向的研究计划，与指导和结构化的教学课程相结合，将为 Westover 博士提供以下技能： 对于在科学前沿的临床神经生理学研究中发展独立的职业生涯至关重要。