Vasoactive Agents and Cerebral Outcomes in Brain Injury
血管活性药物和脑损伤中的脑结果
基本信息
- 批准号:9029235
- 负责人:
- 金额:$ 24.99万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2015
- 资助国家:美国
- 起止时间:2015-09-30 至 2017-08-31
- 项目状态:已结题
- 来源:
- 关键词:4 year oldAdolescentAffectAgeBlood PressureBrainBrain InjuriesBrain IschemiaCaringCause of DeathCerebral perfusion pressureCerebrospinal FluidCerebrovascular CirculationCerebrumCessation of lifeCharacteristicsChildChildhood InjuryDataDopamineEmergency MedicineEndothelin-1EpinephrineFamily suidaeHistopathologyHomeostasisHypotensionImpairmentIntravenousLearningLiquid substanceMeasuresModelingNewborn InfantNorepinephrineOutcomePatientsPerfusionPhenylephrinePhysiciansPlayPotassium ChannelProcessRecommendationResearchResearch PersonnelRoleSurgeonTestingTraumaTraumatic Brain InjuryVasodilationVasodilator AgentsWorkadrenomedullinage relatedblood productboysdisabilityevidence based guidelinesfluid percussion injurygirlshemodynamicsindexinginjuredmalemiddle cerebral arteryneurovascular unitpediatric traumapediatric traumatic brain injurypreventpublic health relevancesexvasoactive agent
项目摘要
DESCRIPTION (provided by applicant): Trauma is the leading killer of children and adolescents, and traumatic brain injury (TBI) is the leading cause of pediatric trauma related death, where boys and young children have worse outcomes. When caring for injured children, front line physicians such as surgeons, anesthesiologists, emergency medicine physicians, and intensivists often struggle to prevent and/or expediently correct the unwanted but prevalent hypotension. This is problematic because systemic hypotension causes low cerebral perfusion (cerebral perfusion pressure [CPP] and cerebral blood flow [CBF], resulting in brain ischemia and poor outcomes. Moreover, cerebral autoregulation is impaired after TBI, which prevents brain perfusion during systemic hypotension. Current Level II recommendations are to maintain systolic blood pressure > 70 + 2 (age) and CPP above 40 mmHg. Intravenous vasoactive agents such as phenylephrine (PHE), norepinephrine (NE), dopamine (DA) and epinephrine (EPI), while used to treat hypotension after correction with fluids/ blood products, lack comparison with respect to desired effect. Thus, initial choice of vasoactive agent is largely empiric, and variable. Importantly, vasoactive agents have not been compared vis-à-vis their effect on cerebral outcomes (hemodynamics [CPP] and perfusion [CBF and cerebral autoregulation]) after trauma; virtually nothing is known about their mechanisms or how these mechanisms relate to TBI. Our previous work suggests that knowing which intravenous vasoactive better corrects hypotension is clinically important, vasoactive agents differentially affect the neurovascular unit (NVU), and that the NVU plays an important role in cerebral perfusion and outcomes. Yet, no mechanisms for cerebral perfusion or dysautoregulation have been elucidated in pediatric trauma/TBI. The overarching hypothesis is that commonly used intravenous vasoactive agents have differential mechanistic effects on cerebral outcomes in TBI, and these differences are related to sex and age. The Specific Aims are to: 1) Examine the association between intravenously administered vasoactive agents (PHE, NE, DA, EPI) and cerebral perfusion (hemodynamics and autoregulation) after TBI by age and sex, and 2) Investigate the mechanism by which vasoactive agents (PHE, NE, DA, EPI) affect cerebral hemodynamics and autoregulation after TBI in children by age and sex. The impact of this exploratory R21 study will be to provide new information as to whether and how initial choice of vasoactive agent affects the NVU, cerebral hemodynamics and cerebral perfusion characteristics in pediatric TBI by age and sex.
描述(申请人提供):创伤是儿童和青少年的头号杀手,而创伤性脑损伤(TBI)是儿童创伤相关死亡的主要原因,男孩和幼儿的预后更差。在照顾受伤的儿童时,一线医生,如外科医生、麻醉师、急救内科医生和重症医生,经常努力预防和/或方便地纠正不必要的但普遍存在的低血压。这是有问题的,因为全身性低血压导致低脑灌注量(脑灌注压[CPP]和脑血流量[CBF],从而导致脑缺血和不良预后。此外,颅脑损伤后的脑自动调节功能受损,从而在全身低血压时阻止脑灌流。目前的II级建议是保持收缩压>;70+2(年龄)和CPP在40毫米汞以上。静脉血管活性物质,如苯肾上腺素(Phe)、去甲肾上腺素(NE)、多巴胺(DA)和肾上腺素(EPI),虽然用于治疗液体/血液制品纠正后的低血压,但缺乏与预期效果的比较。因此,血管活性物质的初始选择在很大程度上是经验性的,而且是可变的。重要的是,血管活性物质对创伤后脑部转归(血流动力学[CPP]和脑血流灌注[CBF和脑自动调节])的影响还没有被比较;几乎对它们的机制或这些机制与脑外伤的关系知之甚少。我们以前的工作表明,了解哪种静脉血管活性物质更好地纠正低血压具有临床重要性,血管活性物质对神经血管单位(NVU)的影响不同,NVU在脑血流灌注和预后中发挥重要作用。然而,在儿童创伤/脑损伤中,脑血流灌注或自身调节失调的机制尚未阐明。最重要的假设是,常用的静脉血管活性物质对脑损伤患者的脑预后有不同的机制影响,这些差异与性别和年龄有关。研究的具体目的是:1)研究脑损伤后静脉应用血管活性物质(Phe、NE、DA、EPI)与脑血流动力学和自身调节之间的年龄和性别相关性;2)探讨血管活性物质(Phe、NE、DA、EPI)对儿童颅脑损伤后脑血流动力学和自身调节的影响机制。这项探索性的R21研究的影响将是提供新的信息,即初始血管活性物质的选择是否以及如何影响年龄和性别对儿童脑外伤患者的NVU、脑血流动力学和脑血流灌注特性的影响。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
数据更新时间:{{ journalArticles.updateTime }}
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
数据更新时间:{{ journalArticles.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ monograph.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ sciAawards.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ conferencePapers.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ patent.updateTime }}
Monica S Vavilala其他文献
Racial and Ethnic Differences in Time to Completion of Academic Enrichment Program Applications
完成学术强化计划申请的时间上的种族和民族差异
- DOI:
10.7759/cureus.60054 - 发表时间:
2024 - 期刊:
- 影响因子:0
- 作者:
Kristian V Jones;A. Chitwanga;Qian Qiu;Aspen D Avery;Darya Yemets;Carolyn Theard;Chelsea Hicks;keith Hullenaar;Monica S Vavilala;Marie A Theard - 通讯作者:
Marie A Theard
Identifying Common Data Elements to Achieve Injury-related Health Equity Across the Lifespan: A Consensus-Driven Approach
确定通用数据元素以实现整个生命周期中与伤害相关的健康公平:共识驱动的方法
- DOI:
10.1089/heq.2023.0044 - 发表时间:
2024 - 期刊:
- 影响因子:2.7
- 作者:
K. Conrick;Brianna Mills;Molly Fuentes;J. Graves;Christopher St Vil;Monica S Vavilala;Eileen M Bulger;Saman Arbabi;Ali Rowhani;Megan Moore - 通讯作者:
Megan Moore
Computer Simulation to Assess Emergency Department Length of Stay in Pediatric Traumatic Brain Injury.
计算机模拟评估小儿脑外伤急诊科住院时间。
- DOI:
- 发表时间:
2024 - 期刊:
- 影响因子:1.4
- 作者:
Tianshu Feng;Ali Ajdari;Linda Ng Boyle;N. Kannan;Randall Burd;Jonathan I Groner;R. A. Farneth;Monica S Vavilala - 通讯作者:
Monica S Vavilala
Insights from Developing and Implementing a Novel School Community Collaborative Model to Promote School Safety.
开发和实施新型学校社区协作模式以促进学校安全的见解。
- DOI:
10.1111/josh.13451 - 发表时间:
2024 - 期刊:
- 影响因子:2.2
- 作者:
Keith L. Hullenaar;Chelsea D Hicks;Marcus W Stubblefield;Lester Herndon Flip;Susan K Seabrooks;Monica S Vavilala;Sharon S Laing - 通讯作者:
Sharon S Laing
Monica S Vavilala的其他文献
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
{{ truncateString('Monica S Vavilala', 18)}}的其他基金
Pediatric Injury Prevention Student Internship Training (INSIGHT)
儿科伤害预防学生实习培训(INSIGHT)
- 批准号:
10382766 - 财政年份:2021
- 资助金额:
$ 24.99万 - 项目类别:
CE19-001, Injury Health-related Equity across the Lifespan (iHeal)
CE19-001,整个生命周期中与伤害健康相关的公平性 (iHeal)
- 批准号:
10220784 - 财政年份:2019
- 资助金额:
$ 24.99万 - 项目类别:
CE19-001, Injury Health-related Equity across the Lifespan (iHeal)
CE19-001,整个生命周期中与伤害健康相关的公平性 (iHeal)
- 批准号:
10054917 - 财政年份:2019
- 资助金额:
$ 24.99万 - 项目类别:
CE19-001, Injury Health-related Equity across the Lifespan (iHeal)
CE19-001,整个生命周期中与伤害健康相关的公平性 (iHeal)
- 批准号:
10451467 - 财政年份:2019
- 资助金额:
$ 24.99万 - 项目类别:
CE19-001, Injury Health-related Equity across the Lifespan (iHeal)
CE19-001,整个生命周期中与伤害健康相关的公平性 (iHeal)
- 批准号:
10640214 - 财政年份:2019
- 资助金额:
$ 24.99万 - 项目类别:
Pediatric Injury Prevention Student Internship Training (INSIGHT)
儿科伤害预防学生实习培训(INSIGHT)
- 批准号:
10200104 - 财政年份:2018
- 资助金额:
$ 24.99万 - 项目类别:
Pediatric Injury Prevention Student Internship Training (INSIGHT)
儿科伤害预防学生实习培训(INSIGHT)
- 批准号:
10427207 - 财政年份:2018
- 资助金额:
$ 24.99万 - 项目类别:
Pediatric Injury Prevention Student Internship Training (INSIGHT)
儿科伤害预防学生实习培训(INSIGHT)
- 批准号:
9766885 - 财政年份:2018
- 资助金额:
$ 24.99万 - 项目类别:
Vasoactive Agents and Cerebral Outcomes in Brain Injury
血管活性药物和脑损伤中的脑结果
- 批准号:
9148197 - 财政年份:2015
- 资助金额:
$ 24.99万 - 项目类别:
Improving Indo-US Traumatic Brain Injury Outcomes
改善印美创伤性脑损伤的结果
- 批准号:
8244122 - 财政年份:2011
- 资助金额:
$ 24.99万 - 项目类别:
相似海外基金
Understanding How Adolescent Bullying Experiences Affect Traumatic Stress,Sexual Health and STI Risk among Men Who Have Sex with Men (MSM)
了解青少年欺凌经历如何影响男男性行为者 (MSM) 的创伤性压力、性健康和性传播感染风险
- 批准号:
10553263 - 财政年份:2022
- 资助金额:
$ 24.99万 - 项目类别:
Understanding How Adolescent Bullying Experiences Affect Traumatic Stress,Sexual Health and STI Risk among Men Who Have Sex with Men (MSM)
了解青少年欺凌经历如何影响男男性行为者 (MSM) 的创伤性压力、性健康和性传播感染风险
- 批准号:
10347813 - 财政年份:2022
- 资助金额:
$ 24.99万 - 项目类别:
Visuocortical Dynamics of Affect-Biased Attention in the Development of Adolescent Depression
青少年抑郁症发展过程中情感偏向注意力的视觉皮层动力学
- 批准号:
10380686 - 财政年份:2019
- 资助金额:
$ 24.99万 - 项目类别:
Visuocortical Dynamics of Affect-Biased Attention in the Development of Adolescent Depression
青少年抑郁症发展过程中情感偏向注意力的视觉皮层动力学
- 批准号:
9888437 - 财政年份:2019
- 资助金额:
$ 24.99万 - 项目类别:
Visuocortical Dynamics of Affect-Biased Attention in the Development of Adolescent Depression
青少年抑郁症发展过程中情感偏向注意力的视觉皮层动力学
- 批准号:
10597082 - 财政年份:2019
- 资助金额:
$ 24.99万 - 项目类别:
Targeting maladaptive responding to negative affect in adolescent cannabis users
针对青少年大麻使用者的负面影响的适应不良反应
- 批准号:
9371970 - 财政年份:2017
- 资助金额:
$ 24.99万 - 项目类别:
Childhood positive affect and anger as predictors of adolescent risky behavior
童年积极影响和愤怒是青少年危险行为的预测因素
- 批准号:
9139461 - 财政年份:2015
- 资助金额:
$ 24.99万 - 项目类别:
Do State Marijuana Policies Affect Adolescent Marijuana and Alcohol Use?
州大麻政策会影响青少年大麻和酒精的使用吗?
- 批准号:
8783159 - 财政年份:2014
- 资助金额:
$ 24.99万 - 项目类别:
Do State Marijuana Policies Affect Adolescent Marijuana and Alcohol Use?
州大麻政策会影响青少年大麻和酒精的使用吗?
- 批准号:
8853783 - 财政年份:2014
- 资助金额:
$ 24.99万 - 项目类别:
Assessment of Affect Instability in Adolescent Girls with BPD Features
具有 BPD 特征的青春期女孩的情绪不稳定评估
- 批准号:
8122499 - 财政年份:2011
- 资助金额:
$ 24.99万 - 项目类别: