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Generation and Validation of a Clinical Prediction Rule for Sedative-Associated Delirium During Acute Respiratory Failure

急性呼吸衰竭期间镇静相关谵妄的临床预测规则的生成和验证

基本信息

批准号：
10676716
负责人：
Niall Prendergast
金额：
$ 4.38万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2022-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10676716
关键词：
Acute Acute respiratory failure Address Adult Affect Alzheimer&apos s Disease American Attention Awareness COVID-19 COVID-19 pandemic COVID-19 patient Calibration Characteristics Clinical Clinical Research Cognition Cohort Studies Convalescence Critical Care Critical Illness Data Data Set Decision Making Delirium Development Discrimination Exposure to Functional disorder Funding Generations Health Care Costs Impaired cognition Intensive Care Units Knowledge Lead Length of Stay Logistic Regressions Mechanical ventilation Mentors Multicenter Studies National Heart, Lung, and Blood Institute National Research Service Awards Outcome Patient-Focused Outcomes Patients Pharmaceutical Preparations Pharmacology Predictive Factor Prospective cohort study Research Methodology Research Personnel Risk Risk Factors Sedation procedure Severities Survivors Syndrome Techniques Testing Training Training Programs Traumatic Brain Injury Treatment Factor Validation Work adverse outcome base brain dysfunction career cognitive testing cohort confusion assessment method disability effective therapy experience follow-up high risk improved improved outcome indexing innovation mortality optimism personalized decision preclinical study prospective sedative skills tool translational study

项目摘要

PROJECT SUMMARY/ABSTRACT More than half of the >10 million patients who are mechanically ventilated for acute respiratory failure throughout the world each year experience delirium, a brain dysfunction syndrome characterized by acute disturbances in attention, awareness, and cognition. Delirium is a risk factor for numerous adverse outcomes, including delayed liberation from mechanical ventilation, increased health care costs, increased mortality, and—for those who survive—long-term disability and persistent cognitive impairment. Up to one third of survivors of acute respiratory failure are affected by long-term cognitive impairment, the severity of which is similar to that caused by traumatic brain injury or Alzheimer’s Disease. The pathophysiology of delirium during acute respiratory failure remains poorly understood, and effective therapies have yet to be identified. Thus, avoidance of risk factors is key to improving outcomes. One of the common risk factors for delirium during acute respiratory failure is exposure to sedating medications, which are often necessary when managing mechanically ventilated patients. When choosing whether and how to sedate a patient with acute respiratory failure, a clinician would ideally use information about risk for sedative-associated delirium, the duration of which predicts long-term cognitive impairment. The identification and quantification of risk for sedative- associated delirium during acute respiratory failure would allow clinicians to personalize decision-making regarding sedation in the intensive care unit (ICU), making efforts to avoid sedation (or avoid specific sedatives) when managing those patients at high risk for sedative-associated delirium. Such an approach to personalized sedation would lead to less delirium and to improved patient-centered outcomes. Thus, we plan in this NRSA project to test the central hypothesis that risk for sedative-associated delirium during acute respiratory failure can be quantified in a clinical prediction rule based on patient characteristics and treatment factors. To test this hypothesis, we will accomplish two specific aims. First, we use existing data collected during the multicenter, prospective BRAIN-ICU cohort study to derive a clinical prediction rule that uses readily available patient characteristics and treatment factors to predict sedative-associated delirium among adults with acute respiratory failure (Aim 1). Next, we will validate the sedative-associated delirium clinical prediction rule both internally to correct estimates for optimism (Aim 2A) and externally, assessing calibration and discrimination in two ongoing, NHLBI-funded prospective cohort studies (Aim 2B). During this project, the applicant’s mentors and training program will provide him with expert training in clinical research methodology and cognitive assessments and outcomes, and he will cultivate the skills necessary for a career as an independent clinical researcher in the field of critical care.

项目总结/文摘