Improving Long-Term Physical and Mental Health after Acute Lung Injury

描述（由研究者提供）：急性肺损伤（Acute Lung Injury， ALI）是一种以急性弥漫性肺毛细血管渗漏导致缺氧呼吸衰竭为特征的综合征。它是由多种肺部（如误吸）和非肺部（如败血症）因素引起的。急性呼吸道感染造成严重的公共卫生负担，其发病率远高于先前认识的水平（每10万人年86例），死亡总人数与乳腺癌或艾滋病毒感染相似。由于医疗保健的进步，急性呼吸道感染的死亡率已从约70%降至约40%。以前可能死亡的病人现在存活下来；然而，他们的恢复往往是漫长而复杂的。研究这些急性脑损伤幸存者的长期预后变得越来越重要。最近的研究表明，急性脑损伤幸存者中存在重要且持续的发病率。然而，这些研究的样本量和随访时间有限，并且提供的关于重症监护病房（ICU）治疗对长期预后影响的信息很少。因此，我们的目标是了解如何使用现有的ICU治疗方法来最大限度地减少ALI后患者的长期身心健康发病率，改善患者的功能状态和生活质量。我们建议延长我们现有的队列研究，即ALI后随访患者2年，以允许5年随访。在本研究中，我们将研究ICU治疗与患者长期预后的新关系。具体而言，我们将研究ALI后长达5年的肌肉无力、焦虑、抑郁和创伤后应激障碍症状的流行病学，以及这些后遗症与患者身体功能和生活质量限制的关系[目的1a和2a]。然后，我们将确定ICU中营养和皮质类固醇与长期肌肉无力的关系[Aim 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[Aim 2b]。通过这项研究，我们将了解现有的ICU治疗和暴露如何改善急性肺损伤后的长期身心健康。急性肺损伤（ALI）通常需要在重症监护室（ICU）进行人工生命支持，这是一种常见、昂贵的疾病，存活患者伴有明显的长期肌肉无力以及焦虑、抑郁和创伤后应激障碍症状。这项研究将提供新的知识，了解这些发病率的频率、对患者的影响，以及ICU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。

DESCRIPTION (provided by investigator): Acute Lung Injury (ALI) is a syndrome characterized by acute, diffuse pulmonary capillary leak resulting in hypoxic respiratory failure. It is caused by a diverse group of pulmonary (e.g. aspiration) and non-pulmonary (e.g. sepsis) factors. ALI imposes a significant public health burden with an incidence that is much higher than previously recognized (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 per cent to ~40 per cent. 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. Recent studies have demonstrated important and persistent morbidity in ALI survivors. However, these studies were limited in sample size and duration of follow-up, and provided little information on the effect of intensive care unit (ICU) therapies on long-term outcomes. Consequently, our goal 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 cohort study, which follows patients for 2 years after ALI, to allow 5- year follow-up. In this proposed research, we will study new relationships of ICU therapies with patients' long term outcomes. 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, and the association of these sequelae with limitations in patients' physical function and quality of life [Aims 1a and 2a]. 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]. Through this research, we will understand how existing ICU therapies and exposures can improve long-term physical and mental health after acute lung injury. PUBLIC HEALTH RELEVANCE Acute lung injury (ALI) usually requires artificial life support in the intensive care unit (ICU) and is common, costly and associated with significant long-term muscle weakness and symptoms of anxiety, depression and post-traumatic stress disorder in surviving patients. This research will provide new knowledge regarding the frequency of these morbidities, 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.