Validation of a Mortality Prediction Model for Prolonged Mechanical Ventilation

长时间机械通气死亡率预测模型的验证

• 批准号: 7739858
• 负责人: Shannon S Carson
• 金额: $ 36.04万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7739858
• 关键词: Accounting; Acute; Acute Lung Injury; Adult Respiratory Distress Syndrome; Affect; Caring; Catheters; Cessation of life; Characteristics; Clinical; Clinical Trials Network; Companions; Critical Care; Critical Illness; Data; Databases; Decision Making; Diagnosis; Discrimination; Enrollment; Environmental air flow; Failure; Family; Family Physicians; Future; Hospitals; Intervention; Intervention Studies; Life Support Systems; Liquid substance; Measures; Mechanical ventilation; Medical; Medical Records; Medical center; Modeling; Multiple Organ Failure; National Heart, Lung, and Blood Institute; Organ; Organ failure; Outcome; Patients; Performance; Physicians; Population; Research; Research Personnel; Residual state; Resources; Risk; Sensitivity and Specificity; Severity of illness; Staging; Support System; Syndrome; System; Techniques; United States; Validation; base; clinical application; cohort; cost; high risk; indexing; innovation; mortality; outcome forecast; patient population; prognostic; public health relevance; tertiary care; treatment trial

DESCRIPTION (provided by applicant): Many patients who survive the first few days of critical illness do so with multiple residual organ failures. These patients become dependent on mechanical ventilation and other organ support systems initiated in the ICU. Patients requiring prolonged mechanical ventilation (PMV) account for up to 20% of mechanically ventilated patients and consume up to 40% of all ICU resources. The patients have survived the initial severe stages of their illness, yet they remain dependent on life support systems, progress is slow, and complications are frequent. Physicians are often confused and uncertain about prognosis for PMV patients, therefore they usually do not share prognostic information with patients' families. In order to clarify prognosis for these complicated patients, a prognostic model that identifies PMV patients who are at high risk of death at 3 months and 1 year was developed and validated at a single tertiary care medical center. This model is based upon 4 easily measured variables and converts to a clinical prediction rule called the ProVent Score. External validation of the model is required before general clinical application can be considered. This study proposes to validate the PMV prognostic model in two external cohorts with the following Aims: 1. To validate the PMV prognostic model and ProVent Score in a heterogeneous group of patients from multiple medical centers. 2. To evaluate the performance of the ProVent Score and develop new models in patients who are earlier in the course of PMV. 3. To validate the ProVent Score in patients with Acute Lung Injury and the Acute Respiratory Distress Syndrome. The cohort for the first two Aims will consist of 600 consecutive PMV patients identified at 5 diverse tertiary care hospitals. Data will be obtained by review of medical records, and one-year survival will be confirmed by the National Death Index. The second cohort will consist of all patients in the NHLBI ARDS Clinical Trials Network FACTT trial who received PMV. A valid PMV prognostic model will allow investigators to standardize illness severity in future studies of interventions for PMV patients, and a clinically useful prognostic score will enhance the confidence of clinicians in communicating prognosis to patients and families. PUBLIC HEALTH RELEVANCE: Many patients who become critically ill require mechanical ventilation for weeks or months, and a large number of them do not survive. A scoring system that can determine the risk of death for these patients has been developed in a single hospital. This study will determine if this scoring system is accurate in patients who require prolonged mechanical ventilation at other hospitals in the United States.

描述（由申请人提供）：许多在危重疾病的最初几天幸存下来的患者都患有多个残余器官衰竭。这些患者变得依赖于 ICU 启动的机械通气和其他器官支持系统。需要长时间机械通气（PMV）的患者占机械通气患者的比例高达20%，消耗了所有ICU资源的40%。患者在病情最初的严重阶段幸存下来，但仍然依赖生命支持系统，进展缓慢，并发症频繁。医生常常对 PMV 患者的预后感到困惑和不确定，因此他们通常不与患者家属分享预后信息。为了明确这些复杂患者的预后，我们在一家三级医疗中心开发并验证了一种预后模型，该模型可识别 3 个月和 1 年内死亡风险较高的 PMV 患者。该模型基于 4 个易于测量的变量，并转换为称为 ProVent 评分的临床预测规则。在考虑一般临床应用之前，需要对模型进行外部验证。本研究拟在两个外部队列中验证 PMV 预后模型，目的如下： 1. 在来自多个医疗中心的异质患者组中验证 PMV 预后模型和 ProVent 评分。 2. 评估 ProVent 评分的性能并在 PMV 早期患者中开发新模型。 3. 验证急性肺损伤和急性呼吸窘迫综合征患者的 ProVent 评分。前两个目标的队列将由 5 家不同三级护理医院确定的 600 名连续 PMV 患者组成。数据将通过审查医疗记录获得，一年生存率将由国家死亡指数确认。第二组将包括 NHLBI ARDS 临床试验网络 FACTT 试验中接受 PMV 的所有患者。有效的 PMV 预后模型将使研究人员能够在未来 PMV 患者干预研究中标准化疾病严重程度，而临床上有用的预后评分将增强临床医生向患者和家属传达预后的信心。公共卫生相关性：许多危重患者需要机械通气数周或数月，其中许多人无法存活。一家医院已经开发出一种可以确定这些患者死亡风险的评分系统。这项研究将确定该评分系统对于在美国其他医院需要长时间机械通气的患者是否准确。