Aspiration in Acute Respiratory Failure Survivors

急性呼吸衰竭幸存者的误吸

• 批准号: 10617388
• 负责人: MARC MOSS
• 金额: $ 64.11万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-23 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10617388
• 关键词: Acute respiratory failure; Admission activity; Algorithms; Boston; Breathing; Caregiver Burden; Classification; Cohort Studies; Colorado; Confounding Factors (Epidemiology); Critical Illness; Decision Trees; Deglutition; Deglutition Disorders; Development; Diagnosis; Diagnostic tests; Diameter; Dyes; Enteral; Enteral Feeding; Epidemiology; Evaluable Disease; Evaluation; Exploratory/Developmental Grant for Diagnostic Cancer Imaging; Fiber Optics; Focus Groups; Functional disorder; Funding; Health; Health care facility; Hospital Mortality; Infrastructure; Intratracheal Intubation; Intubation; Journals; Language; Larynx; Life; Long-Term Care; Measures; Mechanical ventilation; Medicine; Methods; Mosses; New England; Oral; Pathologist; Patient Care; Patient-Focused Outcomes; Patients; Persons; Pharyngeal structure; Pneumonia; Procedures; Process; Prospective Studies; Quality of life; Recovery; Research; Risk; Risk Factors; Screening procedure; Speech; Structure; Survivors; Testing; Therapeutic; Trachea; Tube; Universities; Water; Work; acute care; aspirate; cost; endotracheal; feeding; high risk; improved; infancy; innovation; interest; modifiable risk; multidisciplinary; novel; nutrition; optical fiber; personalized medicine; pressure; prevent; prospective; screening; targeted treatment; tool; ultrasound

PROJECT SUMMARY/ABSTRACT Each year more than 700,000 patients survive an episode of acute respiratory failure (ARF) that required endotracheal intubation with mechanical ventilation. Occurring in as many as 44% of these ARF survivors, post-extubation aspiration is associated with deleterious consequences including pneumonia, percutaneous feeding tube placement, long term care facility admission, and increased hospital mortality. Nevertheless, the complications of aspiration must be weighed against the consequences of inappropriately delaying the resumption of oral feeding. Delayed resumption of oral nutrition is associated with prolonged enteral tube feeding, increased caregiver burden, patient dissatisfaction, and increased health-related costs. With the support of an NINR R21 award, our multidisciplinary and multicenter team discovered three novel findings: 1) we developed a 5-item screening decision tree algorithm that detects patients at high risk for post-extubation aspiration; 2) we identified certain unique upper airway abnormalities that are associated with post-extubation aspiration and dysphagia; and 3) the size of the endotracheal tube (ETT) is independently associated with post-extubation aspiration. This proposal will continue to utilize our robust and established multi-center research group at Colorado, Boston University, Stanford, and Yale; all of whom have long-standing dysphagia and aspiration research groups focused on ARF. We will conduct a multi-center cohort study with three complementary aims that are interrelated and use the same patients; but are not dependent upon the results of each other. Aim #1 will determine whether our 5-item decision tree algorithm is a more effective screening tool to identify patients at high risk for post-extubation aspiration compared to the three-ounce water swallow test (3-WST) and the Toronto Bedside Swallowing Screening Test (TOR-BSST). These results will establish the optimal screening test for post-extubation aspiration and identify those patients who require further invasive diagnostic testing such as a FEES examination. Aim #2 will identify unique subphenotypes of patients with post-extubation aspiration based upon FEES-related measures of upper airway structure and function. Using a novel latent class analysis, we will determine whether these subphenotypes are associated with different trajectories of recovery and identify unique patients who benefit from different personalized and targeted therapies. Aim #3 will determine the association between ultrasound determined ETT size/tracheal diameter ratio and post-extubation aspiration while accounting for other confounding variables. This aim will identify the most effective method to select the ETT size that optimizes ventilatory management and decreases post- extubation aspiration. The results of this aim will pave the wave for dramatic improvements in the intubation process for all ARF patients who require mechanical ventilation. With an innovative and protocolized approach, the results of this proposal will demonstrate novel methods to minimize post-extubation aspiration, transform the multidisciplinary care of ARF survivors, and improve patient outcomes and quality of life.

项目总结/摘要 每年有超过70万名患者在急性呼吸衰竭（ARF）发作后存活， 气管插管和机械通气。在多达44%的ARF幸存者中， 拔管后误吸与有害后果相关，包括肺炎、经皮 喂食管放置、长期护理设施入院和增加的住院死亡率。但 必须权衡抽吸的并发症与不适当地延迟抽吸的后果。 恢复口服喂养。延迟恢复口服营养与延长肠内管有关 喂养，增加照顾者的负担，病人的不满，并增加健康相关的成本。与 在NINR R21奖的支持下，我们的多学科和多中心团队发现了三个新的发现：1） 我们开发了一种5项筛选决策树算法，用于检测拔管后高危患者 2）我们确定了某些与拔管后相关的独特的上气道异常 误吸和吞咽困难; 3）气管插管（ETT）的大小与 拔管后抽吸。该提案将继续利用我们强大和成熟的多中心 科罗拉多、波士顿大学、斯坦福大学和耶鲁大学的一个研究小组;他们都有长期的吞咽困难 和抱负研究小组的重点是ARF。我们将进行一项多中心队列研究， 相互关联并使用相同患者的互补目标;但不依赖于 对方.目标#1将确定我们的5项决策树算法是否是一个更有效的筛选工具 与3盎司水吞咽试验相比，识别拔管后误吸的高风险患者 （3-WST）和多伦多床边吞咽筛查试验（TOR-BSST）。这些结果将确立 拔管后误吸的最佳筛选试验，并确定需要进一步侵入性检查的患者 诊断测试，如FEES检查。目标#2将确定患有以下疾病的患者的独特亚表型： 基于FEES相关上气道结构和功能测量的拔管后抽吸。使用 新的潜在类别分析，我们将确定这些亚表型是否与不同的 恢复轨迹，并确定受益于不同个性化和有针对性的独特患者 治疗目标3将确定超声确定的ETT尺寸/气管直径之间的关联 比率和拔管后误吸，同时考虑其他混杂变量。这一目标将确定 最有效的方法来选择ETT的大小，优化的行政管理，减少后， 拔管抽吸。这一目标的结果将为插管技术的显著改进铺平道路。 所有需要机械通气的ARF患者的流程。通过创新和协议化的方法， 该提案的结果将证明新的方法，以尽量减少拔管后误吸， ARF幸存者的多学科护理，并改善患者的预后和生活质量。