Nurse-Led Interventions in Pediatric Critical Care: Training in Pediatric Sleep Health, Delirium, and Multi-Site Research

项目总结/摘要 谵妄是儿科重症监护病房（PICU）护理的一种严重的、潜在医源性的并发症， 与不良临床结局相关。危重病期间睡眠质量差是谵妄的一个原因。 入院后，儿童经历了混乱的PICU环境，扰乱了睡眠/觉醒模式，包括 缺乏日/夜照明和声音循环，以及频繁的检查和程序。PICU护理模式 既不以儿童为中心，也不以家庭为中心，可能会破坏睡眠健康。良好的睡眠健康需要规律性， 睡眠/唤醒模式，具有适当的睡眠时间、高睡眠效率和充足的睡眠持续时间， 促进身心健康。本研究培训计划（R2-PD）的主要目的是 使用现有数据来探索睡眠健康之间的关联（即，定时、效率、持续时间、规律性）、睡眠 生物学（即，褪黑激素失调）和小儿谵妄。数据来自RESTORE Resilience（R2; R21 HD 093369），这是一项2中心、前瞻性队列试验，旨在维持 54名儿童（6个月- 17岁）急性呼吸衰竭需要机械通气 R2-PD的具体目标包括：（1）检查睡眠健康（即，日间活动率 估计[时间]、睡眠发作持续时间、总睡眠时间[持续时间]、睡眠效率）和小儿谵妄 (i.e.,发病率、持续时间）。(2)确定实施护士驱动的护理包 其促进睡眠/觉醒周期规律性和小儿谵妄（即，发病率、持续时间）。（探索性） 探索唾液褪黑激素水平的差异（即，中尺度，振幅，顶相）随时间的变化（即，研究第2天 （5）有或无谵妄的危重患儿。这项研究将是第一批探索 在一个相当大的危重儿科队列中， 9.8（SD=7.7）天。结合Martha Curley博士在多中心临床试验实施方面的深入培训 （申办者）和Monica Ordway博士（Mentor）的儿科睡眠健康，R2-PD分析将提供 为未来大规模护士主导的个性化睡眠促进干预临床试验提供初步数据 防止小儿谵妄18个月的博士后培训目标 宾夕法尼亚州包括：（1）扩大儿科睡眠健康的知识，作为一个多维度的结构， 了解睡眠健康与儿科重症监护和谵妄的关系。(2)接受高级培训 多中心临床试验的开展和数据协调。(3)提高对儿科危重病的科学认识 通过研究传播疾病。(4)专业发展，为独立职业做准备 儿科重症监护研究员该应用程序符合NINR对培训护士科学家的兴趣 PICU护理实践意义的干预研究（NOT-NR-21-001）。远景目标 这项研究计划的目的是改善儿科危重病幸存者的临床结局和生活质量。 疾病的干预措施，包括个人的家庭护理模式，以优化在PICU愈合。

PROJECT SUMMARY/ABSTRACT Delirium is a serious, potentially iatrogenic, complication of pediatric intensive care unit (PICU) care and is associated with poor clinical outcomes. Poor sleep quality during critical illness is a proposed cause of delirium. Upon admission, children experience a chaotic PICU environment that disrupts sleep/wake patterns, including lack of day/night light and sound cycling and frequent examinations and procedures. This PICU care model is neither child- nor family-centered and likely disrupts sleep health. Good sleep health requires regularity in sleep/wake patterns with appropriate sleep timing, high sleep efficiency, and adequate sleep duration to promote physical and mental well-being. The primary purpose of this research training plan (R2-PD) is to use existing data to explore associations among sleep health (i.e., timing, efficiency, duration, regularity), sleep biology (i.e., melatonin dysregulation), and pediatric delirium. The data are from RESTORE Resilience (R2; R21HD093369), a 2-center, prospective cohort trial of a nurse-driven care bundle designed to maintain sleep/wake rhythms in 54 children (6 m.o.-17 y.o.) with acute respiratory failure on mechanical ventilation. Specific aims of R2-PD include: (1) Examine relationship between sleep health (i.e., daytime activity ratio estimate [timing], sleep episode duration, total sleep time [duration], sleep efficiency) and pediatric delirium (i.e., incidence, duration). (2) Determine association between implementation of a nurse-driven care bundle that promotes sleep/wake cycle regularity and pediatric delirium (i.e., incidence, duration). (Exploratory) Explore differences in salivary melatonin levels (i.e., mesor, amplitude, acrophase) over time (i.e., study days 2 and 5) in critically ill children with and without delirium. This study will be among the first to explore links among sleep disruption, melatonin levels, and delirium in a sizeable critically ill pediatric cohort followed for 9.8 (SD=7.7) days. Combined with in-depth training in multi-site clinical trial conduct with Dr. Martha Curley (Sponsor) and pediatric sleep health with Dr. Monica Ordway (Mentor), the R2-PD analysis will provide preliminary data for future, large-scale nurse-led clinical trials of individualized sleep-promoting interventions to prevent pediatric delirium. Training goals for the 18-month post-doctoral period at the University of Pennsylvania include: (1) Expand knowledge of pediatric sleep health as a multi-dimensional construct and understand how sleep health relates to pediatric critical care and delirium. (2) Receive advanced training in multi-site clinical trial conduct and data coordination. (3) Advance scientific understanding of pediatric critical illness through research dissemination. (4) Develop professionally in preparation for career as an independent pediatric critical care researcher. This application aligns with NINR interest in training nurse scientists in intervention research with PICU nursing practice implications (NOT-NR-21-001). The long-term goal of this research program is to improve clinical outcomes and quality of life in survivors of pediatric critical illness with interventions that incorporate individual family care patterns to optimize healing in the PICU.