Caregivers of Prolonged Mechanical Ventilation: Mind-Body Interaction Model

描述（由申请人提供）：本提案的广泛长期目标是获得深入的生物行为研究经验，重点是改善长期机械通气（PMV）患者及其家庭护理人员的结果，以加强申请人开展竞争性和独立研究事业的能力。患有PMV的人在重症监护病房（ICU）存活后往往会遭受长期的身体和心理后遗症，因此需要家庭照顾者的大力帮助。研究表明，慢性病患者（如痴呆症）的照护者的消极心理和行为反应与照护者的消极健康结果有关。尽管有报道称PMV患者的照顾者存在心理困扰和负担，但对这种应激反应的程度了解有限，包括在疾病持续过程中的心理、行为和生物学反应（ICU入院至出院）。这项试点可行性研究的目的是使用多学科综合生物行为模型，即匹兹堡身心中心模型：1)评估在PMV患者的照顾者中开展纵向生物行为研究的可行性；2)探索照顾者对急性和慢性应激的心理（如负担）、行为（如睡眠）和生物学（如il - 1）反应随时间的相互作用，以及这些相互作用如何与被照顾者的特征相关。将采用纵向前瞻性描述性重复测量设计。共有40对护理人员和PMV（护理接受者）接受了>=4天的机械通气，将被纳入研究。数据收集将进行三次（基线[ICU入院]、ICU出院和ICU出院后2个月）。可行性将使用描述性统计进行评估，包括招募率和保留率，以及护理人员对行为和生物数据收集的可接受性。为了探讨照顾者反应的潜在纵向变化和反应之间的关系，将使用描述性统计和相关系数的变化趋势。这项研究符合NINR的使命，即整合生物学和行为科学，采用新技术研究问题，改进研究方法，培养未来的科学家。拟议的研究也符合国家自然研究中心的研究重点之一，即家庭照顾。本研究与公共卫生的相关性在于确定特定的时间点，以预防和干预，以改善照顾者的情绪和身体健康，而不是照顾者的疾病轨迹。改善照顾者的情绪和身体健康也可能改善照顾的提供以及被照顾者的生活质量。

DESCRIPTION (provided by applicant): The broad long-term objective of this proposal is to gain in-depth experience in biobehavioral research focusing on improving outcomes in persons on prolonged mechanical ventilation (PMV) and their family caregivers to strengthen the applicant's ability to launch a competitive and independent research career. Persons on PMV often suffer from long-term physical and psychological sequelae after surviving in the intensive care unit (ICU) and therefore require significant assistance from family caregivers. Research has shown that negative psychological and behavioral responses in caregivers of persons with chronic disease (e.g., dementia) are associated with negative caregiver health outcomes. Despite reports of psychological distress and burden in caregivers of persons on PMV, there is limited understanding of the extent of this stress responses, including psychological, behavioral and biological responses over the continuum of illness (ICU admission to post discharge). The purposes of this pilot feasibility study using a multidisciplinary, integrative biobehavioral model, the Pittsburgh Mind-Body Center Model are: 1) to evaluate the feasibility of conducting a longitudinal biobehavioral study in caregivers of persons on PMV and 2) to explore the interactions among caregivers' psychological (e.g., burden), behavioral (e.g., sleep) and biological (e.g., IL1) responses of acute and chronic stress over time and how those interactions are related to characteristics of care recipients. A longitudinal prospective descriptive repeated measure design will be used. A total of 40 dyads of caregivers and persons on PMV (care recipient) who spent >=4 days on mechanical ventilation will be enrolled in the study. Data collection will occur three times (baseline [ICU admission], ICU discharge, and 2 months after ICU discharge). Feasibility will be evaluated using descriptive statistics including recruitment and retention rates, and caregivers' acceptability of behavioral and biological data collection. To explore the potential longitudinal changes in caregivers' responses and relationships among responses, trends of changes in descriptive statistics and correlation coefficients will be used. This study is consistent with NINR's mission to integrate the biological and behavioral sciences, employ new technologies to research questions, improve research methods, and develop scientists of the future. The proposed research also meets one of NINR's areas of research emphasis on family caregiving. The relevance of this research to public health is to identify specific time-points to prevent and intervene to improve caregivers' emotional and physical health over the care recipient's illness trajectory. Improving caregivers' emotional and physical health may also improve the delivery of care as well as quality of life for the care recipient.