Psychological support based on positive suggestions in acute respiratory failure patients

项目总结/摘要 在需要机械通气的急性呼吸衰竭（ARF）患者中， 从焦虑，抑郁或创伤后应激障碍（PTSD）的症状离开密集后， 监护室（ICU）。在重症监护室里的恐惧和妄想经历的记忆似乎是最强烈的 潜在的可改变的风险因素。对恐惧和相关记忆形成的研究表明， 关于创伤事件的减轻信息是在记忆形成与其 回忆，记忆的情感体验可以以积极的方式被修改。这意味着为了 为了预防ARF患者的心理健康问题，心理支持需要与 在ICU接受治疗。以前，基于积极建议的心理支持的应用 （PSBPS）缩短了机械通气的持续时间，减少了对镇静剂的需求。我们 假设PSBPS也可以减轻ARF幸存者心理健康发病率。然而，提供 可靠的PSBPS干预对于忙碌的ICU临床医生来说是一个挑战。助产士，受过训练的非专业保健提供者 为分娩中的妇女提供情感支持的人被认为是一种可靠但负担得起的替代方案。 考虑到他们的服务和我们的干预的共同要素，导视处于管理的理想位置。 PSBPS。这个项目的目的是完善和测试一种行为干预， 与ICU中的药物治疗平行。这将通过两个具体目标来实现，即： 与经过培训的导乐师一起完成PSBPS试点，并根据利益相关者的反馈改进干预措施 和2）进行随机对照试验，以评估PSBPS与常规治疗的潜在疗效， ARF患者的心理健康发病率和认知结果。在AIM 1中，PSBPS将在30 ARF患者随后对所有相关利益相关者进行半结构化访谈;患者还将 完整的焦虑、抑郁、急性应激/创伤后应激障碍和认知功能评估， 仪器.对于AIM 2，我们将进行一项随机对照试验，以测试PSBPS的有效性。我们 假设接受标准化EPSCI的ARF患者焦虑症状较少， ICU出院时和6个月随访时的抑郁和急性应激/PTSD，以及更好的认知功能。 拟议的职业发展奖支持NHLBI的使命，努力改善以下方面的成果： ARF患者，同时培训初级研究者的基本技能，成为一个独立的研究者。

PROJECT SUMMARY/ABSTRACT Up to two thirds of those who survive acute respiratory failure (ARF) requiring mechanical ventilation suffer from symptoms of anxiety, depression, or post-traumatic stress disorder (PTSD) after leaving the intensive care unit (ICU). Memories of frightening and delusional experiences in the ICU appear to be the strongest potentially modifiable risk factor. Research on the formation of fear and associated memories shows that if mitigating information about a traumatic event is introduced during the time between memory formation and its recall, the emotional experience of the memory can be modified in a positive manner. This means that in order to prevent mental health problems in ARF patients, psychological support needs to take place in parallel with medical treatment in the ICU. Previously, application of Psychological Support Based on Positive Suggestions (PSBPS) resulted in shorter duration of mechanical ventilation and decreased need for sedatives. We hypothesize that PSBPS can also mitigate mental health morbidity in ARF survivors. However, providing reliable PSBPS intervention is a challenge for busy ICU clinicians. Doulas, trained lay health care providers who provide emotional support to women in labor have been identified as a reliable yet affordable alternative. Given common elements of their services and our intervention, doulas are in an ideal position to administer PSBPS. The objective of this project is to refine and test a behavioral intervention to be administered in parallel with medical treatment in the ICU. This will be accomplished through two specific aims, which are: 1) to complete the pilot PSBPS with trained doulas and to refine the intervention based on stakeholder feedback and 2) to conduct a randomized controlled trial to evaluate the potential efficacy of PSBPS vs usual care in ARF patients on mental health morbidity and cognitive outcomes. In AIM 1, PSBPS will be performed on 30 ARF patients with subsequent semi-structured interviews of all involved stakeholders; patients will also complete anxiety, depression, acute stress/PTSD, and cognitive function evaluation as measured by validated instruments. For AIM 2, we will conduct a randomized, controlled trial to test the effectiveness of PSBPS. We hypothesize that ARF patients who receive standardized EPSCI will have fewer symptoms of anxiety, depression and acute stress/PTSD at ICU discharge and at 6-month follow-up, and better cognitive function. The proposed Career Development Award supports the NHLBI mission by striving to improve outcomes in ARF patients while training a junior investigator in essential skills to become an independent researcher.