Circadian Diurnal Motor Synchrony and Delirium Amongst Older Cardiac Surgery ICU Patients

这项建议的长期目标是确定昼夜节律与术后 选择性心脏手术后入住ICU的老年人的谵妄。超过25万美国老年人 每年接受心脏手术，使他们能够过上更有功能和更充实的生活，但如果 手术并发谵妄，则有功能或认知能力下降的风险，长期出院 护理设施，死亡率大幅上升。Prin博士是一名重症监护麻醉师，致力于 改善老年人术后ICU入院后的临床结局， 该计划旨在为她提供成为领导者所需的结构化指导和培训 在围手术期衰老研究和重症监护试验中。她建立了一个协作指导团队， 由Adit Ginde博士撰写，他是一名急诊医师，也是大型多中心PETAL的国家PI 网络临床试验，有3,000多名参与者，由Tobias Eckle博士（国家 昼夜节律基础科学的领导者）和约翰·德夫林博士（国际公认的谵妄 研究员）。Alex Kaizer博士是一名生物统计学家，在新颖和适应性临床试验设计方面具有专业知识， 指导普林博士的试验方法这项建议利用了一个既有 导师团队和科罗拉多大学安舒茨医学中心的独特环境， 在一所大型公立研究型大学的背景下，合并了一个心脏外科三级转诊中心。 这些充足的资源将使普林博士能够严格研究昼夜节律与心脏病的关系。 心脏手术后谵妄的发生率。她的总体假设是， 重症监护室的环境导致了谵妄的发生。她将通过确定 一项前瞻性观察队列研究中昼夜运动活动模式与谵妄的相关性（目的1） 并为未来的临床试验做准备， 活动模式（目标2）。这些特定目标旨在评估昼夜节律的关联 精神错乱，这在危重病人中还没有建立。这些研究要求普林博士 发展昼夜节律研究、谵妄评估工具和临床试验方法学方面的专业知识。她将 通过一个有重点的专业发展计划来实现这一目标，包括临床试验设计课程， 神经认知评估和衰老研究。完成拟议项目将提供 必要的指导，培训和经验，使普林博士成为围手术期老龄化的领导者 研究以改善术后ICU入院后的结局。

The long term goal of this proposal is to determine the association of circadian rhythms with postoperative delirium in older adults admitted to the ICU after elective cardiac surgery. More than 250,000 older Americans undergo cardiac surgery every year which allows them to lead more functional and fulfilling lives, but if the procedure is complicated by delirium then the risk of functional or cognitive decline, discharge to a long-term care facility, and mortality increases substantially. Dr. Prin is a Critical Care Anesthesiologist dedicated to improving clinical outcomes after postoperative ICU admission for older adults and this NIA GEMSSTAR proposal is designed to provide her with the structured mentorship and training necessary to become a leader in perioperative aging research and critical care trials. She has developed a collaborative mentorship team led by Dr. Adit Ginde who is an Emergency Medicine Physician and national PI for the large multicenter PETAL network clinical trial with over 3,000 participants, with co-mentorship provided by Dr. Tobias Eckle (a national leader in the basic science of circadian rhythms) and Dr. John Devlin (an internationally recognized delirium researcher). Dr. Alex Kaizer, a biostatistician with expertise in novel and adaptive clinical trial design, will mentor Dr. Prin in trial methodology. This proposal leverages the collective expertise of an established mentorship team and the unique environment at the University of Colorado Anschutz Medical Center that incorporates a tertiary referral center for cardiac surgery in the setting of a large public research university. These ample resources will allow Dr. Prin to rigorously study the relationship of circadian rhythms with the incidence of delirium after cardiac surgery. Her global hypothesis is that disruption of circadian rhythmicity in the ICU environment drives the incidence of delirium. She will test this hypothesis by determining the association of diurnal motor activity patterns with delirium in a prospective observational cohort study (Aim 1) and preparing for a future clinical trial with an unblinded pilot trial of intense morning light for circadian motor activity patterns (Aim 2). These Specific Aims are designed to evaluate the association of circadian rhythms with delirium, which has not been established in critically ill human subjects. These studies require Dr. Prin to develop expertise in circadian research, delirium assessment tools, and clinical trial methodology. She will accomplish this with a focused Professional Development Plan including coursework on clinical trial design, neurocognitive assessments, and aging research. Completion of the proposed project will provide the necessary mentorship, training, and experience to allow Dr. Prin to become a leader in perioperative aging research to improve outcomes after postoperative ICU admission.