Cognitive Impairment in the ICU: Evaluation and Outcomes

描述（来自应用程序）：认知的整体缺陷，形式为 谵妄、木僵或昏迷在老年重症监护室中极为常见和危险 患者认知障碍与长期住院有关， 制度化和死亡因为急性认知障碍 损害患者脱离机械通气的能力， 可能是一个与长期神经心理后遗症相关的因素， 医生和护士需要能够识别高风险的患者， 认知障碍和了解护理的潜在可修改方面 可以减少认知障碍意识被定义为拥有两个 成分：唤醒（清醒）和内容（注意力）。 唤醒，a 心理功能的基本过程，通常在ICU患者中进行监测。 注意力是由更复杂的神经系统相互作用产生的， 经常受到损害，但很少受到客观监测。没有经过验证的 可供护士或医生在床边使用的仪器， 机械通气患者的意识成分。我们建议 修改ICU中使用的现有工具，以开发和 验证用于监测大脑及其功能的系统， ICU护理期间和之后的通气患者（目标1）。一旦确认，我们可以 确定老年ICU中急性认知障碍的患病率 患者及其与临床结局的相关性（目标2）。这群 患者将被用于确定与神经心理相关的因素 ICU住院后6个月时的功能缺陷（目标3）。这是建立在 候选人以前在ICU和老年学的工作，并延伸到一个 一个重要的新领域，即重症老年人的认知障碍 人士长期目标是改善老年ICU的健康结果 患者通过未来的研究，将寻求减少发病率 认知障碍，以增强从机械通气中解放出来， 将这些观察结果纳入常规ICU监测，并改善 了解和预防ICU后神经心理缺陷。到 为实现这一目标，他提出的职业发展计划包括高级 老年认知评估、流行病学和生物统计学方面的培训， 心理测量学和研究方法，通过临床培训，课程工作， 和独立的阅读。沿着候选人的出版记录， 成就，他将拥有丰富的学术环境，优秀的导师， 确保他实现这些目标强有力的体制承诺。

DESCRIPTION (From the application): Global deficits in cognition in the form of delirium, stupor, or coma are extremely common and hazardous in older ICU patients. Cognitive impairment is associated with prolonged hospital stays, institutionalization, and death. Because acute cognitive impairment compromises patients' ability to be removed from mechanical ventilation and may be a factor associated with long-term neuropsychological sequelae, physicians and nurses need to be able to identify patients at high risk for cognitive impairment and understand potentially modifiable aspects of care that may reduce cognitive impairment. Consciousness is defined as having two components: arousal (wakefulness) and content (attentiveness). Arousal, a basic process of mental function, is commonly monitored in ICU patients. Attentiveness, which results from more complex neurologic interactions, is often impaired yet rarely objectively monitored. There are no validated instruments available for bedside use by nurses or physicians to monitor both components of consciousness in mechanically ventilated patients. We propose to modify existing instruments for use in the ICU in order to develop and validate a system for monitoring the brain and its function in mechanically ventilated patients during and after ICU care (Aim 1). Once validated, we can determine the prevalence of acute cognitive impairments in elderly ICU patients and its association with clinical outcomes (Aim 2). This cohort of patients will be used to determine factors associated with neuro-psychological deficits at 6 months following the ICU stay (Aim 3). This builds on the candidate's previous work in the ICU and gerontology and extends into an important new area, which is cognitive impairment in critically ill older persons. The long-term goal is to improve health outcomes for elderly ICU patients through future studies which will seek to reduce the incidence of cognitive impairment, to enhance liberation from mechanical ventilation, to integrate these observations into routine ICU monitoring, and to improve the understanding and prevention of post-ICU neuropsychological deficits. To prepare for this goal, his proposed career development plan includes advanced training in geriatric cognitive assessment, epidemiology and biostatistics, psychometrics and research methodology through clinical training, course work, and independent reading. Along with the candidate's record of publications and achievement, he will have rich academic surroundings, excellent mentors and strong institutional commitment to ensure that he achieve these goals.