Outcomes of specific ventilator strategies

急性肺损伤（AL 1）相对常见，并且与显著的短期死亡率和长期发病率相关。尽管有证据表明肺保护性常规呼吸机方法（CVLP）与28天死亡率降低相关，但尚不清楚CVLP的使用范围，我们对其使用的障碍了解甚少。此外，关于AL 1患者的长期死亡率和结果或CVLP是否改善这些长期结果知之甚少。为了改善ALL患者的结局，我们必须了解CVLP依从性的障碍、长期死亡率和与ALL相关的其他结局，以及可能与这些结局相关的因素和其他治疗的组合。这项研究将增加重要的新知识，以我们的理解， 对ALL患者的护理。我们建议评估以下2个具体目标：1a。评价CVLP作为一种护理策略在一组ALL患者中的应用。1b.识别患者、提供者和组织使用CVLP的障碍。2.评价CVLP通气和其他方面的护理与ALL患者长期死亡率之间的相关性。我们还将评估一个次要目的：评估CVLP和其他方面的护理与一组广泛的患者结局之间的关联。为了评估目标，我们将在巴尔的摩大都市区的4家医院--6个重症监护病房（ICU）--进行一项队列研究。我们将评估特定药物治疗的暴露情况：CVLP、麻痹、类固醇、抗生素和营养的使用;以及患者入住ICU期间气管切开术的时机。结果变量为：出院、6个月、1年和2年死亡率;以及生物功能障碍， 临床事件和患者报告的结局。我们将在出院时、诊断为ALL后1年和2年在综合临床研究中心评价结局。我们将在6个月时通过电话调查评估结果。该研究是重要的，因为它增加了关于使用CVLP策略的障碍、患有ALL的患者的长期结果以及CVLP对这些结果的影响的新知识。此外，通过鉴定除了与这些结果相关的CVLP之外的医学疗法;我们将鉴定改善患有ALL的患者的护理的机会。该项目的各个方面代表了与该SCCOR的其他项目和核心的合作努力，重点关注呼吸机相关的肺损伤。

Acute Lung Injury (ALl) is relatively common and associated with significant short-term mortality and long-term morbidity. Despite evidence that a lung-protective conventional ventilator approach (CVLP) is associated with reduced 28 day mortality, it is unknown how widely CVLP is used, and we have a poor understanding of the barriers to its use. Moreover, little is known regarding the long-term mortality and outcomes in ALl patients or whether CVLP improves these long-term outcomes. To improve outcomes for patients with ALl, we must understand the barriers to compliance with CVLP, long-term mortality and other outcomes associated with ALl, and the constellation of factors and other therapies that may be associated with those outcomes. This study will add important new knowledge to our understanding of ways to improve the care of patients with ALl. We propose to evaluate the following 2 specific aims: 1a. To evaluate the use of CVLP as a care strategy in a cohort of patients with ALl. 1b. To identify patient, provider and organizational barriers to using CVLP. 2. To evaluate the association between CVLP ventilation and other aspects of care with long-term mortality in patients with ALl. We will also evaluate a secondary aim: to evaluate the association between CVLP and other aspects of care with a broad group of patient outcomes. To evaluate the aims, we will conduct a cohort study at 4 hospitals--6 intensive care units (ICUs)--in the Baltimore metropolitan area. We will evaluate exposure to specific medical therapies: use of CVLP, paralysis, steroids, antibiotics and nutrition; and timing of tracheotomy during patient ICU stay. Outcome variables are: discharge, 6 month, one year and 2 year mortality; and disorders of biologic functioning, clinical events and patient reported outcomes. We will evaluate outcomes in the General Clinical Research Center at discharge, 1 year and 2 years after diagnosis of ALl. We will evaluate outcomes at 6 months with phone survey. This study is significant as it adds new knowledge about barriers to using CVLP strategies, long-term outcomes of patients with ALl and the impact of CVLP on these outcomes. Moreover, by identifying medical therapies in addition to CVLP that are associated with these outcomes; we will identify opportunities to improve care of patients with ALl. Aspects of this project represent collaborative efforts with other projects and cores on this SCCOR focused on ventilator associated lung injury.