Outcomes of Prolonged Mechanical Ventilation

描述（由申请人提供）： 香农卡森博士的职业目标包括成为一个富有成效的 将进行临床研究和结局的独立研究者 涉及重症患者的研究。为了获得必要的背景知识， 他将参加临床研究会议和研讨会， 医学院，他将完成在公共卫生学院的课程， 与临床流行病学、研究设计、数据分析和 负责任地进行以病人为中心的研究。另外他还会 在Tim Carey博士的指导下完成一个为期5年的研究项目。 该研究的主要目标是开发一年的预测模型 生存和功能状态。次要目的是描述 长期以患者为导向的结果，包括健康状况和 生活需要长期机械通气的患者占10至 占ICU患者的20%，占重症监护病房（ICU）总面积的37% 资源幸存者往往是高龄和离开医院与 许多未解决的医疗问题。初步数据显示， 存活率低至23%。这些病人会随着我们的老龄化而增加 人口继续遇到生命维持疗法的进步。是 重要的是要确定这些先进的治疗方法是否能转化为可接受的 长期成果。本研究的具体目的包括：1）评估一年 需要长时间机械通气的患者的生存和功能状态 急性病后的通风。2)确定健康状况和质量 幸存者的生活3)开发并验证一年期预测模型 生存3)开发并验证独立的预测模型 功能状态 这项研究将招募200名成年患者的前瞻性队列， 在大型三级医疗机构进行至少21天的机械通气 中心患者将在住院期间和整个 随后几年。电话面试将进行3个月，6个月和 研究入组后12个月，以确定患者生存期、健康状况， 和感知的生活质量。使用第21天测量的变量， 机械通气，预测模型将开发一年 生存和独立功能状态。将对模型进行验证 前瞻性地在100名类似患者的队列中， 将一年生存率和功能状态与模型估计值进行比较。 这些结果的知识将有助于临床医生，因为他们建议 患者及其家属关于适当的积极护理水平 并帮助他们了解将获得的资源和支持类型， 在出院后进行最佳恢复所需的时间。此外，这些数据将 为未来的队列研究和随机对照试验提供信息， 改善这一不断增长的患者群体的结果。

DESCRIPTION (provided by applicant): The career goals of Dr. Shannon Carson include becoming a productive independent investigator who will conduct clinical research and outcomes studies involving critically ill patients. To gain the necessary background, he will participate in clinical research conferences and seminars at the UNC School of Medicine, and he will complete courses in the UNC School of Public Health that pertain to clinical epidemiology, study design, data analysis, and the responsible conduct of patient-oriented research. In addition, he will complete a 5-year research project under the mentorship of Dr. Tim Carey. The primary objective of the study is to develop predictive models for one-year survival and functional status. Secondary objectives will be to describe long-term patient oriented outcomes including health status and quality of life. Patients who require prolonged mechanical ventilation account for 10 to 20% of ICU patients and consume up to 37% of total intensive care unit (ICU) resources. Survivors are often of advanced age and leave the hospital with numerous unresolved medical problems. Preliminary data indicate that one-year survival is as low as 23%. These patients will increase in number as our aging population continues to encounter advances in life sustaining therapies. It is important to determine if these advanced therapies translate into acceptable long-term outcomes. Specific Aims of this study include: 1) Assess one-year survival and functional status for patients who require prolonged mechanical ventilation after acute illness. 2) Determine Health Status and Quality of Life for survivors. 3) Develop and validate a prediction model for one-year survival. 3) Develop and validate a prediction model for independent functional status. This study will enroll a prospective cohort of 200 adult patients requiring mechanical ventilation for at least 21 days at a large tertiary care medical center. Patients will be followed during hospitalization and through the subsequent year. Telephone interviews will be conducted 3 months, 6 months and 12 months after study enrollment to determine patient survival, health status, and perceived quality of life. Using variables measured on day 21 of mechanical ventilation, predictive models will be developed for one-year survival and independent functional status. Models will be validated prospectively in a cohort of 100 similar patients, and physician estimates of one-year survival and functional status will be compared to model estimates. Knowledge of these outcomes would be helpful to clinicians as they counsel patients and their families regarding appropriate levels of aggressive care and help them understand the types of resources and support that will be needed for optimal recovery upon discharge. In addition, these data will inform future cohort studies and randomized controlled trials designed to improve outcomes for this growing patient population.