Improving Long-Term Physical and Mental Health after Acute Lung Injury

描述(由研究人员提供)：急性肺损伤(ALI)是一种以急性弥漫性肺毛细血管渗漏为特征的综合征，导致缺氧性呼吸衰竭。它是由多种肺性因素(如吸入)和非肺性因素(如败血症)引起的。ALI造成了巨大的公共卫生负担，其发病率远远高于以前认识的发病率(每10万人年86人)，死亡总数类似于乳腺癌或艾滋病毒感染。由于医疗保健的进步，ALI的死亡率已从约70%降至约40%。以前可能已经死亡的患者现在在ALI中幸存下来；然而，他们的恢复往往是漫长和复杂的。研究这些ALI幸存者的长期结局变得越来越重要。最近的研究表明，ALI幸存者中有重要且持续的发病率。然而，这些研究在样本量和随访持续时间方面受到限制，并且几乎没有提供有关重症监护病房(ICU)治疗对长期结果的影响的信息。因此，我们的目标是了解如何利用现有的ICU疗法将长期的身心健康发病率降至最低，并改善ALI后患者的功能状态和生活质量。我们建议延长我们现有的队列研究，即ALI后对患者进行2年的跟踪研究，以便进行5年的随访。在这项拟议的研究中，我们将研究ICU治疗与患者长期结果的新关系。具体地说，我们将研究ALI后长达5年的肌肉无力、焦虑、抑郁和创伤后应激障碍症状的流行病学，以及这些后遗症与患者身体功能和生活质量限制的关联[目标1a和2a]。然后，我们将确定ICU中的营养和皮质类固醇与长期肌肉无力的相关性[目标1b]。我们还将确定ICU中的精神错乱和皮质类固醇与创伤后应激障碍的长期症状的相关性[目标2b]。通过这项研究，我们将了解现有的ICU治疗和暴露如何改善急性肺损伤后的长期身心健康。与公共卫生相关急性肺损伤(ALI)通常需要重症监护病房(ICU)的人工生命支持，是一种常见的、费用高昂的疾病，并与存活患者的严重长期肌肉无力、焦虑、抑郁和创伤后应激障碍症状有关。这项研究将提供有关这些疾病的频率、它们对患者的后果以及ICU中的营养、皮质类固醇和精神错乱如何在ALI后5年内减少或加剧这些疾病的新知识。

DESCRIPTION (provided by investigator): Acute Lung Injury (ALI) is a syndrome characterized by acute, diffuse pulmonary capillary leak resulting in hypoxic respiratory failure. It is caused by a diverse group of pulmonary (e.g. aspiration) and non-pulmonary (e.g. sepsis) factors. ALI imposes a significant public health burden with an incidence that is much higher than previously recognized (86 per 100,000 person years) and a total number of deaths similar to breast cancer or HIV infection. Due to advances in medical care, the mortality rate for ALI has decreased from ~70 per cent to ~40 per cent. Patients who previously may have died now survive ALI; however, their recovery is often long and complicated. Research studying the long-term outcomes of these ALI survivors has become increasingly important. Recent studies have demonstrated important and persistent morbidity in ALI survivors. However, these studies were limited in sample size and duration of follow-up, and provided little information on the effect of intensive care unit (ICU) therapies on long-term outcomes. Consequently, our goal is to learn how existing ICU therapies can be used to minimize long-term physical and mental health morbidities and improve patients' functional status and quality of life after ALI. We propose to extend our existing cohort study, which follows patients for 2 years after ALI, to allow 5- year follow-up. In this proposed research, we will study new relationships of ICU therapies with patients' long term outcomes. Specifically, we will study the epidemiology of muscle weakness, and symptoms of anxiety, depression and post-traumatic stress disorder at up to 5 years after ALI, and the association of these sequelae with limitations in patients' physical function and quality of life [Aims 1a and 2a]. We will then determine the association of nutrition and corticosteroids in the ICU with long-term muscle weakness [Aim 1b]. We also will determine the association of delirium and corticosteroids in the ICU with long-term symptoms of post-traumatic stress disorder [Aim 2b]. Through this research, we will understand how existing ICU therapies and exposures can improve long-term physical and mental health after acute lung injury. PUBLIC HEALTH RELEVANCE Acute lung injury (ALI) usually requires artificial life support in the intensive care unit (ICU) and is common, costly and associated with significant long-term muscle weakness and symptoms of anxiety, depression and post-traumatic stress disorder in surviving patients. This research will provide new knowledge regarding the frequency of these morbidities, their consequences for patients, and how nutrition, corticosteroids and delirium in the ICU may reduce or exacerbate these morbidities up to 5 years after ALI.