Five Year Outcomes from Acute Lung Injury

描述(申请人提供)：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。ALI造成了巨大的公共卫生负担，发病率为每10万人年86例，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-70%降至-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。本申请是第三次提交K24奖项。PI是以患者为导向的危重患者研究的领导者，特别是那些患有ALI的患者，并在指导学员方面有着出色的记录。这项建议的目的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NIH资助的队列研究，该研究在ALI后对患者进行2年的跟踪调查，以便进行5年的随访。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[目标1a和2a]，以及这些后遗症与患者身体功能和生活质量限制的关系。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]。对受训者来说，有许多研究机会。这项研究方案描述了一项对ALI患者进行的新的队列研究，该研究将跟踪观察5年。这项研究将提供关于ALI后发病率的新知识，它们对患者的影响，以及营养、皮质类固醇和ICU中的精神错乱如何在ALI后5年内减少或加剧这些发病率。这项研究将增加我们的基础设施，让受训人员参与临床研究，并设计未来的研究，包括干预研究，以改善ALI患者的预后。相关性(见说明)：急性肺损伤是一个重大的公共卫生问题，可能导致死亡或长期的身体和精神疾病。虽然医疗保健的进步降低了死亡率，但ALI的恢复期很长，患者的发病率很高。这笔赠款将研究现有的ICU疗法，这些疗法可以改善康复，减少ALI的长期身心健康疾病。

DESCRIPTION (provided by applicant): Acute Lung Injury (ALI) is a syndrome characterized by acute, diffuse pulmonary capillary leak resulting in hypoxic respiratory failure. ALI imposes a significant public health burden with an incidence of 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% to -40%. 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. The present application is a third submission for a K24 award. The PI is a leader is patient -oriented research in critically ill patients especially those with ALI, and has an outstanding record of mentoring trainees. The goal of this proposal 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 NIH funded cohort study, which follows patients for 2 years after ALI, to allow 5-year follow-up. 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 [Aims 1a and 2a] and the association of these sequelae with limitations in patients' physical function and quality of life. 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]. A number of research opportunities exist for trainees. This research proposal describes a new cohort study of ALI patients who will be followed for 5 years. This research will provide new knowledge regarding the frequency of morbidities after ALI, 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. The study will add to our infrastructure for trainees to participate in clinical research and to design future studies, including intervention studies, to improve outcomes in ALI patients. RELEVANCE (See instructions): Acute lung injury is a significant public health problem that can lead to death or long-term physical and mental illnesses. While death rates have been decreased by advances in medical care, the recovery period from ALI is long and patients are left with significant morbidity. This grant would research existing ICU therapies that could improve recovery and reduce long-term physical and mental health morbidities from ALI.