Five Year Outcomes from Acute Lung Injury

急性肺损伤（acute lung Injury，ALI）是一种以急性弥漫性肺毛细血管渗漏为特征的综合征，可导致缺氧性呼吸衰竭。急性肺损伤给公共卫生带来了巨大的负担，发病率为每10万人年86例，死亡总数与乳腺癌或艾滋病毒感染相似。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可以在ALI中存活下来;然而，他们的恢复通常是漫长而复杂的。研究这些ALI幸存者的长期结果变得越来越重要。 本申请是第三次提交K24裁决。PI是一个领导者，是以病人为导向的研究，在危重病人，特别是那些与急性肺损伤，并有一个优秀的记录指导学员。该提案的目标是了解如何使用现有的ICU疗法来最大限度地减少长期的身心健康发病率，并改善ALI后患者的功能状态和生活质量。我们建议扩展我们现有的NIH资助的队列研究，该研究在ALI后随访患者2年，以允许5年随访。具体而言，我们将研究ALI后5年内肌无力的流行病学，焦虑、抑郁和创伤后应激障碍的症状[目的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相关性。然后，我们将确定ICU中营养和皮质类固醇与长期肌无力的相关性[目的1b]。我们还将确定ICU中谵妄和皮质类固醇与创伤后应激障碍长期症状的相关性[目的2b]。 为学员提供了一些研究机会。这项研究计划描述了一项新的ALI患者队列研究，将对这些患者进行5年随访。这项研究将提供有关ALI后发病率的新知识，其对患者的后果，以及ICU中的营养，皮质类固醇和谵妄如何在ALI后5年内减少或加重这些发病率。这项研究将增加我们的基础设施，使受训者能够参与临床研究，并设计未来的研究，包括干预研究，以改善ALI患者的结局。

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.