Sleep Disruption and Delirium in Critically Ill Children

项目总结/摘要 谵妄是儿科重症监护病房（PICU）的一种严重并发症，但研究不足。睡眠 在谵妄儿童中经常观察到中断，由于不良的生理节律失调， 危重病期间的睡眠质量是导致谵妄的一个建议途径。进入PICU的儿童 经历多种可能干扰睡眠的环境暴露，包括过度的光线， 声音和频繁的重复。这项研究的科学前提是， 儿科重症监护环境，包括过度的光线和声音以及频繁的呼吸，有助于 睡眠中断并因此具有可能导致谵妄生理效应。这个的主要目的 研究培训计划是制定一个衡量框架，说明之间的关系 儿科重症监护环境的可修改特征（即，光和声暴露，曝光 频率）、睡眠中断和谵妄。这 观察性重复测量研究将实现以下具体目标：（1）描述选定的 儿科重症监护环境的可改变特征、睡眠中断以及 在20名5岁及以下重症儿童的样本中，5天内谵妄的持续时间。 (2)检查儿科重症监护的选定可修改特征之间的关系 环境、睡眠中断以及谵妄的发生率和持续时间。(2a)检查中介效应 睡眠中断与儿科重症监护的选定特征之间的关系 环境和谵妄的发生率和持续时间。这项研究是第一批探索 重症儿童睡眠中断与谵妄之间的关系这与联合国的使命是一致的。 NINR症状科学战略计划，了解症状的生物和行为方面。一旦 经过验证，本研究中开发的测量框架将用于设计和测试环境 修改和/或睡眠促进干预，以防止儿童群体中的谵妄。长期 这项研究计划的目标是改善神经认知症状管理和长期 通过优化儿科重症监护环境，改善危重患儿的预后。这三年的博士预科 培训计划有以下目标：（1）建立对定量研究方法的理解和熟练程度 和统计分析。(2)获得必要的技能和知识，以评估 儿科重症监护环境有助于危重病患者谵妄的发生率和持续时间 孩子(3)通过学术写作推进对小儿谵妄的科学理解， 传播研究成果。(4)专业发展，准备在一个教师职位 研究密集型学术机构。本报告中提出的各种教育和专业经验 培训计划将支持申请人发展成为早期护士调查员。

PROJECT SUMMARY/ABSTRACT Delirium is a serious but under-studied complication of stay in the pediatric intensive care unit (PICU). Sleep disruption is frequently observed in children with delirium, and circadian rhythm dysregulation due to poor sleep quality during critical illness is one proposed pathway to delirium. Children admitted to the PICU experience multiple environmental exposures with the potential to disrupt sleep, including excessive light and sound and frequent caregiving. The scientific premise of this study is that modifiable characteristics of the pediatric critical care environment, including excessive light and sound and frequent caregiving, contribute to sleep disruption and thus have a physiological effect that may lead to delirium. The primary purpose of this research training plan is to develop a measurement framework that illustrates the relationship between modifiable characteristics of the pediatric critical care environment (i.e., light and sound exposure, caregiving frequency), sleep disruption, and delirium in a critically ill pediatric sample 5 years of age and younger. This observational, repeated measures study will accomplish the following specific aims: (1) Describe selected modifiable characteristics of the pediatric critical care environment, sleep disruption, and the incidence and duration of delirium across a 5-day period in a sample of 20 critically ill children 5 years of age and younger. (2) Examine the relationships among selected modifiable characteristics of the pediatric critical care environment, sleep disruption, and the incidence and duration of delirium. (2a) Examine the mediating effect of sleep disruption on the relationship between selected characteristics of the pediatric critical care environment and the incidence and duration of delirium. This study is among the first to explore the association between sleep disruption and delirium in critically ill children. This aligns with the mission of the NINR Strategic Plan in Symptom Science to understand biological and behavioral aspects of symptoms. Once validated, the measurement framework developed in this study will be used to design and test environmental modification and/or sleep promotion interventions to prevent delirium in pediatric populations. The long-term goal of this program of research is to improve the neurocognitive symptom management and long-term outcomes of critically ill children by optimizing the pediatric critical care environment. This 3-year pre-doctoral training plan has the following goals: (1) Build understanding and proficiency in quantitative research methods and statistical analyses. (2) Acquire the necessary skills and knowledge to evaluate how exposures in the pediatric intensive care environment contribute to the incidence and duration of delirium in critically ill children. (3) Advance scientific understanding of pediatric delirium through scholarly writing and dissemination of research findings. (4) Develop professionally in preparation for a faculty position at a research-intensive academic institution. The diverse educational and professional experiences proposed in this training plan will support development of the applicant into an early-stage nurse investigator.