Epidemiology of Chronic Critical Illness in Surgical ICU Patients After Sepsis

项目摘要 通过脓毒症筛查，提高对循证、指南驱动的标准操作的遵从性 外科重症监护病房(ICU)患者脓毒症的早期诊断和治疗程序 死亡率大幅下降，迟发性暴发性多器官衰竭几乎 消失了。然而，外科ICU患者中出现了一种新的慢性危重病(CCI)表型 特点是住ICU时间长，反复发生医院感染，伤口愈合差，进展 恶病质和可控制的器官功能障碍。我们创造了持续性炎症这个术语， 免疫抑制和分解代谢综合征(PICS)反映了这种生长的病理生理特征 流行病。其中许多患者(特别是老年人)出院后被送往长期的急诊护理机构。 在那里，他们经常遭受懒惰的死亡。我们假设CCI的特征是病态的长期 结果现在是外科ICU患者在脓毒症中存活的主要临床轨迹。整体而言 项目1的目标是描述外科ICU患者并发脓毒症的CCI的流行病学特征 并确定其长期后果。挑战是让那些外科ICU患者返回 从脓毒症中幸存下来，过上有功能的、有成效的生活，并减轻他们对医疗保健系统和 通过早期干预促进社会进步。然而，我们需要及早确定哪些患者风险最高。 病态的长期结果，并可能受益于新的干预措施。 项目#1‘S的主要职能如下： *界定外科ICU患者败血症的流行病学和长期后果。显然，有一个 迫切需要更好地了解外科ICU患者脓毒症的长期后果， 尤其是那些进入CCI的人，他们是PICS的高危人群。 *及早(48小时内)确定可预测外科ICU患者CCI的临床指标和生物标志物 脓毒症后。这些预测模型可以帮助深入了解潜在的病理生理学和 在未来的试验中设计进入标准。 *确定脓毒症后CCI患者第14天的临床指标和生物标志物，以预测疾病 结果(定义为1年内死亡或完全功能依赖)。这些发现可以用来获得 通过比较患者早期时间点的新生物标志物来洞察潜在的病理生理 与风险最低的患者相比，病态长期结果的风险最高。CCI分数可能会是 在未来的干预试验中发展为复合终点。 为了实现上述目标，项目1将在5年内实施单站点、前瞻性、纵向的 400例成人外科和创伤ICU患者并发脓毒症的研究

PROJECT ABSTRACT With sepsis screening and increased compliance with evidence based, guidelines-driven standard operating procedures for early diagnosis and treatment of sepsis in surgical intensive care unit (ICU) patients, early mortality has been dramatically reduced and late-onset fulminant multiple organ failure has virtually disappeared. A new phenotype of chronic critical illness (CCI), however, has emerged in surgical ICU patients characterized by prolonged ICU stays, recurrent nosocomial infections, poor wound healing, progressive cachexia and manageable organ dysfunctions. We have coined the term persistent inflammation, immunosuppression and catabolism syndrome (PICS) to reflect the pathophysiologic hallmarks of this growing epidemic. Many of these patients (especially the elderly) are discharged to long-term acute care facilities where they often suffer an indolent death. We hypothesize that CCI characterized by morbid long-term outcomes is now a predominant clinical trajectory of surgical ICU patients who survive sepsis. The overall objective of Project #1 is to characterize the epidemiology of CCI in surgical ICU patients who develop sepsis and to determine its long-term consequences. The challenge is to return those surgical ICU patients who survive sepsis to a functional, productive life, and to reduce their burden to the healthcare system and to society through early interventions. We need to identify early, however, which patients are at highest risk for morbid long-term outcomes and might benefit from novel interventions. Project #1's main functions will be the following: * Define the epidemiology and long-term consequences of sepsis in surgical ICU patients. Clearly, there is a compelling need to better understand the long-term consequences of sepsis in surgical ICU patients, especially those who progress into CCI who are at high risk for PICS. * Identify clinical indices and biomarkers that can predict CCI in surgical ICU patients early (within 48 hours) after sepsis. These prediction models could help provide insight into underlying pathophysiology and design entry criteria in future trials. * Identify clinical indices and biomarkers on day 14 in patients with CCI after sepsis that predict morbid outcome (defined as death or full functional dependency at 1 year). These findings could be used to gain insight into underlying pathophysiology by comparing novel biomarkers at earlier time points in patients at highest risk for morbid long-term outcomes versus those patients at lowest risk. A CCI score could then be developed as a composite endpoint in future interventional trials. To accomplish the above goals, Project #1 will perform, over 5 years, a single-site, prospective, longitudinal study of 400 adult surgery and trauma ICU patients who develop sepsis.