Impact of Alcohol Misuse on Cognitive and Respiratory Outcomes in COVID-19-associated Acute Respiratory Failure

滥用酒精对 COVID-19 相关急性呼吸衰竭患者认知和呼吸结果的影响

• 批准号: 10491334
• 负责人: ELLEN L BURNHAM
• 金额: $ 27.33万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-22 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10491334
• 关键词: Accounting; Acute; Acute Respiratory Distress Syndrome; Acute respiratory failure; Address; Admission activity; Adult; Alcohol consumption; Alcohols; Automobile Driving; Brain; COVID-19; COVID-19 pandemic; COVID-19 patient; COVID-19 survivors; COVID-19/ARDS; Characteristics; Clinic; Cognition; Cognitive; Colorado; Consumption; Convalescence; Coronavirus; Critical Illness; Data; Delirium; Development; Diagnosis; Enrollment; Functional disorder; Funding; Goals; Health; Health system; High Prevalence; Hospitalization; Hospitals; Hypoxemic Respiratory Failure; Impaired cognition; Impairment; Infection; Intensive Care Units; Intervention; Investigation; Lung; Mechanical Ventilators; Mechanical ventilation; Mental Health; Monoclonal Antibody R24; Morbidity - disease rate; National Institute on Alcohol Abuse and Alcoholism; Neurocognitive; Outcome; Patients; Post-Acute Sequelae of SARS-CoV-2 Infection; Predisposition; Recording of previous events; Recovery; Reporting; Research; Residual state; Resources; Respiration Disorders; Respiratory Failure; Respiratory physiology; Retrospective cohort; Risk; Risk Factors; Role; Services; Severities; Severity of illness; Subgroup; Survivors; Universities; Waxes; Work; alcohol misuse; alcohol research; brain dysfunction; cohort; health assessment; improved; lung development; lung injury; mental state; mortality; multidisciplinary; pandemic disease; prospective; pulmonary function; respiratory; respiratory health; response

Project Summary/Abstract During the Coronavirus (COVID)-19 pandemic, the number of patients diagnosed with the acute respiratory distress syndrome (ARDS) has increased dramatically in the US. COVID-19-associated ARDS is characterized by high morbidity, including a requirement for protracted mechanical ventilator support. In a substantial percentage of patients who survive hospitalization, deficits including neurocognitive dysfunction and residual pulmonary impairment have been reported as so-called Post-Acute Sequelae of COVID-19 (PASC). Therefore, it is imperative to urgently establish addressable factors that drive poor outcomes. Prior to the COVID-19 pandemic, investigations by our research group demonstrated that alcohol misuse is associated with an increased severity of ARDS, which may contribute to residual pulmonary dysfunction in survivors. Alcohol misuse can also propagate development of delirium that may increase risk for cognitive impairment in recovery. Notably, delirium has been reported in half of all COVID-19 patients in the ICU, and alcohol misuse appears to increase odds for its development. Although reports of increasing alcohol misuse during the pandemic are widespread and might be one modifiable factor driving severity of illness and outcomes, its impact on the trajectory of illness in COVID-19 has not been fully evaluated. The goal of this proposal is to determine if alcohol misuse promotes ICU delirium that in turn increases requirements for mechanical ventilation among patients with COVID-19-associated ARDS. Also, we wish to establish if alcohol misuse contributes to persistent cognitive and respiratory PASC in COVID-19 survivors. To address these questions, two aims are proposed. Aim 1: In hospitalized patients with COVID-19-associated ARDS, determine if alcohol misuse is associated with increased mechanical ventilation requirements, and if delirium further influences this relationship. Investigations will be conducted in a prospectively enrolled cohort of patients with COVID-19- associated ARDS, who are in the ICU at the University of Colorado Hospital (Aim 1a), and in a retrospective cohort of hospitalized patients with COVID-19, previously admitted in the University of Colorado Health system (Aim 1b). Aim 2: Among patients recovering from COVID-19, determine the impact of alcohol misuse on cognition and respiratory function in recovery, accounting for characteristics of acute illness that include requirements for mechanical ventilation and ICU delirium. Investigations will be conducted in patients followed in a multidisciplinary COVID-19 Recovery Clinic, who will have cognitive, mental, and respiratory health evaluated over the year following hospital discharge. Our proposed research will help determine if patients with alcohol misuse warrant targeted strategies to identify and treat delirium in the setting of COVID-19-associated respiratory failure, and it will clarify if hospitalized patients with COVID-19 and alcohol misuse represent a unique subgroup at risk for PASC who may merit specific services or interventions.

项目摘要/摘要 在冠状病毒（Covid）-19大流行期间，被诊断为急性呼吸道的患者人数 在美国，遇险综合征（ARDS）急剧增加。 COVID-19相关的ARD的表征 通过高发病率，包括对持久的机械呼吸机的支撑。实质性 存活住院的患者百分比，包括神经认知功能障碍和残留的患者百分比 据报道，肺部受损是Covid-19（PASC）的所谓急性后遗症。所以， 必须紧急建立可寻求不良结果的可寻址因素。在19号之前 大流行，我们的研究小组的调查表明，滥用酒精与 ARDS的严重程度增加，这可能导致幸存者中残留的肺部功能障碍。酒精 滥用还可以传播ir妄的发展，这可能会增加认知障碍的风险 恢复。值得注意的是，在ICU中的所有Covid-19患者中，del妄已有一半，滥用酒精 似乎增加了其发展的赔率。尽管在此期间有滥用酒精的报道 大流行是普遍的 尚未完全评估COVID-19中对疾病轨迹的影响。该提议的目的是 确定滥用酒精是否促进了ICU del妄，进而增加了机械的要求 共同19-19相关的ARDS患者的通风。另外，我们希望确定是否滥用酒精 有助于19009幸存者的持续认知和呼吸道PASC。要解决这些问题， 提出了两个目标。 AIM 1：在与19009年相关ARDS的住院治疗患者中，确定是否酒精 滥用与增加机械通气要求有关，如果del妄进一步影响这一点 关系。将在前瞻性招收的COVID-19-患者队列中进行调查。 在科罗拉多大学医院（AIM 1A）的ICU和回顾性的ARDS 先前在科罗拉多大学卫生系统中录取的Covid-19患者的同类 （AIM 1B）。 AIM 2：在从Covid-19的患者中，确定滥用酒精的影响 恢复中的认知和呼吸功能，考虑到包括急性疾病的特征 机械通气和ICU del妄的要求。随后将对患者进行调查 在多学科的Covid-19恢复诊所中，他们将具有认知，心理和呼吸健康 出院后的一年中进行了评估。我们提出的研究将有助于确定患者是否 滥用酒精的有针对性的策略，以识别和治疗del妄，以期为19次相关 呼吸衰竭，它将澄清住院的19. Covid-19和滥用酗酒的患者 对PASC的风险独特的子组，可能需要特定的服务或干预措施。