Circadian Diurnal Motor Synchrony and Delirium Amongst Older Cardiac Surgery ICU Patients

老年心脏手术 ICU 患者的昼夜节律运动同步性和谵妄

• 批准号: 10518974
• 负责人: Meghan Prin
• 金额: $ 12.6万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2023-02-20
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10518974
• 关键词: Acute Disease; Admission activity; Adverse event; Affect; Age; Aging; Alzheimer' s disease related dementia; American; Animal Model; Assessment tool; Attention; Award; Basic Science; Cardiac; Cardiac Surgery procedures; Caring; Circadian Dysregulation; Circadian Rhythms; Clinical; Clinical Trials; Clinical Trials Design; Clinical Trials Network; Cognition; Cognition Disorders; Cognitive; Cohort Studies; Colorado; Complication; Critical Care; Critical Illness; Cues; Data; Delirium; Development Plans; Early Mobilizations; Early identification; Elderly; Emergency Medicine; Enrollment; Environment; Etiology; Exposure to; Future; Goals; Health care facility; Homeostasis; Hospital Mortality; Hospitalization; Hour; Human; Human Volunteers; Impaired cognition; Incidence; International; Intervention; Laboratories; Lead; Light; Literature; Long-Term Care; Measures; Medical center; Medicare; Mentors; Mentorship; Methodology; Methods; Motor; Motor Activity; Movement; Neurocognitive; Operative Surgical Procedures; Outcome; Participant; Patients; Pattern; Periodicity; Perioperative; Phototherapy; Physicians; Population; Postoperative Complications; Postoperative Period; Procedures; Quality of life; Randomized Controlled Trials; Research; Research Personnel; Resources; Risk; Sample Size; Screening procedure; Sleep; Stress; Structure; Test Result; Testing; Time; Training; Universities; Work; Wrist; actigraphy; aging population; arm; bench to bedside; biomedical referral center; career; circadian; circadian pacemaker; circadian regulation; cognitive testing; cost; design; experience; faculty research; functional decline; functional outcomes; human subject; improved; improved outcome; innovation; mortality; mouse model; novel; pilot trial; postoperative delirium; primary outcome; prospective; randomized trial; recruit; restoration; screening; secondary outcome; standard care; tool; trial design

The long term goal of this proposal is to determine the association of circadian rhythms with postoperative delirium in older adults admitted to the ICU after elective cardiac surgery. More than 250,000 older Americans undergo cardiac surgery every year which allows them to lead more functional and fulfilling lives, but if the procedure is complicated by delirium then the risk of functional or cognitive decline, discharge to a long-term care facility, and mortality increases substantially. Dr. Prin is a Critical Care Anesthesiologist dedicated to improving clinical outcomes after postoperative ICU admission for older adults and this NIA GEMSSTAR proposal is designed to provide her with the structured mentorship and training necessary to become a leader in perioperative aging research and critical care trials. She has developed a collaborative mentorship team led by Dr. Adit Ginde who is an Emergency Medicine Physician and national PI for the large multicenter PETAL network clinical trial with over 3,000 participants, with co-mentorship provided by Dr. Tobias Eckle (a national leader in the basic science of circadian rhythms) and Dr. John Devlin (an internationally recognized delirium researcher). Dr. Alex Kaizer, a biostatistician with expertise in novel and adaptive clinical trial design, will mentor Dr. Prin in trial methodology. This proposal leverages the collective expertise of an established mentorship team and the unique environment at the University of Colorado Anschutz Medical Center that incorporates a tertiary referral center for cardiac surgery in the setting of a large public research university. These ample resources will allow Dr. Prin to rigorously study the relationship of circadian rhythms with the incidence of delirium after cardiac surgery. Her global hypothesis is that disruption of circadian rhythmicity in the ICU environment drives the incidence of delirium. She will test this hypothesis by determining the association of diurnal motor activity patterns with delirium in a prospective observational cohort study (Aim 1) and preparing for a future clinical trial with an unblinded pilot trial of intense morning light for circadian motor activity patterns (Aim 2). These Specific Aims are designed to evaluate the association of circadian rhythms with delirium, which has not been established in critically ill human subjects. These studies require Dr. Prin to develop expertise in circadian research, delirium assessment tools, and clinical trial methodology. She will accomplish this with a focused Professional Development Plan including coursework on clinical trial design, neurocognitive assessments, and aging research. Completion of the proposed project will provide the necessary mentorship, training, and experience to allow Dr. Prin to become a leader in perioperative aging research to improve outcomes after postoperative ICU admission.

该提案的长期目标是确定昼夜节律与术后的关联 选修心脏手术后，老年人的del妄被接受ICU。超过25万名美国人 每年接受心脏手术 del妄的过程变得复杂，然后出现功能或认知能力下降的风险，长期出现 护理设施和死亡率大大增加。普林博士是一名致力于 术后ICU入院后，改善了老年人和此Nia Gemsstar的临床结果 提案旨在为她提供成为领导者所必需的结构化指导和培训 在围手术期衰老研究和重症监护试验中。她已经建立了一个合作指导团队领导 由Adit Ginde博士撰写，他是急诊医学医师和国家PI的大型多中心花瓣 网络临床试验与3,000多名参与者，并由Tobias Eckle博士提供的会议（国家） 昼夜节律基础科学的领导者和约翰·德夫林（John Devlin）博士（国际认可的ir妄 研究员）。 Alex Kaizer博士是一位具有新颖和自适应临床试验设计专业知识的生物统计学家，将 导师Prin博士在试验方法中。该建议利用了已建立的集体专业知识 科罗拉多大学安索斯大学医学中心的指导团队和独特的环境 在一所大型公共研究大学的环境中纳入了心脏外科第三次转诊中心。 这些充足的资源将使普林博士严格研究昼夜节律与 心脏手术后ir妄的发生率。她的全球假设是昼夜节律的破坏 ICU环境驱动了ir妄的发生率。她将通过确定 在前瞻性观察队列研究中，昼夜运动活动模式与del妄的关联（AIM 1） 并为未来的临床试验做准备，并进行了一项无盲的试点试验，以示为昼夜节律的激烈的早晨灯光试验 活动模式（目标2）。这些特定目标旨在评估昼夜节律的关联 与尚未在重病人类受试者中建立的del妄。这些研究要求Prin博士 在昼夜节律研究，ir妄评估工具和临床试验方法方面发展专业知识。她会的 通过重点的专业发展计划来完成此操作，包括有关临床试验设计的课程， 神经认知评估和衰老研究。拟议项目的完成将提供 必要的指导，培训和经验，以使Prin博士成为围手术期衰老的领导者 术后ICU入院后改善预后的研究。