Functional Outcomes after Prolonged Mechanical Ventilation in Children

儿童长期机械通气后的功能结果

基本信息

批准号：
10222737
负责人：
Aline Bernard Maddux
金额：
$ 16.15万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-08-01 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10222737
关键词：
2 year old Accelerometer Acute Lung Injury Address Admission activity Adult Adult Respiratory Distress Syndrome Appointment Characteristics Child Childhood Clinical Clinical Investigator Clinical Trials Colorado Critical Care Critical Illness Critically ill children Data Databases Development Plans Devices Diagnosis Electronic Health Record Enrollment Evaluation Exercise Tolerance Exhibits Exposure to Fostering Functional disorder Future Goals Health Health Care Visit Healthcare Hospitalization Hospitals Impairment Inpatients Intervention Knowledge Lead Life Link Lung Measures Mechanical ventilation Methods Morbidity - disease rate Occupational Therapy Outcome Outcome Measure Outcomes Research Outpatients Patients Pediatric Acute Respiratory Distress Syndrome Pediatric Hospitals Pediatric Intensive Care Units Phenotype Physical Function Physical activity Physical therapy Prospective cohort Quality of life Recovery of Function Research Personnel Retrospective cohort Risk Factors Sedation procedure Severities Severity of illness Source Speech Therapy Survivors Testing Therapeutic Intervention Training United States Universities Ventilator-induced lung injury Work base career career development cognitive development cohort data warehouse exercise intolerance follow-up functional disability functional outcomes functional status health data health related quality of life healthy lifestyle high risk impaired functional status improved indexing innovation insurance claims mortality novel patient oriented physical conditioning prognostic prospective pulmonary function respiratory skills social integration therapeutic evaluation trial design

项目摘要

Project Summary Every year, more than 100,000 children in the United States require admission to a Pediatric Intensive Care Unit (PICU) with mechanical ventilation support. Of these, one in ten have significant acute lung injury referred to as Pediatric Acute Respiratory Distress Syndrome (PARDS). The majority of these children survive their arduous PICU course, but little is known about their long-term functional outcomes. Adult survivors of mechanical ventilation and ARDS are known to suffer from long-term significant impairments including decreased exercise tolerance, inability to return to work, and low health-related quality of life (HRQOL). There remains a significant knowledge gap in the understanding of long-term outcomes in children who survive prolonged mechanical ventilation and PARDS. In this proposal, we will employ two methods to evaluate the long-term physical functioning of children who survive mechanical ventilation and PARDS. First, we will link detailed data from the inpatient electronic health record to post-discharge outpatient insurance claims data to identify natural clusters of functional outcome phenotypes and the predictive patient and hospitalization characteristics in a large retrospective cohort of children admitted to our PICU who require > 3 days of mechanical ventilation (Aim 1). Second, we will establish a prospective cohort of critically-ill mechanically ventilated children to evaluate post-discharge HRQOL, functional status, and physical activity (Aim 2). We will use accelerometry, a novel, objective measure of physical activity to build upon the currently used, subjective measures of physical functioning. We hypothesize that we will be able to identfy and validate functional outcome phenotypes and predictors of phenotype clusters (Aim 1). Additionally, we hypothesize that severity of PARDS as well as a threshold of duration of mechanical ventilation, a metric of exposure to PICU-related therapies, will be associated with worse functional outcomes including impaired functional recovery and decreased physical activity (Aim 2). The results of this proposal will identify a cohort of critically ill children who are at high risk of poor functional recovery and most likely to benefit from targeted interventions to improve long-term outcomes. These studies will lay the groundwork for Dr. Maddux to obtain the necessary expertise in pediatric critical care outcomes research to employ accurate, clinically-meaningful long-term outcome measures to evaluate targeted in-hospital and post-discharge therapies in clinical trials with the goal to improve the long-term physical functioning of critically ill children. Addditionally, a well orchestrated career development plan will provide the necessary training for Dr. Maddux to become an independent investigator focused on long-term outcomes after critical illness with the skills to evaluate large databases and perform prospective cohort follow-up.

项目概要美国每年有超过 100,000 名儿童需要进入儿科重症监护室具有机械通气支持的病房 (PICU)。其中，十分之一有严重的急性肺损伤称为小儿急性呼吸窘迫综合征（PARDS）。这些儿童中的大多数都幸存下来 PICU 的过程很艰巨，但对其长期功能结果知之甚少。成年幸存者众所周知，机械通气和 ARDS 会遭受长期的重大损害，包括运动耐量下降、无法重返工作岗位以及健康相关生活质量 (HRQOL) 较低。那里在理解幸存儿童的长期结果方面仍然存在重大知识差距长时间机械通气和 PARDS。在本提案中，我们将采用两种方法来评估机械通气和 PARDS 中幸存儿童的长期身体机能。首先，我们将链接从住院电子病历到出院后门诊保险理赔数据的详细数据识别功能结果表型的自然集群以及预测患者和住院治疗我们的 PICU 收治的需要 > 3 天的治疗的儿童的大型回顾性队列的特征机械通气（目标 1）。其次，我们将建立一个机械重症患者的前瞻性队列。通气儿童评估出院后的 HRQOL、功能状态和体力活动（目标 2）。我们将使用加速度测量法，一种新颖的、客观的身体活动测量方法，以当前使用的主观测量方法为基础身体机能的测量。我们假设我们将能够识别和验证功能结果表型和表型簇的预测因子（目标 1）。此外，我们假设严重程度 PARDS 以及机械通气持续时间阈值（PICU 相关暴露指标）疗法，将与更差的功能结果相关，包括功能恢复受损和体力活动减少（目标 2）。该提案的结果将确定一组危重儿童，他们面临功能恢复不良的高风险，并且最有可能受益于有针对性的干预措施来改善长期成果。这些研究将为 Maddux 博士获得必要的专业知识奠定基础儿科重症监护结果研究采用准确的、有临床意义的长期结果在临床试验中评估有针对性的院内和出院后治疗的措施，旨在改善危重儿童的长期身体机能。此外，精心策划的职业发展计划将为 Maddux 博士提供必要的培训，使其成为一名专注于以下方面的独立调查员危重病后的长期结果，具有评估大型数据库和执行前瞻性的技能队列随访。