Cognitive Impairment in the ICU: Evaluation and Outcomes

ICU 中的认知障碍：评估和结果

• 批准号: 6333146
• 负责人: E Wesley ELY
• 金额: $ 12.39万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-08-01 至 2006-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6333146
• 关键词: artificial respiration; bioengineering /biomedical engineering; biomedical equipment development; cognition disorders; comorbidity; consciousness; diagnosis design /evaluation; geriatric nursing; geriatrics; hospital length of stay; human old age (65+); human subject; iatrogenic disease; intensive care; intubation; mental disorder diagnosis; mental health epidemiology; neuropsychological tests; outcomes research; patient monitoring device; patient oriented research; postdoctoral investigator; psychic activity level; psychopharmacologic agent; respirators

DESCRIPTION (From the application): Global deficits in cognition in the form of delirium, stupor, or coma are extremely common and hazardous in older ICU patients. Cognitive impairment is associated with prolonged hospital stays, institutionalization, and death. Because acute cognitive impairment compromises patients' ability to be removed from mechanical ventilation and may be a factor associated with long-term neuropsychological sequelae, physicians and nurses need to be able to identify patients at high risk for cognitive impairment and understand potentially modifiable aspects of care that may reduce cognitive impairment. Consciousness is defined as having two components: arousal (wakefulness) and content (attentiveness). Arousal, a basic process of mental function, is commonly monitored in ICU patients. Attentiveness, which results from more complex neurologic interactions, is often impaired yet rarely objectively monitored. There are no validated instruments available for bedside use by nurses or physicians to monitor both components of consciousness in mechanically ventilated patients. We propose to modify existing instruments for use in the ICU in order to develop and validate a system for monitoring the brain and its function in mechanically ventilated patients during and after ICU care (Aim 1). Once validated, we can determine the prevalence of acute cognitive impairments in elderly ICU patients and its association with clinical outcomes (Aim 2). This cohort of patients will be used to determine factors associated with neuro-psychological deficits at 6 months following the ICU stay (Aim 3). This builds on the candidate's previous work in the ICU and gerontology and extends into an important new area, which is cognitive impairment in critically ill older persons. The long-term goal is to improve health outcomes for elderly ICU patients through future studies which will seek to reduce the incidence of cognitive impairment, to enhance liberation from mechanical ventilation, to integrate these observations into routine ICU monitoring, and to improve the understanding and prevention of post-ICU neuropsychological deficits. To prepare for this goal, his proposed career development plan includes advanced training in geriatric cognitive assessment, epidemiology and biostatistics, psychometrics and research methodology through clinical training, course work, and independent reading. Along with the candidate's record of publications and achievement, he will have rich academic surroundings, excellent mentors and strong institutional commitment to ensure that he achieve these goals.

描述（来自应用程序）：整体认知缺陷的形式 谵妄、昏迷或昏迷在老年 ICU 中极为常见且危险 患者。认知障碍与住院时间延长有关， 制度化和死亡。因为急性认知障碍 损害患者脱离机械通气的能力，并且 可能是与长期神经心理后遗症相关的一个因素， 医生和护士需要能够识别高危患者 认知障碍并了解护理的潜在可改变方面 这可能会减少认知障碍。意识被定义​​为具有两个 组成部分：唤醒（觉醒）和内容（注意力）。 唤醒，一个 心理功能的基本过程通常在 ICU 患者中进行监测。 注意力是由更复杂的神经系统相互作用产生的 经常受到损害但很少进行客观监测。没有经过验证的 护士或医生可在床边使用仪器来监测两者 机械通气患者的意识成分。我们建议 修改 ICU 中使用的现有仪器，以便开发和 验证用于机械监测大脑及其功能的系统 在 ICU 护理期间和之后对患者进行通气（目标 1）。一旦验证通过，我们就可以 确定老年 ICU 中急性认知障碍的患病率 患者及其与临床结果的关联（目标 2）。这一批 患者将被用来确定与神经心理相关的因素 入住 ICU 后 6 个月时出现赤字（目标 3）。这建立在 候选人之前在 ICU 和老年学领域的工作，并扩展到 重要的新领域，即危重老年人的认知障碍 人。长期目标是改善 ICU 老年人的健康状况 未来的研究将寻求降低患者的发病率 认知障碍，以增强从机械通气中的解放， 将这些观察结果纳入常规 ICU 监测中，并改善 了解和预防 ICU 后神经心理缺陷。到 为了这个目标做准备，他提出的职业发展计划包括高级 老年认知评估、流行病学和生物统计学培训， 通过临床培训、课程作业进行心理测量和研究方法， 以及独立阅读。以及候选人的出版物记录和 取得成就，他将拥有丰富的学术环境、优秀的导师和 确保他实现这些目标的强有力的机构承诺。