Outcomes of Prolonged Mechanical Ventilation

长期机械通气的结果

• 批准号: 6988519
• 负责人: Shannon S Carson
• 金额: $ 12.52万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-01-01 至 2006-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6988519
• 关键词: adult human (21+); attitude; functional ability; hospital length of stay; human subject; interview; mathematical model; model design /development; outcomes research; patient care planning; patient oriented research; postdoctoral investigator; prognosis; quality of life; respirators; respiratory therapy; telecommunications

DESCRIPTION (provided by applicant): The career goals of Dr. Shannon Carson include becoming a productive independent investigator who will conduct clinical research and outcomes studies involving critically ill patients. To gain the necessary background, he will participate in clinical research conferences and seminars at the UNC School of Medicine, and he will complete courses in the UNC School of Public Health that pertain to clinical epidemiology, study design, data analysis, and the responsible conduct of patient-oriented research. In addition, he will complete a 5-year research project under the mentorship of Dr. Tim Carey. The primary objective of the study is to develop predictive models for one-year survival and functional status. Secondary objectives will be to describe long-term patient oriented outcomes including health status and quality of life. Patients who require prolonged mechanical ventilation account for 10 to 20% of ICU patients and consume up to 37% of total intensive care unit (ICU) resources. Survivors are often of advanced age and leave the hospital with numerous unresolved medical problems. Preliminary data indicate that one-year survival is as low as 23%. These patients will increase in number as our aging population continues to encounter advances in life sustaining therapies. It is important to determine if these advanced therapies translate into acceptable long-term outcomes. Specific Aims of this study include: 1) Assess one-year survival and functional status for patients who require prolonged mechanical ventilation after acute illness. 2) Determine Health Status and Quality of Life for survivors. 3) Develop and validate a prediction model for one-year survival. 3) Develop and validate a prediction model for independent functional status. This study will enroll a prospective cohort of 200 adult patients requiring mechanical ventilation for at least 21 days at a large tertiary care medical center. Patients will be followed during hospitalization and through the subsequent year. Telephone interviews will be conducted 3 months, 6 months and 12 months after study enrollment to determine patient survival, health status, and perceived quality of life. Using variables measured on day 21 of mechanical ventilation, predictive models will be developed for one-year survival and independent functional status. Models will be validated prospectively in a cohort of 100 similar patients, and physician estimates of one-year survival and functional status will be compared to model estimates. Knowledge of these outcomes would be helpful to clinicians as they counsel patients and their families regarding appropriate levels of aggressive care and help them understand the types of resources and support that will be needed for optimal recovery upon discharge. In addition, these data will inform future cohort studies and randomized controlled trials designed to improve outcomes for this growing patient population.

描述（由申请人提供）： 香农·卡森（Shannon Carson）博士的职业目标包括成为一个富有成效的 将进行临床研究和结果的独立研究者 涉及重症患者的研究。为了获得必要的背景 他将参加UNC的临床研究会议和研讨会 医学院，他将在UNC公立学校完成课程 与临床流行病学，研究设计，数据分析和 负责患者研究的负责任。此外，他会 在蒂姆·凯里（Tim Carey）博士的指导下完成一个为期5年的研究项目。 该研究的主要目的是开发一年的预测模型 生存和功能状态。次要目标是描述 长期以患者为导向的结果，包括健康状况和质量 生活。需要延长机械通气的患者占10至 ICU患者的20％，最多占重症监护病房（ICU）的37％ 资源。幸存者通常是高龄，离开医院 许多未解决的医疗问题。初步数据表明一年 生存率高达23％。随着我们的衰老，这些患者的数量会增加 人口继续遇到维持疗法的生活进展。这是 重要的是确定这些高级疗法是否转化为可接受的 长期结局。这项研究的具体目的包括：1）评估一年 需要延长机械的患者的生存和功能状态 急性疾病后通风。 2）确定健康状况和质量 幸存者的生活。 3）开发和验证一年的预测模型 生存。 3）开发和验证独立的预测模型 功能状态。 这项研究将招募200名成年患者的前瞻性队列 在大型三级护理医疗中，机械通气至少21天 中心。住院期间和通过 随后的一年。电话采访将进行3个月零6个月，并且 研究入学后12个月以确定患者生存，健康状况， 和感知的生活质量。使用在第21天测量的变量 机械通气，预测模型将开发一年 生存和独立功能状态。模型将被验证 前瞻性地在100名类似患者的队列中，医师的估计值 将一年的生存和功能状态与模型估计进行比较。 对这些结果的了解对临床医生的咨询会有所帮助 患者及其家人关于适当水平的积极护理 并帮助他们了解将是的资源和支持的类型 出院时最佳恢复所需的需要。此外，这些数据将 告知未来队列研究和旨在的随机对照试验 改善这种不断增长的患者人群的结果。

项目成果

The changing epidemiology of mechanical ventilation: a population-based study.

• DOI: 10.1177/0885066605282784
• 发表时间: 2006-05-01
• 期刊: Journal of intensive care medicine
• 影响因子: 3.1
• 作者: Carson, Shannon S;Cox, Christopher E;Carey, Timothy S
• 通讯作者: Carey, Timothy S

Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation.

异丙酚和劳拉西泮对接受机械通气的危重患者的经济评价。

• DOI: 10.1097/ccm.0b013e3181544248
• 发表时间: 2008
• 期刊: Critical care medicine
• 影响因子: 8.8
• 作者: Cox,ChristopherE;Reed,ShelbyD;Govert,JosephA;Rodgers,JoE;Campbell-Bright,Stacy;Kress,JohnP;Carson,ShannonS
• 通讯作者: Carson,ShannonS

One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study.

• DOI: 10.7326/0003-4819-153-3-201008030-00007
• 发表时间: 2010-08-03
• 期刊: Annals of internal medicine
• 影响因子: 39.2
• 作者: Unroe M;Kahn JM;Carson SS;Govert JA;Martinu T;Sathy SJ;Clay AS;Chia J;Gray A;Tulsky JA;Cox CE
• 通讯作者: Cox CE

Is the implementation of research findings in the critically ill hampered by the lack of universal definitions of illness?

缺乏通用的疾病定义是否会阻碍研究成果在危重病人身上的实施？

• DOI: 10.1097/00075198-200308000-00010
• 发表时间: 2003
• 期刊: Current opinion in critical care
• 影响因子: 3.3
• 作者: Carson,ShannonS;Shorr,AndrewF
• 通讯作者: Shorr,AndrewF