The Diagnosis and Treatment of Critical Illness Polyneuromyopathy in Patients wit

重症多发性神经肌病的诊治

• 批准号: 7846246
• 负责人: MARC MOSS
• 金额: $ 66.5万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7846246
• 关键词: Action Potentials; Acute; Acute respiratory failure; Address; Admission activity; Adult Respiratory Distress Syndrome; Affect; American; Attention; Case Fatality Rates; Case Study; Controlled Clinical Trials; Cost Savings; Critical Illness; Critical Illness Polyneuropathy; Data; Delirium; Development; Diagnosis; Diagnostic; Diagnostic tests; Disease; Early Diagnosis; Effectiveness; Encephalopathies; Family; Fatigue; Frequencies; Hospitalization; Hospitals; Impairment; Individual; Inpatients; Intensive Care; Intensive Care Units; Length of Stay; Lifting; Literature; Lung diseases; Measures; Mechanical ventilation; Mechanics; Medical; Methods; Motor; Multi-Institutional Clinical Trial; Myopathy; Names; Nerve; Neural Conduction; Nutritional Support; Outcome; Patients; Performance; Physical Function; Physical activity; Physical therapy; Physicians; Physiological; Placebo Control; Prospective Studies; Protocols documentation; Publishing; Quality of life; Randomized; Reporting; Safety; Screening procedure; Sensory; Surveys; Survivors; Symptoms; Testing; Therapeutic; United States; Walking; Wit; Work; base; clinically significant; evidence base; functional status; health related quality of life; improved; neuromuscular; neuromuscular function; novel; programs; public health relevance; respiratory; sedative; standard of care; tool development

DESCRIPTION (provided by applicant): Acute respiratory failure is a heterogeneous disorder that results in more than 300,000 Americans requiring admission to an intensive care unit for invasive mechanical ventilatory support each year. Though acute respiratory failure is a pulmonary disorder, patients who survive are not limited by respiratory symptoms after discharge. Rather persistent neuromuscular weakness is the primary disorder that adversely affects their quality of life and ability to function on a daily basis. Weakness in these survivors is related to the development of critical illness polyneuromyopathy (CIPNM). The ability to accurately diagnose CIPNM in these patients is difficult and often delayed. Presently, there is no available diagnostic screening test that accurately identifies those patients with acute respiratory failure that will develop CIPNM. Earlier and less invasive identification of critically ill patients that will eventually develop CIPNM may improve the efficacy of specific medical therapies, nutritional support, or intensive physical therapy. We have identified alterations on nerve conduction studies as early as three days after presentation to the hospital in critically ill patients. A progressive decrease over the subsequent seven days in the baseline amplitude was predictive of the development of CIPNM. In the first part of this proposal, we will prospectively determine whether changes on simple nerve conduction studies can be used as an effective diagnostic tool for the development of CIPNM in patients with acute respiratory failure. Presently, there are no therapies to treat the estimated 110,000 acute respiratory failure survivors who have developed CIPNM each year. Based on the results of our national surveys of physical therapists and intensive care physicians, the utilization and types of physical therapy for patients recovering from acute respiratory failure with neuromuscular weakness varies significantly depending on the type of hospital and primary diagnosis of the patient. In the second part of this proposal, we plan to perform a randomized, placebo controlled clinical trial to determine the effectiveness of an intensive four week physical therapy program for the subset of patients with acute respiratory failure who have developed CIPNM. This trial will determine the efficacy of the physical therapy programs that is currently performed in a non-evidence based manner for patients with acute respiratory failure across the United States. If successful, our studies would identify a novel way to diagnose patients with CIPNM and pave the way for a larger multi-center clinical trial of intensive physical therapy for survivors of acute respiratory failure. PUBLIC HEALTH RELEVANCE: and Relevance Acute respiratory failure is a heterogeneous disorder that results in more than 300,000 Americans requiring admission to an intensive care unit for invasive mechanical ventilatory support each year. Though acute respiratory failure is a pulmonary disorder, patients who survive their hospitalization are not limited by respiratory symptoms after discharge. Rather persistent neuromuscular weakness is the primary disorder that adversely alters their quality of life and ability to function on a daily basis. In this application we propose to identify a novel method of identifying those patients with acute respiratory failure that will develop neuromuscular weakness. In addition, we plan to conduct a randomized, placebo-controlled clinical trial called the Do It Now study (Diagnosis and Treatment of Neuromuscular Weakness) to determine the effectiveness of an intensive physical therapy program for patients recovering from acute respiratory failure who have developed neuromuscular weakness. This trial will establish the efficacy of the physical therapy programs that is currently performed for patients with acute respiratory failure in a non-evidence based manner across the United States.

描述（由申请人提供）：急性呼吸衰竭是一种异质性疾病，导致超过300,000名美国人，需要每年进入重症监护室进行入侵机械通气支持。尽管急性呼吸衰竭是一种肺部疾病，但生存的患者不受排出后呼吸道症状的限制。相反，持续的神经肌肉无力是主要疾病，它每天都会不利地影响其生活质量和功能。这些幸存者的弱点与危害疾病多神经瘤（CIPNM）的发展有关。这些患者准确诊断CIPNM的能力很困难，并且经常延迟。目前，尚无可用的诊断筛查测试，可以准确地识别那些会发展为CIPNM的急性呼吸衰竭患者。对最终将开发CIPNM的重症患者的早期且较少的侵入性鉴定可能会提高特定的医疗疗法，营养支持或强化物理疗法的功效。我们在向医院出现重症患者三天后的三天内就确定了对神经传导研究的改变。在基线幅度的随后七天中，逐渐减少的逐渐减少可以预测CIPNM的发展。在本提案的第一部分中，我们将前瞻性确定简单神经传导研究的变化是否可以用作急性呼吸衰竭患者CIPNM开发CIPNM的有效诊断工具。目前，尚无治疗每年患有CIPNM的估计110,000次急性呼吸衰竭幸存者的疗法。根据我们对物理治疗师和重症监护医师的国家调查的结果，从急性呼吸衰竭中恢复过的患者的利用和类型以及神经肌肉疲弱的患者恢复了明显变化，这取决于医院的类型和患者的主要诊断。在本提案的第二部分中，我们计划进行一项随机的安慰剂对照临床试验，以确定针对患有CIPNM的急性呼吸衰竭患者子集的四周物理治疗计划的有效性。该试验将确定目前以非证据方式对美国急性呼吸衰竭患者进行的物理治疗计划的疗效。如果成功的话，我们的研究将确定一种诊断CIPNM患者的新方法，并为急性呼吸衰竭幸存者进行大量物理治疗的更大多中心临床试验铺平了道路。公共卫生相关性：和相关性急性呼吸衰竭是一种异质性疾病，导致超过300,000名美国人，需要每年进入重症监护室进行入侵机械通气支持。尽管急性呼吸衰竭是一种肺部疾病，但在出院后生存的患者不受呼吸道症状的限制。相反，持续的神经肌肉弱点是主要疾病，它会不利地改变其生活质量和每天运作的能力。在此应用中，我们建议识别一种鉴定那些急性呼吸衰竭患者的新方法，该方法将会发展出神经肌肉无力。此外，我们计划进行一项随机的，安慰剂对照的临床试验，称为IT IT研究（诊断和治疗神经肌肉弱点），以确定针对从急性呼吸衰竭中恢复过神经肌肉无力的急性呼吸衰竭患者的强化物理治疗计划的有效性。该试验将确定当前在美国以非证据的方式对急性呼吸衰竭患者进行的物理治疗计划的功效。