Minimally invasive techniques to measure upper airway obstruction in children

微创技术测量儿童上呼吸道阻塞

基本信息

批准号：
8238781
负责人：
Robinder Khemani
金额：
$ 13.36万
依托单位：
CHILDREN'S HOSPITAL OF LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-01 至 2017-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8238781
关键词：
Abdomen Acute Lung Injury Adrenal Cortex Hormones Adrenergic Agents Adult Affect Age Animal Model Animals Attention Award Breathing Caring Characteristics Child Child Care Child Support Childhood Clinical Clinical Research Clinical Trials Clinical assessments Combined Modality Therapy Commit Complication Conduct Clinical Trials Critical Care Critically ill children Croup Data Development Diagnosis Disease Environmental air flow Epinephrine Esophageal Evaluation Exploratory/Developmental Grant Failure Family Fostering Funding Future Health Care Costs Helium Hospitals Incidence Individual Infant Intensive Care Intensive Care Units Interobserver Variability Intervention Intratracheal Intubation Intravenous Intubation K-Series Research Career Programs Knowledge Label Lead Learning Length Length of Stay Life Macaca mulatta Manometry Measurement Measures Mechanical ventilation Medicine Methods Modeling Monitor Morbidity - disease rate National Institute of Child Health and Human Development Nature Outcome Outcome Measure Oxygen Patients Pattern Pediatric Intensive Care Units Physiological Plethysmography Primates Pulmonary function tests Research Research Personnel Research Project Grants Resolution Risk Factors Secondary to Sedation procedure Sepsis Series Severities Severity of illness Site Spirometry Stenosis Stridor Supportive care System Techniques Therapeutic Therapeutic Intervention Training Viral Work of Breathing airway obstruction base career design endotracheal evidence base experience heliox high risk medical specialties meetings minimal risk minimally invasive novel pressure prevent prospective pulmonary function respiratory response skills statistics success therapeutic target

项目摘要

DESCRIPTION (provided by applicant): It is an incredible privilege to take care of children at their most critical juncture. As pediatric critical care practitioners we must be able to provide timely and evidenced based care for these children, and support families with the knowledge that one's chosen treatment is based upon evidence and experience. However, as a specialty we can only create evidence based standards through rigorous clinical research. Committed to a career in intensive care medicine, it is my duty to provide my patients with the highest, evidence based care, and help our specialty grow by conducting studies to gather evidence for the best practices. To do this, I must learn the necessary skills to foster my development into a thorough and rigorous clinical researcher. While I have undergraduate and graduate level experience in statistics and clinical investigation, with the "rarity" of pediatric disease, multi-ite studies are needed to draw meaningful conclusions about critically ill children. This is particularly important for mechanically ventilated children-the most common yet most variable intervention in pediatric critical care. Seeking to conduct multi-center mechanical ventilation trials, I must equip myself with knowledge and skills about the design and implementation of such trials, and also gain expertise on evaluating potential objective outcomes for trials on ventilated children. The specific research project detailed in this application is the first step fr me to develop these skills. Using an animal model to validate a minimally invasive measure of upper airway obstruction and subsequently applying this measure to mechanically ventilated children at a single site, I hope to master skills related to the evaluation of pulmonary function, particularly upper airway obstruction. Upper airway obstruction is a complicating factor in ventilation trials because it prolongs length of mechanical ventilation. It is a bigger problem in children (compared to adults) as it is estimated on clinical grounds that 1/3 of all pediatric extubation failures result from upper airway obstruction. However, risk factors for and therapies targeting post-extubation airway obstruction are inconsistent, likely because clinical acumen to measure upper airway obstruction is lacking. Therefore, this project describes validating a minimally invasive technique to measure upper airway obstruction, initially in Rhesus Monkeys. It will then be applied in children to evaluate the accuracy of clinical stridor scales, and determine whether commonly applied therapeutics or supportive care impact resolution of airway obstruction, by demonstrating improvement in the objective, non-invasive measures. While this study will equip me with important skills to conduct clinical trials, I will get specifi experience with the nuances of multi-institutional trials through a series of meetings and activities with the NICHD Collaborative Pediatric Critical Care Research Network (CPCCRN) and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. These networks have undertaken many multi-center trials in critically ill children, and will help me learn the necessary skills to take a multi-center trial from an idea to reality.

描述（由申请人提供）：在最关键的关头照顾孩子是一种令人难以置信的特权。作为小儿重症监护从业人员，我们必须能够为这些孩子提供及时且基于证据的护理，并支持家庭所选择的治疗方法基于证据和经验。但是，作为专业，我们只能通过严格的临床研究来创建基于证据的标准。致力于从事重症监护医学的职业，我有责任为患者提供最高的证据护理，并通过进行研究来收集最佳实践证据来帮助我们的专业发展。为此，我必须学习必要的技能，以促进我的发展成彻底而严格的临床研究人员。尽管我在统计和临床研究方面具有本科生和研究生水平的经验，但由于小儿疾病的“稀有性”，需要多种研究来得出有关重症儿童的有意义的结论。这对于机械通风的儿童尤为重要 - 小儿重症监护中最常见但最可变的干预措施。为了进行多中心的机械通风试验，我必须为自己的设计和实施提供知识和技能，并获得评估通风儿童试验的潜在客观结果的专业知识。在此应用程序中详细介绍的特定研究项目是我发展这些技能的第一步。使用动物模型来验证上呼吸道阻塞的最低侵入性测量，然后将此措施应用于单个部位的机械通风儿童，我希望能够掌握与评估肺功能的技能，尤其是上空通道阻塞。上气道阻塞是通风试验的复杂因素，因为它延长了机械通气的长度。这是儿童（与成年人相比）的更大问题，因为据临床理由估计，所有儿科拔管故障中有1/3是由于上呼吸道阻塞而导致的。然而，针对肠道拔管后气道阻塞的危险因素和疗法是不一致的，这可能是因为缺乏测量上气道阻塞的临床敏锐度。因此，该项目描述了验证一种微创技术，以测量最初在恒河猴中的上呼吸道阻塞。然后，它将应用于儿童中，以评估临床Stridor量表的准确性，并确定是否通过证明客观的非侵入性措施来改善气道阻塞的常用治疗或支持性护理影响的分辨率。尽管这项研究将使我具备进行临床试验的重要技能，但我将通过与NICHD协作性儿科重症监护研究网络（CPCCRN）和儿科急性肺造成肺部受伤和sepsis Resumindators（Palisi）网络（Palisi）网络的一系列会议和活动获得多个机构试验的细微差别。这些网络已经在重病的孩子中进行了许多多中心试验，并将帮助我学习必要的技能，以从一个想法到现实进行多中心试验。