ICU-ACQUIRED NEUROMUSCULAR DYSFUNCTION AND OUTCOMES IN ACUTE LUNG INJURY

ICU 获得性神经肌肉功能障碍和急性肺损伤的结局

基本信息

批准号：
7854088
负责人：
Catherine Lee Hough
金额：
$ 41.48万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-04-01 至 2014-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7854088
关键词：
Activities of Daily Living Acute Acute Lung Injury Address Adult Respiratory Distress Syndrome Affect American Ancillary Study Cessation of life Clinical Trials Clinical Trials Network Cohort Studies Complication Data Enrollment Epidemiology Etiology Evaluation Foundations Functional disorder Funding Goals HIV-1 Hand Hospitalization Hospitals Hypoxemia Impairment Incidence Inflammatory Response Intensive Care Units Intervention Intra-abdominal Investigation Investigational Therapies Knowledge Length of Stay Location Manuals Measures Mechanical ventilation Methods Morbidity - disease rate Muscle National Heart, Lung, and Blood Institute Nerve Neuropathy Nutritional Outcome Outcome Study Pathology Patients Physical Function Pneumonia Prevention Quality of life Randomized Recovery Reporting Research Research Design Respiratory Failure Risk Risk Factors SF-36 Sepsis Site Solid Survivors Syndrome Testing Time Trauma Walking Work aging population cohort coping epidemiology study experience follow-up grasp improved instrument longitudinal course lung injury malignant breast neoplasm mortality muscle strength neuromuscular neuromuscular function prospective public health relevance randomized trial research clinical testing therapy development treatment strategy

项目摘要

DESCRIPTION (provided by applicant): Survivors of acute respiratory distress syndrome/acute lung injury ("ALI") commonly experience significant and persistent neuromuscular weakness and impaired physical function, but little is known about the etiology, treatment and prevention of this important complication. Neuromuscular dysfunction acquired in the intensive care unit (ICU) is common, but has not been systematically studied in ALI patients, and its association with weakness and physical function has not been rigorously evaluated. Our overall goal is to improve ICU survivors' physical function, and through this research, we will conduct relevant and rigorous clinical investigations of ICU-acquired neuromuscular dysfunction. Hypotheses and specific aims. We hypothesize that ICU-acquired neuromuscular dysfunction is common in ALI patients, affected by ICU nutritional and pharmacologic interventions, and associated with short- and long-term impairment of physical function. Our aims are: (1) to determine the incidence of ICU- acquired neuromuscular dysfunction in ALI; (2) to investigate the relationship between ARDS Network randomized trial interventions and development of this dysfunction, and (3) to assess the association of ICU- acquired neuromuscular dysfunction with short- and long-term neuromuscular weakness and physical function. Study design and methods. We propose a prospective longitudinal cohort study of 270 patients enrolled in ARDS Network randomized trials at 4 study sites. We will identify ICU-acquired neuromuscular dysfunction using electrophysiologic assessments performed at study entry and weekly thereafter while in the ICU. Incidence will be measured as the proportion of subjects with ICU-acquired neuromuscular dysfunction (myopathic and/or neuropathic) detected at any time in the ICU. We will investigate the effect of ARDS Network interventions by comparing the incidence of dysfunction at study day 7 between randomized treatment groups. We will assess the association of neuromuscular dysfunction with short- and long-term weakness and physical function via standardized clinical evaluations before hospital discharge and at 6 and 12 months after ALI onset. Significance. This research addresses three critical gaps in scientific knowledge regarding the epidemiology, effect of experimental therapies, and long-term consequences of ICU-acquired neuromuscular dysfunction in ALI patients. Data from this study are essential to build the foundation of knowledge necessary to improve the serious short- and long-term sequelae commonly experienced by ALI survivors. PUBLIC HEALTH RELEVANCE: Since patients in the intensive care unit (ICU) frequently have acute muscle and nerve dysfunction, and persistent weakness and impaired quality of life after hospital discharge, new research is urgently required to understand these short and long-term morbidities. We will study ICU-acquired neuromuscular dysfunction in a subset of patients with acute lung injury (ALI) who are enrolled in National Heart Lung and Blood Institute-funded clinical trials. In studying ICU-acquired neuromuscular dysfunction, our aims are: (1) to systematically measure its incidence within the ALI trials; (2) to evaluate if the treatments tested in the trials affect its incidence; and (3) to investigate its association with longer-term physical function.

描述（由申请人提供）：急性呼吸窘迫综合征/急性肺损伤（“ALI”）的幸存者通常会出现明显且持续的神经肌肉无力和身体功能受损，但人们对这一重要并发症的病因、治疗和预防知之甚少。在重症监护病房 (ICU) 中获得的神经肌肉功能障碍很常见，但尚未在 ALI 患者中进行系统研究，其与虚弱和身体功能的关系尚未经过严格评估。我们的总体目标是改善 ICU 幸存者的身体功能，通过这项研究，我们将对 ICU 获得性神经肌肉功能障碍进行相关且严格的临床调查。假设和具体目标。我们假设 ICU 获得性神经肌肉功能障碍在 ALI 患者中很常见，受到 ICU 营养和药物干预的影响，并与短期和长期身体功能损伤相关。我们的目标是：(1) 确定 ALI 中 ICU 获得性神经肌肉功能障碍的发生率； (2) 调查 ARDS 网络随机试验干预与这种功能障碍的发展之间的关系，以及 (3) 评估 ICU 获得性神经肌肉功能障碍与短期和长期神经肌肉无力和身体功能的关联。研究设计和方法。我们建议对 4 个研究中心参加 ARDS 网络随机试验的 270 名患者进行一项前瞻性纵向队列研究。我们将在研究开始时以及之后在 ICU 期间每周进行电生理评估，以确定 ICU 获得性神经肌肉功能障碍。发病率将根据在 ICU 中任何时间检测到的 ICU 获得性神经肌肉功能障碍（肌病性和/或神经病性）受试者的比例来衡量。我们将通过比较研究第 7 天随机治疗组之间功能障碍的发生率来研究 ARDS 网络干预的效果。我们将在出院前以及 ALI 发病后 6 个月和 12 个月时通过标准化临床评估来评估神经肌肉功能障碍与短期和长期虚弱以及身体功能的关联。意义。这项研究解决了关于流行病学、实验疗法的效果以及 ALI 患者 ICU 获得性神经肌肉功能障碍的长期后果的三个关键科学知识空白。这项研究的数据对于建立改善急性肺损伤幸存者常见的严重短期和长期后遗症所需的知识基础至关重要。公共卫生相关性：由于重症监护病房 (ICU) 的患者经常出现急性肌肉和神经功能障碍、出院后持续虚弱和生活质量受损，因此迫切需要新的研究来了解这些短期和长期发病情况。我们将研究参加国家心肺和血液研究所资助的临床试验的一部分急性肺损伤 (ALI) 患者的 ICU 获得性神经肌肉功能障碍。在研究 ICU 获得性神经肌肉功能障碍时，我们的目标是：（1）在 ALI 试验中系统地测量其发生率； (2) 评估试验中测试的治疗方法是否影响其发生率； (3) 研究其与长期身体功能的关系。