Defining risk for iatrogenic withdrawal syndrome in critically ill children

定义危重儿童医源性戒断综合征的风险

• 批准号: 8779955
• 负责人: Kaitlin Marie Best
• 金额: $ 4.27万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8779955
• 关键词: Acute respiratory failure; Address; Age; Automobile Driving; Behavior; Benzodiazepines; Biological Markers; Caring; Child; Child Support; Childhood; Clinical; Communication; Complex; Complication; Critical Illness; Critically ill children; Data; Development; Diarrhea; Disease; Dose; Environment; Evaluation; Exhibits; Family; Future; Hypertension; Incidence; Individual; Infant; Intensive Care; Intervention; Lead; Length of Stay; Manuscripts; Mechanical ventilation; Mission; Modeling; Nurses; Opioid; Outcome; Parents; Patient Care; Patients; Pediatric Intensive Care Units; Pharmaceutical Preparations; Physiological; Population; Population Study; Primary Prevention; Principal Investigator; Process; Protocols documentation; Randomized; Recovery; Relative (related person); Reporting; Research; Review Literature; Risk; Risk Factors; Science; Sedation procedure; Seizures; Severity of illness; Signs and Symptoms; Statistical Models; Stress; Subgroup; Substance Withdrawal Syndrome; Surveys; System; Tachycardia; Temperature; Therapeutic; Therapeutic Effect; Treatment Protocols; Validation; Vomiting; Weaning; Withdrawal; base; clinically significant; cohort; cost; design; experience; high risk; novel; predictive modeling; programs; prospective; public health relevance; randomized trial; sedative; symptom management; systematic review; therapy duration; tool

DESCRIPTION (provided by applicant): Humane care for critically ill pediatric patients supported on mechanical ventilation necessitates comfort management that includes sedation therapy. Critically ill patients quickly become tolerant to the opioids and benzodiazepines used for sedation therapy and require increasing doses of these medications to achieve the same therapeutic effect. In turn, after recovery from their primary illnesses, rapid weaning or abrupt cessation of sedative therapy in drug tolerant patients precipitates iatrogenic withdrawal syndrome - a problem that adds to the personal and financial burden of intensive care. Using a novel conceptual model relating patient-, process- and system-level risk factors that are thought to contribute to the development of iatrogenic withdrawal syndrome, we believe a new perspective for addressing this preventable complication of pediatric intensive care is warranted. We propose to use data from the recently completed RESTORE study [U01HL086622 and U01 HL086649; 31-center cluster randomized trial of nurse- led sedation management on clinical outcomes in 2448 children requiring mechanical ventilation for acute respiratory failure] to conduct a secondary analysis comparing patient-, process- and system-level data between those subjects who developed iatrogenic withdrawal syndrome and those who did not. By exploring variables at several levels, this study will be the first comprehensive evaluation of iatrogenic withdrawal syndrome ever completed. The study will answer the key question: What factors impact the development of iatrogenic withdrawal syndrome in pediatric patients recovering from critical illness? Furthermore, the relative contributions of patient, process, and systems factors can be combined to create a predictive statistical model of patient risk for clinically significant iatrogenic withdrawal syndrome in pediatric patients recovering from critica illness. The proposed study will contextualize the phenomenon of iatrogenic withdrawal syndrome within the unique clinical circumstances in which it occurs. The results of this study will further NINR's mission to better understand symptom management and the causes of disease, including the behavior of systems (e.g. family units, populations, and/or organizations) that promote the development of personalized interventions.

描述（由申请人提供）：对机械通气支持的危重儿科患者的人道护理需要包括镇静治疗在内的舒适管理。危重患者很快就会对用于镇静治疗的阿片类药物和苯二氮卓类药物产生耐受性，并需要增加这些药物的剂量才能达到相同的治疗效果。反过来，在从原发疾病中恢复后，耐药患者快速断奶或突然停止镇静治疗会导致医源性戒断综合征，这一问题会增加重症监护的个人和经济负担。使用一种新颖的概念模型，将患者、过程和系统层面的风险因素（被认为有助于医源性戒断综合征的发展）联系起来，我们相信有必要从新的角度来解决这种可预防的儿科重症监护并发症。我们建议使用最近完成的 RESTORE 研究 [U01HL086622 和 U01 HL086649； 31 中心集群随机试验，对 2448 名因急性呼吸衰竭而需要机械通气的儿童进行由护士主导的镇静管理对临床结果的影响]，以比较发生医源性戒断综合征的受试者之间的患者、过程和系统水平数据进行二次分析以及那些没有这样做的人。通过探索多个层面的变量，这项研究将是有史以来第一个对医源性戒断综合征进行全面评估的研究。该研究将回答关键问题：哪些因素会影响危重病康复儿科患者出现医源性戒断综合征？此外，可以将患者、过程和系统因素的相对贡献结合起来，创建从危重疾病中恢复的儿科患者发生具有临床意义的医源性戒断综合征的患者风险的预测统计模型。拟议的研究将把医源性戒断综合征现象置于其发生的独特临床环境中。这项研究的结果将进一步推进 NINR 的使命，即更好地了解症状管理和疾病原因，包括促进个性化干预措施发展的系统行为（例如家庭单位、人群和/或组织）。

项目成果

Patient, Process, and System Predictors of Iatrogenic Withdrawal Syndrome in Critically Ill Children.

危重儿童医源性戒断综合征的患者、过程和系统预测因素。

• DOI: 10.1097/ccm.0000000000001953
• 发表时间: 2017
• 期刊: Critical care medicine
• 影响因子: 8.8
• 作者: Best,KaitlinM;Wypij,David;Asaro,LisaA;Curley,MarthaAQ;RandomizedEvaluationofSedationTitrationForRespiratoryFailureStudyInvestigators
• 通讯作者: RandomizedEvaluationofSedationTitrationForRespiratoryFailureStudyInvestigators