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）：针对机械通气支持的重症儿科患者的人道护理需要包括镇静疗法在内的舒适管理。重症患者迅速对用于镇静疗法的阿片类药物和苯二氮卓类药物迅速耐受，需要增加这些药物的剂量以达到相同的治疗作用。反过来，在其主要疾病中恢复后，药物耐受患者的镇静治疗的快速断奶或突然停止会导致医源性戒断综合征 - 这加剧了重症监护的个人和财务负担。使用一种新颖的概念模型，该模型与患者，过程和系统级别的危险因素有关，这些危险因素被认为有助于医源性戒断综合征的发展，我们认为有必要有一种新的观点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还原研究中的数据[U01HL086622和U01 HL086649； 31中心群集护士LED镇静管理对2448名儿童的临床结果的随机试验，需要进行机械通气，以进行急性呼吸衰竭]进行二级分析，以比较患者，过程和系统级别的数据，这些受试者与开发了生病性戒断综合征的受试者和没有。通过探索几个级别的变量，这项研究将是对曾经完成的医源性戒断综合征的首次全面评估。该研究将回答一个关键问题：哪些因素会影响从危重疾病中恢复的小儿患者中医源性戒断综合征的发展？此外，可以将患者，过程和系统因素的相对贡献组合起来，以创建一种预测性统计模型，以在儿科患者中康复的临床意义的临床意义的医源性戒断综合症的风险。拟议的研究将在其发生的独特临床情况下，将医源性戒断综合征的现象背景化。这项研究的结果将进一步了解NINR更好地了解症状管理和疾病原因，包括系统的行为（例如家庭单位，人口和/或组织），这些行为促进了促进个性化干预措施的发展。

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