Sleep Disruption and Delirium in Critically Ill Children

危重儿童的睡眠中断和谵妄

• 批准号: 9759024
• 负责人: Laura Beth Ann Kalvas
• 金额: $ 3.92万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9759024
• 关键词: 5 year old; Adult; Anti-inflammatory; Antioxidants; Area; Attention; Behavioral; Biological; Characteristics; Child; Childhood; Circadian Rhythms; Cognitive; Complication; Critical Care; Critical Illness; Critically ill children; Delirium; Development; Environment; Environmental Exposure; Environmental Monitoring; Exhibits; Faculty; Frequencies; Goals; Impaired cognition; Incidence; Institution; Intensive Care; Intensive Care Units; Intervention; Knowledge; Lead; Length of Stay; Light; Long-Term Effects; Measurement; Measures; Mechanical ventilation; Mediating; Melatonin; Methods; Mission; Modification; Morbidity - disease rate; Neurocognitive; Nurses; Outcome; Pathway interactions; Pediatric Intensive Care Units; Physiological; Population; Positioning Attribute; Preparation; Prevention; Process; Protocols documentation; Publishing; Research; Research Methodology; Research Personnel; Research Training; Risk; Role; Sampling; Scientific Advances and Accomplishments; Short-Term Memory; Sleep; Sleep disturbances; Statistical Data Interpretation; Strategic Planning; Survivors; Symptoms; Testing; Training; Video Recording; Writing; actigraphy; care costs; caregiving; cognitive function; comparative; design; dissemination research; emotion regulation; experience; improved; innovation; mortality; neuroinflammation; pre-doctoral; prevent; programs; psychologic; research data dissemination; screening; sensor; skills; sleep quality; social; sound; symptom management; symptom science

PROJECT SUMMARY/ABSTRACT Delirium is a serious but under-studied complication of stay in the pediatric intensive care unit (PICU). Sleep disruption is frequently observed in children with delirium, and circadian rhythm dysregulation due to poor sleep quality during critical illness is one proposed pathway to delirium. Children admitted to the PICU experience multiple environmental exposures with the potential to disrupt sleep, including excessive light and sound and frequent caregiving. The scientific premise of this study is that modifiable characteristics of the pediatric critical care environment, including excessive light and sound and frequent caregiving, contribute to sleep disruption and thus have a physiological effect that may lead to delirium. The primary purpose of this research training plan is to develop a measurement framework that illustrates the relationship between modifiable characteristics of the pediatric critical care environment (i.e., light and sound exposure, caregiving frequency), sleep disruption, and delirium in a critically ill pediatric sample 5 years of age and younger. This observational, repeated measures study will accomplish the following specific aims: (1) Describe selected modifiable characteristics of the pediatric critical care environment, sleep disruption, and the incidence and duration of delirium across a 5-day period in a sample of 20 critically ill children 5 years of age and younger. (2) Examine the relationships among selected modifiable characteristics of the pediatric critical care environment, sleep disruption, and the incidence and duration of delirium. (2a) Examine the mediating effect of sleep disruption on the relationship between selected characteristics of the pediatric critical care environment and the incidence and duration of delirium. This study is among the first to explore the association between sleep disruption and delirium in critically ill children. This aligns with the mission of the NINR Strategic Plan in Symptom Science to understand biological and behavioral aspects of symptoms. Once validated, the measurement framework developed in this study will be used to design and test environmental modification and/or sleep promotion interventions to prevent delirium in pediatric populations. The long-term goal of this program of research is to improve the neurocognitive symptom management and long-term outcomes of critically ill children by optimizing the pediatric critical care environment. This 3-year pre-doctoral training plan has the following goals: (1) Build understanding and proficiency in quantitative research methods and statistical analyses. (2) Acquire the necessary skills and knowledge to evaluate how exposures in the pediatric intensive care environment contribute to the incidence and duration of delirium in critically ill children. (3) Advance scientific understanding of pediatric delirium through scholarly writing and dissemination of research findings. (4) Develop professionally in preparation for a faculty position at a research-intensive academic institution. The diverse educational and professional experiences proposed in this training plan will support development of the applicant into an early-stage nurse investigator.

项目概要/摘要 谵妄是一种严重但尚未得到充分研究的儿科重症监护室 (PICU) 住院并发症。睡觉 谵妄儿童中经常观察到昼夜节律紊乱，这是由于不良行为引起的。 危重疾病期间的睡眠质量是导致谵妄的一种途径。儿童入住 PICU 经历多种可能扰乱睡眠的环境，包括过度光照和 健全且频繁的护理。这项研究的科学前提是，可改变的特征 儿科重症监护环境，包括过度的光和声音以及频繁的护理，会导致 睡眠中断，从而产生可能导致谵妄的生理效应。这样做的主要目的 研究培训计划是开发一个衡量框架，说明之间的关系 儿科重症监护环境的可修改特征（即光线和声音暴露、护理 5 岁及以下危重儿科样本中的睡眠障碍和谵妄。这 观察性、重复测量研究将实现以下具体目标： (1) 描述所选内容 儿科重症监护环境的可改变特征、睡眠中断以及发生率和 研究人员对 20 名 5 岁及以下危重儿童进行了 5 天的谵妄持续时间调查。 (2) 检查儿科重症监护选定的可修改特征之间的关系 环境、睡眠中断以及谵妄的发生率和持续时间。 (2a)检验中介效应 睡眠中断对儿科重症监护选定特征之间关系的影响 环境与谵妄的发生率和持续时间有关。这项研究是第一个探索 危重儿童睡眠中断与谵妄之间的关联。这与该组织的使命相符 NINR 症状科学战略计划，旨在了解症状的生物学和行为方面。一次 经过验证，本研究中开发的测量框架将用于设计和测试环境 改变和/或睡眠促进干预措施以预防儿科人群的谵妄。长期来看 该研究计划的目标是改善神经认知症状管理和长期治疗 通过优化儿科重症监护环境来改善危重儿童的结局。这三年的博士预科 培训计划有以下目标： (1) 加深对定量研究方法的理解和熟练程度 和统计分析。 (2) 获得必要的技能和知识来评估风险暴露情况 儿科重症监护环境影响重症患者谵妄的发生率和持续时间 孩子们。 (3) 通过学术写作和研究促进对儿科谵妄的科学理解 传播研究成果。 (4) 专业发展，为在大学担任教职做好准备 研究密集型学术机构。本报告中提出的多样化教育和专业经验 培训计划将支持申请人发展成为早期护士调查员。