The Diagnosis and Treatment of Critical Illness Polyneuromyopathy in Patients wit

重症多发性神经肌病的诊治

• 批准号: 8324716
• 负责人: MARC MOSS
• 金额: $ 57.96万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8324716
• 关键词: Action Potentials; Acute; Acute respiratory failure; Address; Admission activity; Adult Respiratory Distress Syndrome; Affect; American; Attention; Case Fatality Rates; Case Study; Controlled Clinical Trials; Cost Savings; Critical Illness; Critical Illness Polyneuropathy; Data; Delirium; Development; Diagnosis; Diagnostic; Diagnostic tests; Disease; Early Diagnosis; Effectiveness; Encephalopathies; Family; Fatigue; Frequencies; Health; Hospitalization; Hospitals; Impairment; Individual; Inpatients; Intensive Care; Intensive Care Units; Length of Stay; Lifting; Literature; Lung diseases; Measures; Mechanical ventilation; Mechanics; Medical; Methods; Motor; Multi-Institutional Clinical Trial; Myopathy; Names; Nerve; Neural Conduction; Nutritional Support; Outcome; Patients; Performance; Physical Function; Physical activity; Physical therapy; Physicians; Physiological; Placebo Control; Prospective Studies; Protocols documentation; Publishing; Quality of life; Randomized; Reporting; Safety; Screening procedure; Sensory; Surveys; Survivors; Symptoms; Testing; Therapeutic; United States; Walking; Wit; Work; base; clinically significant; functional status; health related quality of life; improved; neuromuscular; neuromuscular function; novel; programs; respiratory; sedative; standard of care; tool development

DESCRIPTION (provided by applicant): Acute respiratory failure is a heterogeneous disorder that results in more than 300,000 Americans requiring admission to an intensive care unit for invasive mechanical ventilatory support each year. Though acute respiratory failure is a pulmonary disorder, patients who survive are not limited by respiratory symptoms after discharge. Rather persistent neuromuscular weakness is the primary disorder that adversely affects their quality of life and ability to function on a daily basis. Weakness in these survivors is related to the development of critical illness polyneuromyopathy (CIPNM). The ability to accurately diagnose CIPNM in these patients is difficult and often delayed. Presently, there is no available diagnostic screening test that accurately identifies those patients with acute respiratory failure that will develop CIPNM. Earlier and less invasive identification of critically ill patients that will eventually develop CIPNM may improve the efficacy of specific medical therapies, nutritional support, or intensive physical therapy. We have identified alterations on nerve conduction studies as early as three days after presentation to the hospital in critically ill patients. A progressive decrease over the subsequent seven days in the baseline amplitude was predictive of the development of CIPNM. In the first part of this proposal, we will prospectively determine whether changes on simple nerve conduction studies can be used as an effective diagnostic tool for the development of CIPNM in patients with acute respiratory failure. Presently, there are no therapies to treat the estimated 110,000 acute respiratory failure survivors who have developed CIPNM each year. Based on the results of our national surveys of physical therapists and intensive care physicians, the utilization and types of physical therapy for patients recovering from acute respiratory failure with neuromuscular weakness varies significantly depending on the type of hospital and primary diagnosis of the patient. In the second part of this proposal, we plan to perform a randomized, placebo controlled clinical trial to determine the effectiveness of an intensive four week physical therapy program for the subset of patients with acute respiratory failure who have developed CIPNM. This trial will determine the efficacy of the physical therapy programs that is currently performed in a non-evidence based manner for patients with acute respiratory failure across the United States. If successful, our studies would identify a novel way to diagnose patients with CIPNM and pave the way for a larger multi-center clinical trial of intensive physical therapy for survivors of acute respiratory failure. PUBLIC HEALTH RELEVANCE: and Relevance Acute respiratory failure is a heterogeneous disorder that results in more than 300,000 Americans requiring admission to an intensive care unit for invasive mechanical ventilatory support each year. Though acute respiratory failure is a pulmonary disorder, patients who survive their hospitalization are not limited by respiratory symptoms after discharge. Rather persistent neuromuscular weakness is the primary disorder that adversely alters their quality of life and ability to function on a daily basis. In this application we propose to identify a novel method of identifying those patients with acute respiratory failure that will develop neuromuscular weakness. In addition, we plan to conduct a randomized, placebo-controlled clinical trial called the Do It Now study (Diagnosis and Treatment of Neuromuscular Weakness) to determine the effectiveness of an intensive physical therapy program for patients recovering from acute respiratory failure who have developed neuromuscular weakness. This trial will establish the efficacy of the physical therapy programs that is currently performed for patients with acute respiratory failure in a non-evidence based manner across the United States.

描述（由申请人提供）：急性呼吸衰竭是一种异质性疾病，每年导致超过 300,000 名美国人需要进入重症监护病房接受有创机械通气支持。尽管急性呼吸衰竭是一种肺部疾病，但存活下来的患者出院后不会受到呼吸道症状的限制。持续性神经肌肉无力是对他们的生活质量和日常生活能力产生不利影响的主要疾病。这些幸存者的虚弱与危重病多发性神经肌病（CIPNM）的发展有关。准确诊断这些患者的 CIPNM 非常困难，而且常常会被延误。目前，尚无可用的诊断筛查测试可以准确识别那些将发展为 CIPNM 的急性呼吸衰竭患者。对最终发生 CIPNM 的危重患者进行早期、侵入性较小的识别可能会提高特定药物治疗、营养支持或强化物理治疗的疗效。我们早在危重患者入院三天后就发现了神经传导研究的改变。随后 7 天内基线幅度的逐渐下降预示着 CIPNM 的发展。在本提案的第一部分中，我们将前瞻性地确定简单神经传导研究的变化是否可以用作急性呼吸衰竭患者发生 CIPNM 的有效诊断工具。目前，每年约有 110,000 名患有 CIPNM 的急性呼吸衰竭幸存者尚无治疗方法。根据我们对物理治疗师和重症监护医生的全国调查结果，从急性呼吸衰竭伴神经肌肉无力中恢复的患者的物理治疗的利用和类型根据医院类型和患者的初步诊断而有很大差异。在该提案的第二部分中，我们计划进行一项随机、安慰剂对照临床试验，以确定为期 4 周的强化物理治疗计划对患有 CIPNM 的急性呼吸衰竭患者子集的有效性。该试验将确定目前以非证据为基础的方式对美国各地急性呼吸衰竭患者进行的物理治疗计划的疗效。如果成功，我们的研究将找到一种诊断 CIPNM 患者的新方法，并为针对急性呼吸衰竭幸存者进行强化物理治疗的更大规模多中心临床试验铺平道路。公共卫生相关性：和相关性 急性呼吸衰竭是一种异质性疾病，每年导致超过 300,000 名美国人需要入住重症监护病房接受有创机械通气支持。尽管急性呼吸衰竭是一种肺部疾病，但住院后幸存的患者出院后不会受到呼吸道症状的限制。持续的神经肌肉无力是对他们的生活质量和日常生活能力产生不利影响的主要疾病。在本申请中，我们建议确定一种新方法来识别那些患有急性呼吸衰竭并会出现神经肌肉无力的患者。此外，我们计划进行一项名为 Do It Now 研究（神经肌肉无力的诊断和治疗）的随机、安慰剂对照临床试验，以确定强化物理治疗计划对从急性呼吸衰竭中恢复并出现神经肌肉无力的患者的有效性。弱点。该试验将确定目前在美国以非循证方式对急性呼吸衰竭患者进行的物理治疗计划的有效性。