Functional Outcomes after Prolonged Mechanical Ventilation in Children

儿童长期机械通气后的功能结果

• 批准号: 10456137
• 负责人: Aline Bernard Maddux
• 金额: $ 16.1万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456137
• 关键词: 2 year old; Accelerometer; Acute Lung Injury; Acute Respiratory Distress Syndrome; Address; Admission activity; Adult; Appointment; Characteristics; Child; Childhood; Clinical; Clinical Investigator; Clinical Trials; Colorado; Critical Care; Critical Illness; Critically ill children; Data; Databases; Development Plans; Devices; Diagnosis; Electronic Health Record; Enrollment; Evaluation; Exercise Tolerance; Exhibits; Exposure to; Fostering; Functional disorder; Future; Goals; Health; Health Care Visit; Healthcare; Hospitalization; Hospitals; Impairment; Inpatients; Intervention; Knowledge; Lead; Life; Link; Lung; Measures; Mechanical ventilation; Methods; Morbidity - disease rate; Occupational Therapy; Outcome; Outcome Measure; Outcomes Research; Outpatients; Patients; Pediatric Acute Respiratory Distress Syndrome; Pediatric Hospitals; Pediatric Intensive Care Units; Phenotype; Physical Function; Physical activity; Physical therapy; Prospective cohort; Quality of life; Recovery of Function; Research Personnel; Retrospective cohort; Risk Factors; Sedation procedure; Severities; Severity of illness; Source; Speech Therapy; Survivors; Testing; Therapeutic Intervention; Training; United States; Universities; Ventilator-induced lung injury; Work; base; career; career development; cognitive development; cohort; data warehouse; exercise intolerance; follow-up; functional disability; functional outcomes; functional status; health data; health related quality of life; healthy lifestyle; high risk; impaired functional status; improved; indexing; innovation; insurance claims; mortality; novel; patient oriented; physical conditioning; prognostic; prospective; pulmonary function; respiratory; skills; social integration; therapeutic evaluation; trial design

Project Summary Every year, more than 100,000 children in the United States require admission to a Pediatric Intensive Care Unit (PICU) with mechanical ventilation support. Of these, one in ten have significant acute lung injury referred to as Pediatric Acute Respiratory Distress Syndrome (PARDS). The majority of these children survive their arduous PICU course, but little is known about their long-term functional outcomes. Adult survivors of mechanical ventilation and ARDS are known to suffer from long-term significant impairments including decreased exercise tolerance, inability to return to work, and low health-related quality of life (HRQOL). There remains a significant knowledge gap in the understanding of long-term outcomes in children who survive prolonged mechanical ventilation and PARDS. In this proposal, we will employ two methods to evaluate the long-term physical functioning of children who survive mechanical ventilation and PARDS. First, we will link detailed data from the inpatient electronic health record to post-discharge outpatient insurance claims data to identify natural clusters of functional outcome phenotypes and the predictive patient and hospitalization characteristics in a large retrospective cohort of children admitted to our PICU who require > 3 days of mechanical ventilation (Aim 1). Second, we will establish a prospective cohort of critically-ill mechanically ventilated children to evaluate post-discharge HRQOL, functional status, and physical activity (Aim 2). We will use accelerometry, a novel, objective measure of physical activity to build upon the currently used, subjective measures of physical functioning. We hypothesize that we will be able to identfy and validate functional outcome phenotypes and predictors of phenotype clusters (Aim 1). Additionally, we hypothesize that severity of PARDS as well as a threshold of duration of mechanical ventilation, a metric of exposure to PICU-related therapies, will be associated with worse functional outcomes including impaired functional recovery and decreased physical activity (Aim 2). The results of this proposal will identify a cohort of critically ill children who are at high risk of poor functional recovery and most likely to benefit from targeted interventions to improve long-term outcomes. These studies will lay the groundwork for Dr. Maddux to obtain the necessary expertise in pediatric critical care outcomes research to employ accurate, clinically-meaningful long-term outcome measures to evaluate targeted in-hospital and post-discharge therapies in clinical trials with the goal to improve the long-term physical functioning of critically ill children. Addditionally, a well orchestrated career development plan will provide the necessary training for Dr. Maddux to become an independent investigator focused on long-term outcomes after critical illness with the skills to evaluate large databases and perform prospective cohort follow-up.

项目摘要 每年，美国有100,000多名儿童需要入科重症监护 具有机械通气支持的单位（PICU）。其中，十分之一的急性肺损伤引用了 作为小儿急性呼吸窘迫综合征（PARS）。这些孩子中的大多数幸存 艰苦的PICU课程，但对它们的长期功能结果知之甚少。成人幸存者 已知机械通气和ARD会遭受长期重大损害 运动耐受性降低，无法恢复工作以及与健康相关的生活质量低（HRQOL）。那里 在理解生存的儿童的长期结局方面仍然是一个重大的知识差距 长时间的机械通气和帕克。在此提案中，我们将采用两种方法来评估 在机械通气和帕德的儿童的长期身体功能。首先，我们将链接 从住院电子健康记录到住院后门诊保险索赔的详细数据 确定功能结果表型的自然簇以及预测性患者和住院 在我们的PICU接纳的大量回顾性儿童中，需要3天的特征 机械通气（AIM 1）。其次，我们将在机械上建立一个预期的批判性群体 通风儿童评估病后HRQOL，功能状态和体育锻炼（AIM 2）。我们将 使用ACCELERETRY，这是一种新颖的，客观的体育活动，以建立在当前的主观上 身体功能的度量。我们假设我们将能够识别和验证功能 结果表型和表型簇的预测因子（AIM 1）。此外，我们假设 机械通气持续时间的板块以及与PICU相关的指标 疗法将与功能结果较差有关，包括功能恢复受损和 体育锻炼减少（AIM 2）。该提案的结果将确定一系列重病的孩子 功能恢复差的高风险，最有可能受益于有针对性的干预措施 长期结局。这些研究将为Maddux博士获得必要的专业知识奠定基础 小儿重症监护结果研究以采用准确的，临床上的长期结局 评估临床试验中有针对性的院内和入院后疗法的措施，目的是改善 重症儿童的长期身体机能。另外，精心策划的职业发展 计划将为Maddux博士提供必要的培训，以成为专注于的独立调查员 重病后的长期结局以及评估大型数据库并执行预期的技能 队列随访。