Aspiration in Acute Respiratory Failure Survivors

急性呼吸衰竭幸存者的误吸

• 批准号: 10617388
• 负责人: MARC MOSS
• 金额: $ 64.11万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-23 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10617388
• 关键词: Acute respiratory failure; Admission activity; Algorithms; Boston; Breathing; Caregiver Burden; Classification; Cohort Studies; Colorado; Confounding Factors (Epidemiology); Critical Illness; Decision Trees; Deglutition; Deglutition Disorders; Development; Diagnosis; Diagnostic tests; Diameter; Dyes; Enteral; Enteral Feeding; Epidemiology; Evaluable Disease; Evaluation; Exploratory/Developmental Grant for Diagnostic Cancer Imaging; Fiber Optics; Focus Groups; Functional disorder; Funding; Health; Health care facility; Hospital Mortality; Infrastructure; Intratracheal Intubation; Intubation; Journals; Language; Larynx; Life; Long-Term Care; Measures; Mechanical ventilation; Medicine; Methods; Mosses; New England; Oral; Pathologist; Patient Care; Patient-Focused Outcomes; Patients; Persons; Pharyngeal structure; Pneumonia; Procedures; Process; Prospective Studies; Quality of life; Recovery; Research; Risk; Risk Factors; Screening procedure; Speech; Structure; Survivors; Testing; Therapeutic; Trachea; Tube; Universities; Water; Work; acute care; aspirate; cost; endotracheal; feeding; high risk; improved; infancy; innovation; interest; modifiable risk; multidisciplinary; novel; nutrition; optical fiber; personalized medicine; pressure; prevent; prospective; screening; targeted treatment; tool; ultrasound

PROJECT SUMMARY/ABSTRACT Each year more than 700,000 patients survive an episode of acute respiratory failure (ARF) that required endotracheal intubation with mechanical ventilation. Occurring in as many as 44% of these ARF survivors, post-extubation aspiration is associated with deleterious consequences including pneumonia, percutaneous feeding tube placement, long term care facility admission, and increased hospital mortality. Nevertheless, the complications of aspiration must be weighed against the consequences of inappropriately delaying the resumption of oral feeding. Delayed resumption of oral nutrition is associated with prolonged enteral tube feeding, increased caregiver burden, patient dissatisfaction, and increased health-related costs. With the support of an NINR R21 award, our multidisciplinary and multicenter team discovered three novel findings: 1) we developed a 5-item screening decision tree algorithm that detects patients at high risk for post-extubation aspiration; 2) we identified certain unique upper airway abnormalities that are associated with post-extubation aspiration and dysphagia; and 3) the size of the endotracheal tube (ETT) is independently associated with post-extubation aspiration. This proposal will continue to utilize our robust and established multi-center research group at Colorado, Boston University, Stanford, and Yale; all of whom have long-standing dysphagia and aspiration research groups focused on ARF. We will conduct a multi-center cohort study with three complementary aims that are interrelated and use the same patients; but are not dependent upon the results of each other. Aim #1 will determine whether our 5-item decision tree algorithm is a more effective screening tool to identify patients at high risk for post-extubation aspiration compared to the three-ounce water swallow test (3-WST) and the Toronto Bedside Swallowing Screening Test (TOR-BSST). These results will establish the optimal screening test for post-extubation aspiration and identify those patients who require further invasive diagnostic testing such as a FEES examination. Aim #2 will identify unique subphenotypes of patients with post-extubation aspiration based upon FEES-related measures of upper airway structure and function. Using a novel latent class analysis, we will determine whether these subphenotypes are associated with different trajectories of recovery and identify unique patients who benefit from different personalized and targeted therapies. Aim #3 will determine the association between ultrasound determined ETT size/tracheal diameter ratio and post-extubation aspiration while accounting for other confounding variables. This aim will identify the most effective method to select the ETT size that optimizes ventilatory management and decreases post- extubation aspiration. The results of this aim will pave the wave for dramatic improvements in the intubation process for all ARF patients who require mechanical ventilation. With an innovative and protocolized approach, the results of this proposal will demonstrate novel methods to minimize post-extubation aspiration, transform the multidisciplinary care of ARF survivors, and improve patient outcomes and quality of life.

项目摘要/摘要 每年有700,000多名患者在需要的急性呼吸衰竭（ARF）中幸存 带有机械通气的气管插管。在这些ARF幸存者中多达44％的发生， 肠道后抽吸与包括肺炎，经皮在内的有害后果有关 进食管的放置，长期护理设施入院和增加医院死亡率。然而， 必须权衡抽吸的并发症与不适当延迟的后果 恢复口服喂养。延迟口服营养的恢复与长时间的肠管有关 喂养，增加照料者负担，患者不满以及与健康相关的成本增加。与 支持NINR R21奖的支持，我们的多学科和多中心团队发现了三个新颖的发现：1） 我们开发了一种5项筛选决策树算法，该算法检测到肠道后高风险的患者 抽吸2）我们确定了某些与肠道后的某些独特的上呼吸道异常 抽吸和吞咽困难； 3）气管管（ETT）的大小与 砍伐后抽吸。该建议将继续利用我们的健壮和建立的多中心 科罗拉多州，波士顿大学，斯坦福大学和耶鲁大学的研究小组；所有人都有长期吞咽困难 和志向研究小组集中在ARF上。我们将与三个一起进行多中心队列研究 相互关联并使用相同患者的补充目标；但不依赖于 彼此。 AIM＃1将确定我们的5项决策树算法是否是更有效的筛选工具 与三盎司吞咽测试相比 （3-WST）和多伦多床边吞咽筛查测试（TOR-BSST）。这些结果将确定 最佳筛选后筛选测试，并确定需要进一步侵入性的患者 诊断测试，例如费用检查。 AIM＃2将确定患有患者的独特亚表征 基于上呼吸道结构和功能的费用相关的措施，拔管后抽吸。使用 新型潜在类别分析，我们将确定这些亚表格是否与不同的 康复的轨迹和识别从不同的个性化和有针对性的独特患者 疗法。 AIM＃3将确定超声确定的ETT大小/气管直径之间的关联 在考虑其他混杂变量时，比率和静置后吸气。这个目标将确定 选择优化通风管理并减少质量的ETT大小的最有效方法 拔管抽吸。此目标的结果将为插管的巨大改进铺平波动 所有需要机械通气的ARF患者的过程。采用创新和协议的方法， 该提案的结果将展示新的方法，以最大程度地减少肠道割后的攻击，转化 ARF幸存者的多学科护理，并改善患者的结果和生活质量。