Aspiration in Acute Respiratory Failure Survivors

急性呼吸衰竭幸存者的误吸

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要每年有超过 700,000 名急性呼吸衰竭 (ARF) 患者幸存下来，这需要气管插管并机械通气。多达 44% 的 ARF 幸存者出现这种情况，拔管后误吸与有害后果相关，包括肺炎、经皮饲管放置、长期护理机构入住以及医院死亡率增加。尽管如此，必须权衡抽吸的并发症和不当延迟抽吸的后果恢复经口喂养。延迟恢复口服营养与肠内管延长有关喂养、护理人员负担增加、患者不满以及健康相关费用增加。随着在 NINR R21 奖项的支持下，我们的多学科和多中心团队发现了三个新发现：1) 我们开发了一种 5 项筛查决策树算法，可检测拔管后高风险患者愿望； 2) 我们发现了与拔管后相关的某些独特的上呼吸道异常误吸和吞咽困难； 3) 气管插管 (ETT) 的尺寸与以下因素独立相关：拔管后抽吸。该提案将继续利用我们强大且成熟的多中心科罗拉多大学、波士顿大学、斯坦福大学和耶鲁大学的研究小组；所有人都患有长期吞咽困难以及专注于 ARF 的愿望研究小组。我们将进行一项多中心队列研究，其中包括三个相互关联且使用相同患者的互补目标；但不依赖于结果彼此。目标 #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水吞咽测试相比，识别拔管后误吸高风险的患者 (3-WST) 和多伦多床边吞咽筛查测试 (TOR-BSST)。这些结果将确定拔管后误吸的最佳筛查测试，并确定那些需要进一步侵入性的患者诊断测试，例如 FEES 检查。目标 #2 将识别患有以下疾病的患者的独特亚表型基于 FEES 相关上呼吸道结构和功能测量的拔管后抽吸。使用新颖的潜在类别分析，我们将确定这些亚表型是否与不同的相关康复轨迹并确定受益于不同个性化和有针对性的独特患者疗法。目标 #3 将确定超声确定的 ETT 大小/气管直径之间的关联比率和拔管后愿望，同时考虑其他混杂变量。这一目标将确定选择 ETT 尺寸的最有效方法，可优化通气管理并减少术后并发症拔管抽吸。这一目标的结果将为插管技术的显着改进铺平道路适用于所有需要机械通气的 ARF 患者的流程。通过创新和协议化的方法，该提案的结果将展示减少拔管后误吸、转变的新方法对 ARF 幸存者进行多学科护理，并改善患者的治疗结果和生活质量。