Nurse-Led Interventions in Pediatric Critical Care: Training in Pediatric Sleep Health, Delirium, and Multi-Site Research

护士主导的儿科重症监护干预措施：儿科睡眠健康、谵妄和多中心研究培训

• 批准号: 10751813
• 负责人: Laura Beth Ann Kalvas
• 金额: $ 7.16万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10751813
• 关键词: Acceleration; Acute respiratory failure; Admission activity; Agitation; Area; Arousal; Attention; Biology; Bolus Infusion; Care given by nurses; Caring; Child; Child Mortality; Childhood; Clinical; Clinical Trials; Cognition; Cognitive; Complication; Conduct Clinical Trials; Confusion; Conscious; Continuity of Patient Care; Critical Care; Critical Illness; Critically ill children; Data; Delirium; Dimensions; Discipline of Nursing; Enteral; Environment; Exhibits; Family; Frequencies; Funding; Future; Goals; Health; Health Promotion; Hospitals; Hour; Iatrogenesis; Impaired cognition; Incidence; Individual; Intervention; Intervention Studies; Knowledge; Length of Stay; Light; Link; Loudness; Maintenance; Measurement; Mechanical ventilation; Melatonin; Mentors; Modeling; Morbidity - disease rate; Multi-Institutional Clinical Trial; Neurocognitive; Nurses; Outcome; Outcome Measure; Pain Free; Parents; Pathway interactions; Patients; Pattern; Patterns of Care; Pediatric Intensive Care Units; Pediatric cohort; Pennsylvania; Positioning Attribute; Postdoctoral Fellow; Procedures; Prospective cohort; Quality of life; Research; Research Personnel; Research Priority; Research Training; Salivary; Scientific Advances and Accomplishments; Scientist; Sedation procedure; Short-Term Memory; Site; Sleep; Sleep Architecture; Sleep Wake Cycle; Sleep disturbances; Survivors; Time; Training; United States National Institutes of Health; Universities; Well in self; Withdrawal; Work; actigraphy; adequate sleep; care costs; care systems; career preparation; caregiving; cognitive function; cohort; data sharing; design; diaries; disability; emotion regulation; expectation; experience; healing; hospital readmission; improved; inattention; interest; mortality; neuroprotection; nursing intervention; poor sleep; pre-doctoral; prevent; primary outcome; programs; psychologic; research data dissemination; resilience; secondary outcome; sleep behavior; sleep health; sleep pattern; sleep quality; social; sound

PROJECT SUMMARY/ABSTRACT Delirium is a serious, potentially iatrogenic, complication of pediatric intensive care unit (PICU) care and is associated with poor clinical outcomes. Poor sleep quality during critical illness is a proposed cause of delirium. Upon admission, children experience a chaotic PICU environment that disrupts sleep/wake patterns, including lack of day/night light and sound cycling and frequent examinations and procedures. This PICU care model is neither child- nor family-centered and likely disrupts sleep health. Good sleep health requires regularity in sleep/wake patterns with appropriate sleep timing, high sleep efficiency, and adequate sleep duration to promote physical and mental well-being. The primary purpose of this research training plan (R2-PD) is to use existing data to explore associations among sleep health (i.e., timing, efficiency, duration, regularity), sleep biology (i.e., melatonin dysregulation), and pediatric delirium. The data are from RESTORE Resilience (R2; R21HD093369), a 2-center, prospective cohort trial of a nurse-driven care bundle designed to maintain sleep/wake rhythms in 54 children (6 m.o.-17 y.o.) with acute respiratory failure on mechanical ventilation. Specific aims of R2-PD include: (1) Examine relationship between sleep health (i.e., daytime activity ratio estimate [timing], sleep episode duration, total sleep time [duration], sleep efficiency) and pediatric delirium (i.e., incidence, duration). (2) Determine association between implementation of a nurse-driven care bundle that promotes sleep/wake cycle regularity and pediatric delirium (i.e., incidence, duration). (Exploratory) Explore differences in salivary melatonin levels (i.e., mesor, amplitude, acrophase) over time (i.e., study days 2 and 5) in critically ill children with and without delirium. This study will be among the first to explore links among sleep disruption, melatonin levels, and delirium in a sizeable critically ill pediatric cohort followed for 9.8 (SD=7.7) days. Combined with in-depth training in multi-site clinical trial conduct with Dr. Martha Curley (Sponsor) and pediatric sleep health with Dr. Monica Ordway (Mentor), the R2-PD analysis will provide preliminary data for future, large-scale nurse-led clinical trials of individualized sleep-promoting interventions to prevent pediatric delirium. Training goals for the 18-month post-doctoral period at the University of Pennsylvania include: (1) Expand knowledge of pediatric sleep health as a multi-dimensional construct and understand how sleep health relates to pediatric critical care and delirium. (2) Receive advanced training in multi-site clinical trial conduct and data coordination. (3) Advance scientific understanding of pediatric critical illness through research dissemination. (4) Develop professionally in preparation for career as an independent pediatric critical care researcher. This application aligns with NINR interest in training nurse scientists in intervention research with PICU nursing practice implications (NOT-NR-21-001). The long-term goal of this research program is to improve clinical outcomes and quality of life in survivors of pediatric critical illness with interventions that incorporate individual family care patterns to optimize healing in the PICU.

项目概要/摘要 谵妄是儿科重症监护病房 (PICU) 护理中一种严重的、潜在医源性的并发症， 与不良的临床结果相关。危重疾病期间的睡眠质量差是导致谵妄的一个原因。 入院后，儿童会经历混乱的 PICU 环境，扰乱睡眠/觉醒模式，包括 缺乏日/夜灯光和声音循环以及频繁的检查和程序。这种PICU护理模式 既不以儿童也不以家庭为中心，并且可能会破坏睡眠健康。良好的睡眠健康需要有规律的睡眠 睡眠/觉醒模式，具有适当的睡眠时间、高睡眠效率和足够的睡眠时间 促进身心健康。本研究培训计划 (R2-PD) 的主要目的是 使用现有数据探索睡眠健康（即时间、效率、持续时间、规律性）、睡眠之间的关联 生物学（即褪黑激素失调）和小儿谵妄。数据来自 RESTORE Resilience (R2; R21HD093369），一项由护士驱动的护理组合的 2 中心前瞻性队列试验，旨在维持 54 名接受机械通气治疗的急性呼吸衰竭儿童（6 月至 17 岁）的睡眠/觉醒节律。 R2-PD的具体目标包括：（1）检查睡眠健康（即日间活动比率）之间的关系 估计[时间]、睡眠发作持续时间、总睡眠时间[持续时间]、睡眠效率）和小儿谵妄 （即发生率、持续时间）。 (2) 确定护士驱动的护理捆绑实施之间的关联 促进睡眠/觉醒周期规律性和儿科谵妄（即发生率、持续时间）。 （探索性） 探索唾液褪黑素水平（即中观、振幅、末相）随时间（即研究第 2 天）的差异 5) 患有或不患有谵妄的危重儿童。这项研究将是第一个探索联系的研究之一 在相当多的危重儿科队列中，对睡眠中断、褪黑激素水平和谵妄进行了跟踪研究 9.8 (SD=7.7) 天。结合 Martha Curley 博士进行多中心临床试验的深入培训 （赞助商）和 Monica Ordway 博士（导师）的儿科睡眠健康，R2-PD 分析将提供 未来大规模护士主导的个体化睡眠促进干预临床试验的初步数据 以预防小儿谵妄。大学博士后18个月培养目标 宾夕法尼亚州包括：(1) 扩展儿科睡眠健康的知识，将其作为多维结构和 了解睡眠健康与儿科重症监护和谵妄的关系。 (2) 接受高级培训 多中心临床试验的开展和数据协调。 (3) 增进对儿科危重症的科学认识 通过研究传播来治疗疾病。 (4) 专业发展，为独立职业做好准备 儿科重症监护研究员。该应用程序符合 NINR 对培训护士科学家的兴趣 参与对 PICU 护理实践影响的干预研究 (NOT-NR-21-001)。长期目标 该研究计划的目的是改善儿科危重症幸​​存者的临床结果和生活质量 通过结合个人家庭护理模式的干预措施来治疗疾病，以优化 PICU 的康复。