Quantitative Monitoring and Control of Sedation and Pain in the ICU Environment

ICU 环境中镇静和疼痛的定量监测和控制

• 批准号: 8908065
• 负责人: Michael Brandon Westover
• 金额: $ 19.46万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8908065
• 关键词: Absence of pain sensation; Address; Adrenergic Agonists; Affect; Analgesics; Behavior assessment; Boston; Brain; Cardiac; Cardiovascular system; Caring; Characteristics; Clinical; Computer Simulation; Computer software; Conscious; Critical Illness; Data; Delirium; Development Plans; Dexmedetomidine; Dose; Drug Delivery Systems; Drug Kinetics; Electromyography; Environment; Exhibits; Feedback; General Hospitals; Goals; Health; Health Care Costs; Individual; Infusion procedures; Institution; Intervention; Intravenous; Knowledge; Lung; Massachusetts; Measurable; Measurement; Measures; Medical; Medicine; Mental Depression; Mentors; Mentorship; Methods; Modeling; Monitor; Morbidity - disease rate; Movement; Neurologist; Neurosciences; Opiates; Outcome; Pain; Patients; Performance; Pharmaceutical Preparations; Pharmacodynamics; Physiologic Monitoring; Physiological; Physiology; Population; Positioning Attribute; Process; Research; Research Personnel; Research Proposals; Resources; Science; Sedation procedure; Signal Transduction; Statistical Models; Stream; Stress; Structure; System; Techniques; Technology; Testing; Time; Titrations; Tube; Ventilator; Ventilator Weaning; Work; bench to bedside; career; career development; clinical care; clinical practice; didactic education; healthy volunteer; improved; neurophysiology; novel; patient oriented research; pharmacodynamic model; physiologic model; programs; psychological distress; relating to nervous system; remifentanil; response; sedative; signal processing; skills

DESCRIPTION (provided by applicant): Dr. M. Brandon Westover is a practicing Neurologist and clinical electroencephalographer at Massachusetts General Hospital (MGH), whose goal is to become an independent investigator with expertise in biomedical signal processing and pharmacodynamics as they relate to sedation and analgesia in critically ill patients. His career development plan leverages the resources of a world-class environment by bringing together an out-standing team of investigators centered at a leading academic institution in Boston, Massachusetts General Hospital. Dr. Westover has already obtained preliminary results demonstrating the feasibility of a research plan that combines pharmacokinetic/pharmacodynamic (PK/PD) modeling with real-time automated processing of EEG and other physiological signals to quantitatively monitor and provide closed-loop control of sedation and analgesia in ICU patients. Under the mentorship of Dr. Emery Brown, and co-Mentors Dr. Sydney Cash and Dr. Patrick Purdon, Dr. Westover proposes: 1) To determine which features of the EEG and other physiological signals systematically relate with levels of sedation and analgesia in ICU patients, 2) To determine the full range and variability of pharmacodynamic responses in ICU patients receiving combinations of two specific intravenous sedative-analgesic medications, namely dexmedetomidine and remifentanil, and 3) To investigate whether a closed-loop drug delivery system, which integrates knowledge about population-level PK/PD characteristics of dexmedetomidine and remifentanil with real-time physiological feedback about an individual's level of pain and level of consciousness, can achieve more precise control of sedation-analgesia than is possible under current clinical practices. The overall goal is to develop an understanding of how to objectively and quantitatively monitor pain and sedation in the ICU setting, and to use this understanding to reduce the now pervasive problem of morbidity due to over- and under-dosing of sedative-analgesic drugs. Bringing together cutting-edge technology and a team with relevant expertise, this project will open new avenues for optimizing care and improving outcomes for a broad range of ICU patients. This well-defined patient-oriented research proposal, in concert with mentorship and a structured didactic curriculum, will provide Dr. Westover with the skills that are essential to develop an independent career in clinical neurophysiological research at the cutting edge of science.

描述（由申请人提供）：M。Brandon Westover博士是马萨诸塞州综合医院（MGH）的一名执业神经科医生和临床脑电图摄影师，其目标是成为具有生物医学信号处理和药物治疗方面专业知识的独立研究者，因为他们与危机患者的镇静剂和止痛药有关。他的职业发展计划通过将一支由马萨诸塞州波士顿领先的学术机构集中的户外调查人员组合在一起来利用世界一流环境的资源。 Westover博士已经获得了初步结果，该结果证明了一项研究计划的可行性，该研究计划结合了药代动力学/药效学（PK/PD）建模与EEG和其他生理信号的实时自动化处理，以定量监测并提供ICU患者中静态和镇静的闭环控制。在Emery Brown博士的指导下，以及悉尼Cash博士和帕特里克·普登（Patrick Purdon）博士，Westover博士提出：1）确定脑电图和其他生理信号的哪些特征和其他生理信号系统地与ICU患者的镇静和镇静水平有系统地相关，2）以确定ICU的全部药物反应的全部范围和可变性的ICU脉络性和变异性，包括ICU的两种特定于ICU的组合性组合 - 右美托胺和雷替丹尼尔，以及3）调查闭环药物输送系统，该系统是否可以将右美托咪定和雷利丹尼的人口水平的PK/PD特征与有关个人意识水平的实时生理反馈和实时的生理反馈相比，可以在镇静剂中更精确地控制当前的临床实践。总体目标是对如何在ICU环境中进行客观和定量监测疼痛和镇静的理解，并利用这种理解来减少由于镇静剂 - 氨基甲脂药过度和不足而导致的现在普遍存在的发病率问题。将尖端技术和具有相关专业知识的团队汇总在一起，该项目将开放新的途径，以优化护理和改善广泛的ICU患者的结果。这项定义明确的以患者为导向的研究建议与指导和结构化的教学课程一致，将为Westover博士提供技能 在科学尖端的临床神经生理研究中发展独立职业至关重要。