Minimally invasive techniques to measure upper airway obstruction in children

微创技术测量儿童上呼吸道阻塞

基本信息

批准号：
8898168
负责人：
Robinder Khemani
金额：
$ 13.35万
依托单位：
CHILDREN'S HOSPITAL OF LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-01 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8898168
关键词：
Abdomen Acute Lung Injury Adrenal Cortex Hormones Adrenergic Agents Adult Affect Age Animal Model Animals Attention Award Breathing Caring Characteristics Child Child Care Child Support Childhood Clinical Clinical Research Clinical Trials Clinical assessments Combined Modality Therapy Complication Conduct Clinical Trials Critical Care Critically ill children Croup Data Development Diagnosis Disease Environmental air flow Epinephrine Esophageal Evaluation Exploratory/Developmental Grant Failure Family Fostering Funding Future Health Care Costs Helium Hospitals Incidence Individual Infant Intensive Care Intensive Care Units Interobserver Variability Intervention Intratracheal Intubation Intravenous Intubation K-Series Research Career Programs Knowledge Label Lead Learning Length Length of Stay Life Macaca mulatta Manometry Measurement Measures Mechanical ventilation Medicine Methods Modeling Monitor Morbidity - disease rate Multicenter Studies Multicenter Trials National Institute of Child Health and Human Development Nature Outcome Outcome Measure Oxygen Patients Pattern Pediatric Intensive Care Units Physiological Plethysmography Primates Pulmonary function tests Research Research Personnel Research Project Grants Resolution Risk Factors Secondary to Sedation procedure Sepsis Series Severities Severity of illness Site Spirometry Stenosis Stridor Supportive care System Techniques Therapeutic Therapeutic Intervention Training Viral Work of Breathing airway obstruction base career clinical investigation design endotracheal evidence base experience heliox high risk medical specialties meetings minimal risk minimally invasive novel pressure prevent prospective pulmonary function respiratory response skills statistics success targeted treatment therapeutic target

项目摘要

DESCRIPTION (provided by applicant): It is an incredible privilege to take care of children at their most critical juncture. As pediatric critical care practitioners we must be able to provide timely and evidenced based care for these children, and support families with the knowledge that one's chosen treatment is based upon evidence and experience. However, as a specialty we can only create evidence based standards through rigorous clinical research. Committed to a career in intensive care medicine, it is my duty to provide my patients with the highest, evidence based care, and help our specialty grow by conducting studies to gather evidence for the best practices. To do this, I must learn the necessary skills to foster my development into a thorough and rigorous clinical researcher. While I have undergraduate and graduate level experience in statistics and clinical investigation, with the "rarity" of pediatric disease, multi-ite studies are needed to draw meaningful conclusions about critically ill children. This is particularly important for mechanically ventilated children-the most common yet most variable intervention in pediatric critical care. Seeking to conduct multi-center mechanical ventilation trials, I must equip myself with knowledge and skills about the design and implementation of such trials, and also gain expertise on evaluating potential objective outcomes for trials on ventilated children. The specific research project detailed in this application is the first step fr me to develop these skills. Using an animal model to validate a minimally invasive measure of upper airway obstruction and subsequently applying this measure to mechanically ventilated children at a single site, I hope to master skills related to the evaluation of pulmonary function, particularly upper airway obstruction. Upper airway obstruction is a complicating factor in ventilation trials because it prolongs length of mechanical ventilation. It is a bigger problem in children (compared to adults) as it is estimated on clinical grounds that 1/3 of all pediatric extubation failures result from upper airway obstruction. However, risk factors for and therapies targeting post-extubation airway obstruction are inconsistent, likely because clinical acumen to measure upper airway obstruction is lacking. Therefore, this project describes validating a minimally invasive technique to measure upper airway obstruction, initially in Rhesus Monkeys. It will then be applied in children to evaluate the accuracy of clinical stridor scales, and determine whether commonly applied therapeutics or supportive care impact resolution of airway obstruction, by demonstrating improvement in the objective, non-invasive measures. While this study will equip me with important skills to conduct clinical trials, I will get specifi experience with the nuances of multi-institutional trials through a series of meetings and activities with the NICHD Collaborative Pediatric Critical Care Research Network (CPCCRN) and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. These networks have undertaken many multi-center trials in critically ill children, and will help me learn the necessary skills to take a multi-center trial from an idea to reality.

描述（由申请人提供）：在孩子们最关键的时刻照顾他们是一种令人难以置信的荣幸。作为儿科重症监护从业者，我们必须能够为这些儿童提供及时且基于证据的护理，并为家庭提供支持，让他们知道自己选择的治疗方法是基于证据和经验。然而，作为一个专业，我们只能通过严格的临床研究来制定基于证据的标准。致力于重症监护医学的职业生涯，我有责任为我的患者提供最高水平的、基于证据的护理，并通过开展研究收集最佳实践的证据来帮助我们的专业发展。为此，我必须学习必要的技能，以促进我发展成为一名彻底而严谨的临床研究员。虽然我在统计学和临床调查方面拥有本科和研究生水平的经验，但由于儿科疾病的“罕见”，需要进行多项研究才能得出关于危重儿童的有意义的结论。这对于机械通气儿童尤其重要——这是儿科重症监护中最常见但变化最大的干预措施。为了进行多中心机械通气试验，我必须具备有关此类试验的设计和实施的知识和技能，并获得评估通气儿童试验的潜在客观结果的专业知识。本申请中详细介绍的具体研究项目是我发展这些技能的第一步。使用动物模型来验证上气道阻塞的微创测量，然后将该测量应用于单个部位的机械通气儿童，我希望掌握与肺功能评估相关的技能，特别是上呼吸道阻塞。上呼吸道阻塞是通气试验中的一个复杂因素，因为它会延长机械通气的时间。这对儿童来说是一个更大的问题（与成人相比），因为据临床估计，所有儿童拔管失败的 1/3 是由上呼吸道阻塞引起的。然而，拔管后气道阻塞的危险因素和针对拔管后气道阻塞的治疗方法并不一致，可能是因为缺乏测量上气道阻塞的临床智慧。因此，该项目描述了验证一种微创技术来测量上呼吸道阻塞，最初是在恒河猴中进行的。然后将其应用于儿童，以评估临床喘鸣量表的准确性，并通过证明客观、非侵入性措施的改善来确定常用的治疗或支持性护理是否影响气道阻塞的解决。虽然这项研究将为我提供进行临床试验的重要技能，但我将通过与 NICHD 儿科重症监护协作研究网络 (CPCCRN) 和儿科急性病研究中心的一系列会议和活动，获得有关多机构试验细微差别的具体经验。肺损伤和脓毒症调查员 (PALISI) 网络。这些网络已经对危重儿童进行了许多多中心试验，并将帮助我学习将多中心试验从想法变为现实所需的技能。