This Mentored Patient-Oriented Research Career Development Award (K23) will provide Dr. Timothy D. Girard the opportunity to develop his career as a clinical investigator in the field of geriatric critical care and to establish an independent program of aging research focused on the clinical and molecular epidemiology of critical-illness associated cognitive impairment. Through an integrated program of didactic activities and course work in geriatrics, clinical and molecular epidemiology, and neuropsychology;intensive mentorship by local experts;and hands-on experience in the design, implementation, and analysis of a prospective clinical investigation, Dr. Girard will use this award to become a highly trained investigator in aging research. The primary scientific goal of this proposal is to identify and study the clinical and molecular predictors of long-term cognitive impairment (LTCI) after critical illness. Older patients account for the majority of ICU admissions, and cognitive impairment is a major impediment to meaningful recovery in this vulnerable population;survivors of critical illness have a 25%-75% risk of developing LTCI, a manifestation of persistent brain dysfunction associated with reduced quality of life and significant societal costs. Utilizing a prospective cohort investigation, Dr. Girard will identify those ICU patients at highest risk for LTCI and quantify the contribution of important risk factors to LTCI after critical illness. Specifically, the candidate will identify clinical risk factors for an increased incidence and severity of long-term cognitive impairment after critical illness (Aim 1). Furthermore, he will determine whether inflammation and coagulopathy are risk factors for an increased incidence and severity of LTCI after critical illness (Aim 2). Finally, Dr. Girard will determine which categories of delirium defined by clinical risk factors in critically ill patients are associated with an increased incidence and severity of LTCI after critical illness (Aim 3). This work will pave the way for the study of preventive and therapeutic interventions by ensuring that such efforts will be focused on patients at highest risk. Dr. Girard's long-term research goal is to improve the outcomes of older critically ill patients through the prevention and treatment of critical illness-associated cognitive impairment.

Public Health Relevance

Advances in intensive care medicine have improved the likelihood of survival for patients with critical illness, but studies have shown that many survivors develop persistent cognitive impairment, which reduces quality of life. This study seeks to identify risk factors for cognitive impairment after critical illness in order to guide the development of strategies to prevent and treat this potentially devastating complication of critical illness.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AG034257-02
Application #
7922527
Study Section
National Institute on Aging Initial Review Group (NIA)
Program Officer
Wagster, Molly V
Project Start
2009-09-01
Project End
2014-08-31
Budget Start
2010-09-01
Budget End
2011-08-31
Support Year
2
Fiscal Year
2010
Total Cost
$140,249
Indirect Cost
Name
Vanderbilt University Medical Center
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004413456
City
Nashville
State
TN
Country
United States
Zip Code
37212
Vasilevskis, Eduard E; Chandrasekhar, Rameela; Holtze, Colin H et al. (2018) The Cost of ICU Delirium and Coma in the Intensive Care Unit Patient. Med Care 56:890-897
Marra, Annachiara; Pandharipande, Pratik P; Shotwell, Matthew S et al. (2018) Acute Brain Dysfunction: Development and Validation of a Daily Prediction Model. Chest 154:293-301
Stollings, Joanna L; Thompson, Jennifer L; Ferrell, Benjamin A et al. (2018) Sedative Plasma Concentrations and Delirium Risk in Critical Illness. Ann Pharmacother 52:513-521
Hughes, Christopher G; Patel, Mayur B; Brummel, Nathan E et al. (2018) Relationships between markers of neurologic and endothelial injury during critical illness and long-term cognitive impairment and disability. Intensive Care Med 44:345-355
Han, Jin H; Brummel, Nathan E; Chandrasekhar, Rameela et al. (2017) Exploring Delirium's Heterogeneity: Association Between Arousal Subtypes at Initial Presentation and 6-Month Mortality in Older Emergency Department Patients. Am J Geriatr Psychiatry 25:233-242
Siew, Edward D; Fissell, William H; Tripp, Christina M et al. (2017) Acute Kidney Injury as a Risk Factor for Delirium and Coma during Critical Illness. Am J Respir Crit Care Med 195:1597-1607
Hughes, Christopher G; Patel, Mayur B; Jackson, James C et al. (2017) Surgery and Anesthesia Exposure Is Not a Risk Factor for Cognitive Impairment After Major Noncardiac Surgery and Critical Illness. Ann Surg 265:1126-1133
Wilson, Jo E; Carlson, Richard; Duggan, Maria C et al. (2017) Delirium and Catatonia in Critically Ill Patients: The Delirium and Catatonia Prospective Cohort Investigation. Crit Care Med 45:1837-1844
Boehm, Leanne M; Dietrich, Mary S; Vasilevskis, Eduard E et al. (2017) Perceptions of Workload Burden and Adherence to ABCDE Bundle Among Intensive Care Providers. Am J Crit Care 26:e38-e47
Boehm, Leanne M; Vasilevskis, Eduard E; Dietrich, Mary S et al. (2017) Organizational Domains and Variation in Attitudes of Intensive Care Providers Toward the ABCDE Bundle. Am J Crit Care 26:e18-e28

Showing the most recent 10 out of 51 publications