(From the application): Global deficits in cognition in the form of delirium, stupor, or coma are extremely common and hazardous in older ICU patients. Cognitive impairment is associated with prolonged hospital stays, institutionalization, and death. Because acute cognitive impairment compromises patients' ability to be removed from mechanical ventilation and may be a factor associated with long-term neuropsychological sequelae, physicians and nurses need to be able to identify patients at high risk for cognitive impairment and understand potentially modifiable aspects of care that may reduce cognitive impairment. Consciousness is defined as having two components: arousal (wakefulness) and content (attentiveness). Arousal, a basic process of mental function, is commonly monitored in ICU patients. Attentiveness, which results from more complex neurologic interactions, is often impaired yet rarely objectively monitored. There are no validated instruments available for bedside use by nurses or physicians to monitor both components of consciousness in mechanically ventilated patients. We propose to modify existing instruments for use in the ICU in order to develop and validate a system for monitoring the brain and its function in mechanically ventilated patients during and after ICU care (Aim 1). Once validated, we can determine the prevalence of acute cognitive impairments in elderly ICU patients and its association with clinical outcomes (Aim 2). This cohort of patients will be used to determine factors associated with neuro-psychological deficits at 6 months following the ICU stay (Aim 3). This builds on the candidate's previous work in the ICU and gerontology and extends into an important new area, which is cognitive impairment in critically ill older persons. The long-term goal is to improve health outcomes for elderly ICU patients through future studies which will seek to reduce the incidence of cognitive impairment, to enhance liberation from mechanical ventilation, to integrate these observations into routine ICU monitoring, and to improve the understanding and prevention of post-ICU neuropsychological deficits. To prepare for this goal, his proposed career development plan includes advanced training in geriatric cognitive assessment, epidemiology and biostatistics, psychometrics and research methodology through clinical training, course work, and independent reading. Along with the candidate's record of publications and achievement, he will have rich academic surroundings, excellent mentors and strong institutional commitment to ensure that he achieve these goals.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AG001023-03
Application #
6615652
Study Section
National Institute on Aging Initial Review Group (NIA)
Program Officer
Wagster, Molly V
Project Start
2001-08-01
Project End
2006-07-31
Budget Start
2003-09-01
Budget End
2004-07-31
Support Year
3
Fiscal Year
2003
Total Cost
$124,035
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
Ely, E Wesley (2017) The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families. Crit Care Med 45:321-330
Franco, José G; Ricardo, Carmenza; Muñoz, Juan F et al. (2012) Diagnosing delirium in critically ill children: Spanish translation and cultural adaptation of the Pediatric Confusion Assessment Method for the Intensive Care Unit. Crit Care Med 40:1034
Girard, Timothy D; Ware, Lorraine B; Bernard, Gordon R et al. (2012) Associations of markers of inflammation and coagulation with delirium during critical illness. Intensive Care Med 38:1965-73
Seymour, Christopher W; Pandharipande, Pratik P; Koestner, Tyler et al. (2012) Diurnal sedative changes during intensive care: impact on liberation from mechanical ventilation and delirium. Crit Care Med 40:2788-96
Smith, Heidi A B; Fuchs, D Catherine; Pandharipande, Pratik P et al. (2011) Delirium: an emerging frontier in the management of critically ill children. Anesthesiol Clin 29:729-50
Girard, Timothy D; Jackson, James C; Pandharipande, Pratik P et al. (2010) Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 38:1513-20
Jackson, James C; Girard, Timothy D; Gordon, Sharon M et al. (2010) Long-term cognitive and psychological outcomes in the awakening and breathing controlled trial. Am J Respir Crit Care Med 182:183-91
Iwashyna, Theodore J; Ely, E Wesley; Smith, Dylan M et al. (2010) Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 304:1787-94
Han, Jin H; Wilson, Amanda; Ely, E Wesley (2010) Delirium in the older emergency department patient: a quiet epidemic. Emerg Med Clin North Am 28:611-31
Han, Jin H; Shintani, Ayumi; Eden, Svetlana et al. (2010) Delirium in the emergency department: an independent predictor of death within 6 months. Ann Emerg Med 56:244-252.e1

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