Journal
JOURNAL OF CRITICAL CARE
Volume 22, Issue 4, Pages 275-284Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.jcrc.2007.02.001
Keywords
respiratory distress syndrome, adult; methodological study; cohort studies; prospective studies; risk factors; epidemiologic methods
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Funding
- NHLBI NIH HHS [P50 HL073994, P50 HL073994-02] Funding Source: Medline
- NIGMS NIH HHS [K23 GM071399-02, K23 GM071399-03, K23 GM071399] Funding Source: Medline
- NINR NIH HHS [K23 NR009193, K23 NR009193-02] Funding Source: Medline
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Purpose: Long-term follow-up studies in critical care have described survivors' outcomes, but provided less insight into the patient/disease characteristics and intensive care therapies (exposures) associated with these outcomes. Such insights are essential for improving patients' long-term outcomes. This report describes the development of a strategy for comprehensively measuring relevant exposures for long-term outcomes research, and presents empiric results from its implementation. Materials and Methods: A multistep, iterative process was used to develop the exposures strategy. First, a comprehensive list of potential exposures was generated and subsequently reduced based on feasibility, redundancy, and relevance criteria. Next, data abstraction methods were designed and tested. Finally, the strategy was implemented in 150 patients with acute lung injury with iterative refinement. Results: The strategy resulted in the development of more than 60 unique exposures requiring less than 45 minutes per patient-day for data collection. Most exposures had minimal missing data and adequate reliability. These data revealed that evidence-based practices including lower tidal volume ventilation, spontaneous breathing trials, sedation interruption, adequate nutrition, and blood glucose of less than 6.1 mmol/L (110 mg/dL) occurred in only 23% to 50% of assessments. Conclusions: Using a multistep, iterative process, a comprehensive and feasible exposure measurement strategy for long-term outcomes research was successfully developed and implemented. (c) 2007 Elsevier Inc. All rights reserved.
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