Goal 2: Reduce Human Disease

Early cognitive rehabilitation

Does early cognitive rehabilitation (while on vent) improve long term cognitive function in ALI survivors?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

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Goal 2: Reduce Human Disease

Molecular determinants of pulmonary failure in sepsis

Respiratory failure in sepsis is almost universal and leads to worse clinical outcomes, yet it is poorly understood. Recent epidemics of pulmonary failure from respiratory viruses (e.g. influenza, SARS, MERS, etc) makes understanding molecular determinants of respiratory failure and the associated inflammatory and physiologic responses, critical for improving the health of our nation and potentially mitigating future ...more »

Submitted by (@greg.martin)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Exploring and understanding the molecular determinants of pulmonary failure will impact not only the predictable complications of acute respiratory illnesses such as influenza, but also inform our understanidng and treatment of myriad other common respiratory illnesses resulting in pulmonary failure, such as pneumonia, chronic obstructive pulmonary disease, asthma, obesity hypoventilation, etc.

Feasibility and challenges of addressing this CQ or CC :

Patients receiving critical care services in the United States are among the most close monitored, including continuous monitoring of cardiorespiratory physiology. This highly monitored population is a nature source for studying longitudinal changes in molecular patterns and respiratory physiology.

Name of idea submitter and other team members who worked on this idea : Society of Critical Care Medicine Executive Committee/Council

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6 net votes
9 up votes
3 down votes
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Goal 1: Promote Human Health

Patient- and Family-Centered Care in the ICU

Many medical centers have incorporated the concept of patient- and family-centered care into their mission statements and are now introducing policies that address topics such as open visiting hours in the ICU and family presence at resuscitation. These changes are often being made in the absence of robust evidence to support their introduction. There must be a commitment to rigorous study of these issues so that we can ...more »

Submitted by (@along11)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : acl

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-1 net votes
8 up votes
9 down votes
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Goal 2: Reduce Human Disease

Addition of albumin to fluid conservative management of AL

Does the addition of albumin to fluid conservative management of ALI (ARDSnet FACTT trial protocol, Wiedemann et al) further shorten ventilator time and/or improve survival?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

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1 net vote
1 up votes
0 down votes
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Goal 3: Advance Translational Research

Durable gene activity map at the individual level

A durable gene activity map of the individual to understand when certain gene sets are on vs off or dysfunctional over an individual’s lifetime as one way of guiding the precision of medicine for that patient. It would need to be person portable and universally exportable and interpretable across all of the EHRs.

Submitted by (@greg.martin)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : Society of Critical Care Medicine Executive Committee/Council

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2 net votes
3 up votes
1 down votes
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Goal 2: Reduce Human Disease

Develop and validate a metric to address the full spectrum of patient-level comorbidities affecting critical illness

An individual metric to inform about the additive and not individual impact of comorbidities on critical illness and peri-operative mortality. For instance, we know the impact of COPD or MI or CKD on mortality after hemicolectomy, but not necessarily the additive impact of all three.

Submitted by (@greg.martin)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : Society of Critical Care Medicine Executive Committee/Council

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2 net votes
4 up votes
2 down votes
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Goal 2: Reduce Human Disease

Palliation of symptoms associated with pulmonary conditions; promotion of patient participation in symptom self-management

Palliation of symptoms associated with a number of pulmonary conditions; promotion of patient participation in symptom self-management across the spectrum of illness, from ICU admission to rehabilitation to home; requires a multi-disciplinary perspective and team. There are a plethora of distressing symptoms (anxiety, shortness of breath, cough, fatigue, weakness) associated with a number of chronic pulmonary conditions, ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Innovative symptom management strategies are needed that empower patients and their family members to engage in self-management strategies across the spectrum of illness from hospitalization through recovery.

Feasibility and challenges of addressing this CQ or CC :

Longitudinal studies with a multi-disciplinary team of investigators are needed to address the varying needs of these patients and their family members over the course of recovery or transition to death in these patients. Interventions need to be cost-effective and prevent readmission to the critical care unit.

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

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1 net vote
1 up votes
0 down votes
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Goal 2: Reduce Human Disease

Vasopressin layered on to norepinephrine treatment for septic shock

We know that vasopressin layered on to norepinephrine treatment for septic shock tends to produce better outcomes (VASST trial, Russell et al) than norepinephrine alone. We still need to know if norepinephrine should be first line or if vasopressin should be first line (and perhaps monotherapy) for septic shock.

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

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1 net vote
1 up votes
0 down votes
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Goal 2: Reduce Human Disease

Dietary nitrates and the enterosalivary nitrate cycle

Are dietary fruits and vegetables, particularly leafy greens, protective against cardiovascular disease due to their ability to increase bioavailability of nitric oxide?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Understanding the biological rationale behind the benefit of a particular dietary component that promotes CV health will substantiate public health recommendations about diet.

Feasibility and challenges of addressing this CQ or CC :

Our understanding of the nitrate/nitrite cycle and of cardiovascular activity of nitric oxide has advanced rapidly in the past 10-15 years. The time is ripe for linking these advances in the science of nitrates to the consequences of dietary nitrate.

The role of dietary fruits and vegetables in the protection against cardiovascular disease is supported by many studies, especially leafy green vegetables. However, identification of the component of fruits and vegetables affording this protection has been elusive. Recent discoveries about the ability of the body to cycle dietary nitrates to produce bioactive nitric oxide via the enterosalivary cycle and lingual microbiome lends strength to the argument that leafy green vegetables may be protective due to their high nitrate content. This possibility should be examined in both large cohort studies and in clinical series. Would be helpful for the USDA to add nitrates to their standard database of food nutrients. NHLBI needs to partner with NCI to coordinate with ongoing research about the potential nitrosylation of dietary nitrites to carcinogenic n-nitrosamines in the setting of low antioxidant intake.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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17 net votes
52 up votes
35 down votes
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Goal 2: Reduce Human Disease

Pathogenesis and treatment of cardiovascular disease in survivors of critical illness.

Acute cardiovascular complications are frequent in critical illness and injury, occurring on a spectrum that includes troponin leak or demand ischemia to acute occlusive coronary events and lethal arrhythmias. They arise in the course of similar acute illnesses but they epidemiology, pathogenesis, treatment and long-term consequences are unknown. Are they the result of a generalized inflammatory state that persists ...more »

Submitted by (@greg.martin)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Complications of critical illness are frequent and the most common are cardiovascular in nature but not well understood. Understanding the pathogenesis of these consequences will lead to improve treatments, acute survival of critical illness and injury, and improved long-term outcomes.

Feasibility and challenges of addressing this CQ or CC :

Patients receiving critical care services in the United States are among the most close monitored, including continuous monitoring of cardiorespiratory physiology. Integrating high dimensional data from ICU data streams and applying big data analytics, in combination with primetime genomic and metabolomic technologies, makes this question imminently feasible.

Name of idea submitter and other team members who worked on this idea : Society of Critical Care Medicine Executive Committee/Council

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1 net vote
3 up votes
2 down votes
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Goal 2: Reduce Human Disease

Effect of obesity on recovery of lung function in pediatric survivors of critical illness

What are the determinants of persistent respiratory failure in children? Are obese children at greater risk for prolonged mechanical ventilation than non-obese children? Does BMI affect the time to recovery of lung function in obese children with ARDS? What is the pathogenesis and molecular contributors of obesity on respiratory failure in critical illness?

Submitted by (@greg.martin)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : Society of Critical Care Medicine Executive Committee/Council

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1 net vote
3 up votes
2 down votes
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Goal 2: Reduce Human Disease

Role of sleep quality in critical care

Would improving sleep and circadian rhythms in the critical care setting result in improved patient outcomes (e.g., reduce severity of infection, duration of intubation, length of hospital stay)?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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71 net votes
98 up votes
27 down votes
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