Showing 33 ideas for tag "failure"

Goal 2: Reduce Human Disease

Optimal hemoglobin threshold for transfusion in children with ARDS?

Do different hemoglobin transfusion thresholds alter outcomes in children with ARDS? What is the optimal *minimum* transfusion threshold for children with ARDS? What patient-centered outcomes can be affected by transfusion strategies: ventilator free days, time to organ function recovery, duration of intensive care stay, survival?

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

What is the Relationship Between CVD and Dementia in the Elderly?

The successes of preventing and treating CHD, CVD has resulted in a substantial increase in life expectancy, a very important success story, but unfortunately it has led to a growing population of elderly 80+ years of age.

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

Details on the impact of addressing this CQ or CC

Their high prevalence of congestive heart failure (CHF), atrial fibrillation (Afib), stroke, peripheral vascular disease, dementia, frailty, and disability is clearly going to lead to the public health tsunami of the 21st century and bankrupt the health systems. Further studies are badly needed to determine the interrelationship between CVD, dementia, disability, and whether prevention of CVD beginning early in life, middle ages, or even at older ages can impact on successful aging with reduced risks of dementia and disability.

Feasibility and challenges of addressing this CQ or CC

Older individuals with 0 coronary artery calcium (CAC) have extremely low risk of subsequent clinical CHD, CVD, and total mortality even at older ages. Whether these individuals with low risk, e.g. very low CAC, have less extensive brain abnormalities associated with increased risk of dementia needs to be evaluated.

The NHLBI should establish a registry of individuals who have had very low CAC scores at older ages, determine the relationship between these very low CAC scores and risk factors, genetics, and then consider trials to prevent CVD, CHD among older individuals 80+ with relatively low levels of CAC, with dementia, stroke, CHF, Afib, as primary endpoints. The NHLBI should also consider trials in middle-aged individuals to prevent the development and progression of coronary atherosclerosis, e.g. maintenance of 0 CAC. The NHLBI, in collaboration with other institutes at NIH, should evaluate the interrelationship between coronary artery atherosclerosis, e.g. CAC, and other measures of atherosclerosis, other manifestations of CVD, such as CHF, Afib, and brain changes and the development of dementia and Alzheimer’s disease.

Name of idea submitter and other team members who worked on this idea Lewis H. Kuller, MD, DrPH

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3 net votes
21 up votes
18 down votes
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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 »

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 2: Reduce Human Disease

Heart Failure with Preserved Ejection Fraction Needs better understanding

Effective treatment for Heart Failure with Preserved Ejection Fraction (HFpEF) currently does not exist. Lack of understanding of underlying mechanism(s) probably contributed to this lack of treatment. The well studied neural-hormonal blockade will not work for HFpEF because down stream kinase targets of adrenergic stimulation enhances myocardial relaxation. Consequently, sustain research outside current main stream thinking... more »

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

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Modulation of myosin-actin interaction, energetics, and post translational modification need to be studied in the context of HFpEF. Elucidating underlying mechanism(s) and translating the discoveries toward effective treatment can solve the HFpEF enigma. With aging population, finding effective treatment for HFpEF is sorely needed.

Name of idea submitter and other team members who worked on this idea Carl Tong

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2 net votes
13 up votes
11 down votes
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Goal 2: Reduce Human Disease

Long-term pulmonary function in survivors of critical illness

Pulmonary function is known to suffer during the early recovery phases from critical illness, but the long-term patterns of recovery and associated consequences are uncertain. In addition, the clinical and molecular determinants of progressive deterioration or recovery of pulmonary function remain unknown.

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

What is the optimal management of coronary artery disease in patients with chronic kidney disease

Patients with chronic kidney disease (CKD) have an extremely high risk of death from cardiovascular cause. The prognosis of patients with chronic kidney disease who also have coronary artery disease is worse than certain cancer. While great strides have been made to create awareness about breast cancer, there is paucity of knowledge about the cardiovascular risk of CKD patients among both physicians and patients. Moreover,... more »

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

Details on the impact of addressing this CQ or CC

Patients with chronic kidney disease tend to be undertreated (from CV perspective), underrepresented (in clinical trials) and underdiagnosed with less referral for stress testing, even though cardiovascular cause is the leading cause of death in these patients. Patients with chronic kidney disease is a growing cohort and with increase in obesity and diabetes, the prevalence is exploding exponentially. The decision as to what is the best treatment option for patients with coronary artery disease who also have kidney disease- revascularization or medical therapy-is important and can be a paradigm shift in the way we treat such patients

Feasibility and challenges of addressing this CQ or CC

Randomized clinical trials are urgently needed to answer this question.

Name of idea submitter and other team members who worked on this idea Sripal Bangalore

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0 net votes
9 up votes
9 down votes
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Goal 2: Reduce Human Disease

National network to study the pathobiology of sepsis

Sepsis is the leading cause of death in hospitalized patients, the 3rd leading cause of death in all people in the US, the most common condition leading to widespread vascular collapse, among the most common causes of respiratory failure, and a frequent cause of acute cardiac dysfunction.

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

Details on the impact of addressing this CQ or CC

Developing a national network to address important aspects of sepsis (causes and consequences of cardiac dysfunction, molecular determinants of respiratory failure) and serve as a trials group for testing novel interventions for new discoveries.

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

What is the role of diet and nutrition in treatment, management and prevention of Heart Failure?

Heart Failure (HF) remains a major public health burden. A working group was convened by NHLBI and ODS in June, 2013 to address the role of diet and nutrition in management of HF. A review of existing evidence produced no clear rationale for appropriate dietary interventions. On the contrary, the group developed recommendations for conducting additional research specifically on the role of sodium, fluid, nutrients, and... more »

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

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As summarized following the Working Group meeting,compared with the situation for cardiovascular risk factor management, there is little well-founded evidence regarding the efficacy, safety, and clinical impact of dietary modifications for patients with various HF phenotypes. The importance of diet and nutrition to promote health and prevent or control disease is well established. Research on obesity, hypertension and cardiovascular disease have contributed to the development of nutritional guidelines to prevent these disease in the general population but efforts to determine nutritional needs for the patient with HF lack high caliber evidence regarding safety, efficacy, and clinical impact of dietary modifications. The stronger evidence and focus on disease prevention and health promotion with diet modifications like DASH cannot be easily applied or extrapolated for disease management, especially HF, because of critical knowledge gaps and potential harm. Research on HF has more recently identified and differentiated medical treatment and interventions appropriate for HF with or without preserved ejection fractions. This only adds to the questions surrounding diet and nutritional approaches to help reduce and prevent HF readmissions.

Feasibility and challenges of addressing this CQ or CC

Chronic HF often presents as a multisystem disease with important co-morbidities such as anemia, insulin resistance or diabetes, autonomic dysregulation, and impaired renal function. Intestinal dysfunction with impaired motility and circulation and disturbed intestinal barrier and flora may lead to a chronic inflammatory state and nutrient malabsorption. In advanced cases, catabolic/anabolic imbalance is associated with cardiac cachexia, a difficult to treat condition which itself carries a poor prognosis. Furthermore, psychosocial symptoms associated with HF, including depression and impaired cognition, can contribute to poor self-care and lack of adherence to recommended dietary, physical activity, and medication regimens. Nutritional status concerns for patients with HF increase with disease severity. Salt restriction is now controversial and clinicians give little attention to diet as a potential intervention to improve outcomes. Proposed recommendations:
1.Determine the correct sodium threshold; ranges of sodium and fluid intake, and the safety for sub-groups including HFPEF, HFREF, and cardiorenal syndrome. 2.Generate new knowledge which identifies therapeutic targets and understand the role of the gut microbiome on gastrointestinal malabsorption, inflammation, and protein balance in HF.
3.Apply innovative study designs to reduce evidence gaps 4.Develop technologies to facilitate nutrition research and address weight and multiple risk factors should be addressed.

Name of idea submitter and other team members who worked on this idea Linda Van Horn, PhD, RD

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2 net votes
3 up votes
1 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?

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

National ARDS Registry

ARDS remains one of the most common and lethal forms of respiratory failure in critically ill patients. Improvements in understanding the pathogenesis has not led to effective treatments, and heterogeneity of the condition precludes major advances. A national registry would serve to improve understanding of epidemiology, disease characterization (for definitions) and can identify incidence, outcome, disparities, treatment... more »

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

Feasibility and challenges of addressing this CQ or CC

Can be modeled on the ARDS/PETAL Network, but more broadly implemented for epidemiology and pragmatic studies.

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 up votes
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Goal 2: Reduce Human Disease

Targeting Preclinical Diastolic Dysfunction to Prevent Heart Failure

Heart failure (HF) affects over 5 million American adults, and projected estimates show growth of this epidemic by 25% over the next 15 years as the population of the United States continues to age. Heart failure with preserved EF (HFpEF) encompasses 50% of all heart failure cases. Preclinical diastolic dysfunction (PDD) is defined as normal systolic function, moderate or severe diastolic dysfunction determined by Doppler... more »

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

Details on the impact of addressing this CQ or CC

There is currently no FDA approved therapy for HFpEF and yet HFpEF makes up 50% of all HF population. The prevalence of PDD (ACC/AHA Stage B HF) is abt 28% of the general population and these patients do not have symptoms of HF. Understanding the pathophysiology of PDD may leady to the development of therapeutic strategies to prevent the development of HFpEF. This would decrease the burden of HF impact public health and be cost-effective, similar to the use of vaccine to prevent infectious diseases.

Feasibility and challenges of addressing this CQ or CC

With echocardiography, we are able to identify PDD patients before they develop symptomatic HF. Hence with research funding, we can better characterize preclinical diastolic dysfunction, and to discover further targets for this entity to prevent development of HFpEF

Name of idea submitter and other team members who worked on this idea Horng H Chen

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2 up votes
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Goal 2: Reduce Human Disease

Predict the needs for inter and intra-hospital transfer for acute care surgery patients with respiratory failure

Density mapping of the need and flow of patients requiring acute care surgery vis-a-vis inter-facility transfer, care hand-off failures, post-acute care resource mismatch to articulate a funding plan resource allocation and development akin to what has been done for trauma care.

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 Society of Critical Care Medicine Executive Committee/Council

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2 up votes
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Goal 2: Reduce Human Disease

Repair and Regenerate the Kidney

Chronic Kidney Disease (CKD) affects millions in the US, and is one of the new diseases on the rise globally. New therapies to slow CKD and to repair and regenerate failing kidneys are drastically needed to reduce health care costs and improve lives.

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

Details on the impact of addressing this CQ or CC

New therapies to slow CKD and to repair and regenerate failing kidneys are sorely needed to reduce health care costs and improve lives.

Feasibility and challenges of addressing this CQ or CC

Our understanding of renal function and risk factors is greater than ever. Our ability to diagnose is technologically advanced. We now need to increase efforts to identify therapeutic targets and develop regenerative approaches to prevent and treat CKD.

Name of idea submitter and other team members who worked on this idea Ceci Giachelli

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Goal 2: Reduce Human Disease

Therapy for Heart Failure with Preserved Ejection Fraction

Are existing neurohormonal antagonist drugs effective in HFPEF ?

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

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HFPEF is as serious as HFREF and as many forms of cancer. But there is no therapy. Generic neurohormonal antagonist drugs are effective in HFREF and have potential in HFPEF. They will not be studied by industry and trials need public funding.

Feasibility and challenges of addressing this CQ or CC

The challenge is streamlined efficient trials. This can be addressed with the registry-randomized trial concept.

Name of idea submitter and other team members who worked on this idea Lars H. Lund

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