Electroencephalograph Guidance of Anesthesia to Alleviate Geriatric Syndromes (EN

脑电图指导麻醉缓解老年综合症（EN

• 批准号: 9298575
• 负责人: Michael Simon Avidan
• 金额: $ 65.96万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9298575
• 关键词: Acute; Address; Adoption; Adverse event; Affect; American; Anesthesia procedures; Anesthetics; Attention; Caring; Cessation of life; Clinic; Cognition; Cognitive; Communities; Coupled; Delirium; Detection; Deterioration; Diagnosis; Distress; Economic Burden; Effectiveness; Elderly; Electroencephalogram; Electroencephalography; Enrollment; Ensure; Family; General Anesthesia; Health; Health Professional; Healthcare; Hospitals; Impaired cognition; Intensive Care Units; Intervention; Length of Stay; Operative Surgical Procedures; Outcome; Patient Outcomes Assessments; Patients; Pattern; Phase; Physiological; Postoperative Complications; Postoperative Period; Prevention; Protocols documentation; Public Health; Quality of life; Randomized Controlled Trials; Recommendation; Reporting; Research; Resolution; Resources; Risk; Safety; Sleep; Societies; Structure; Surveys; Syndrome; Testing; Thinking; United Kingdom; United States; United States National Institutes of Health; Universities; Washington; adverse outcome; age group; base; clinical care; cohort; compare effectiveness; cost; efficacy study; exercise rehabilitation; experience; falls; health related quality of life; high risk; hospital readmission; improved; inattention; individual patient; mortality; nervous system disorder; older patient; postoperative delirium; pragmatic trial; prevent; public health priorities; public health relevance; social; standard of care; success

DESCRIPTION (provided by applicant): Delirium is one of several geriatric syndromes, and is among the most common postoperative complications, affecting up to 70% of surgical patients older than 60. Delirium is an acute change that manifests as inattention and inability to think logically, and is deeply distressing to patients and their families. Based on our surveys of 1,000 surgical patients, over 30% were worried about experiencing delirium. Delirious patients are unable to participate effectively in rehabilitation exercises and are susceptible to other geriatri syndromes, like falls. The occurrence and duration of delirium are associated with longer intensive care unit and hospital stay, persistent cognitive deterioration, hospital readmission and increased mortality rate. Additionally, delirium carries a huge social and economic burden, costing over $60,000 per patient per year. Despite the importance of delirium to patients and to society, no approach has been proven to prevent postoperative delirium. Furthermore postoperative delirium is frequently unrecognized, and surgical patients are not followed systematically after they are discharged from hospital. Without diagnosing delirium or following patients postoperatively, we are limited in our ability to test the effectiveness of any interventin to prevent or treat postoperative delirium and its sequelae. There is mounting evidence that electroencephalography guidance of general anesthesia can decrease postoperative delirium. Specifically, our group has found that a suppressed electroencephalogram pattern, which occurs with deep anesthesia, is associated with increased delirium and death after surgery. The Electroencephalograph Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) Study will therefore compare the effectiveness of two anesthetic protocols for reduction of postoperative delirium. One protocol will be based on current standard anesthetic practice, and the other protocol will be based on electroencephalography guidance. We also expect to determine the impact of the anesthetic protocols on patient reported outcomes of health-related quality of life. At Washington University, we have successfully implemented an ambitious study that enrolls patients at the preoperative assessment clinic, and tracks their health and wellbeing at 30 days and at 1-year postoperatively. This will enable us to assess the consequences of postoperative delirium and to determine whether anesthetic management can impact patient reported outcomes, such as health-related quality of life. We shall also explore whether a multi-component safety intervention for delirious patients prevents downstream adverse events, like falls. The ENGAGES study - through its structured anesthesia protocols, its thorough approach to delirium assessment, and its ability to track patients' health and well-being postoperatively - s poised to make a major contribution to the care of elderly patients who are at risk of postoperative delirium and other adverse outcomes.

描述（由申请人提供）：del妄是几种老年综合症之一，是术后最常见的并发症之一，影响了60岁以上的手术患者中多达70％的手术患者。del妄是一种急性变化，表现为逻辑上的障碍和无能为力，并且对患者及其家人造成深深的痛苦。根据我们对1000名外科手术患者的调查，超过30％的人担心经历del妄。精神错乱的患者无法有效参与康复运动，并且容易受到其他老年综合症的影响，例如瀑布。 ir妄的发生和持续时间与更长的重症监护室和住院，持续的认知劣化，医院再入院和 死亡率提高。此外，ir妄带有巨大的社会和经济负担，每年每年的患者耗资超过60,000美元。尽管del妄对患者和社会来说是重要的，但尚未证明尚未证明可以防止术后ir妄的方法。此外，术后del妄经常被识别，并且在出院出院后不会系统地遵守手术患者。在术后未诊断del妄或关注患者的情况下，我们的能力有限，无法测试任何干预蛋白预防或治疗术后del妄及其后遗症的有效性。有越来越多的证据表明，全身麻醉的脑电图指导可以减少术后del妄。具体而言，我们的小组发现，在深度麻醉的情况下，抑制的脑电图模式与手术后的del妄和死亡增加有关。因此，麻醉减轻老年综合征的脑电图指导（参与）研究将比较两种麻醉方案减少术后del妄的有效性。一个协议将基于当前的标准麻醉实践，另一个方案将基于脑电图指导。我们还期望确定麻醉方案对患者报告的与健康相关的生活质量结果的影响。在华盛顿大学，我们成功地实施了一项雄心勃勃的研究，该研究将患者纳入术前评估诊所，并在30天和术后1年追踪其健康和福祉。这将使我们能够评估术后ir妄的后果，并确定麻醉管理是否会影响患者报告的结果，例如与健康相关的生活质量。我们还将探讨为狂热的患者进行多组分的安全干预是否可以防止下游不良事件，例如跌倒。参与研究 - 通过其结构化麻醉方案，其详尽的ir妄评估方法以及术后跟踪患者的健康和福祉的能力 - 准备对有术后妄想危险和其他不良癌症风险的老年患者做出重大贡献。