Cardiac sURgery anesthesia Best practices to reduce Acute Kidney Injury (CURB-AKI)

心脏手术麻醉减少急性肾损伤 (CURB-AKI) 的最佳实践

基本信息

批准号：
10656576
负责人：
Michael Robert Mathis
金额：
$ 66.4万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10656576
关键词：
Acute Renal Failure with Renal Papillary Necrosis Address Adoption Adult Algorithms Anesthesia procedures Anesthesiology Area Under Curve Benchmarking Cardiac Cardiac Surgery procedures Cardiopulmonary Bypass Caring Characteristics Chronic Kidney Failure Clinical Clinical Trials Communication Complication Data Data Set Data Sources Databases Dialysis procedure EHR research Expenditure Feedback Future Goals Health Expenditures Health system Healthcare Hemoglobin Heterogeneity Hospital Societies Hospitals Hypotension Individual Infrastructure Injury to Kidney Intensive Care Units Intervention Intraoperative Care Kidney Knowledge Liquid substance Measures Michigan Multicenter Studies Natural experiment Nurses Operative Surgical Procedures Outcome Oxygen Pathology Patient risk Patients Pattern Patterns of Care Performance Perioperative Pharmaceutical Preparations Physiological Population Postdoctoral Fellow Postoperative Care Postoperative Period Precision therapeutics Procedures Process Provider Records Registries Reporting Research Review Literature Risk Risk Adjustment Risk Factors Risk Reduction Societies Source Standardization Techniques Thoracic Surgeon Translating Universities Update Validation Variant advanced analytics clinically relevant cohort cost data infrastructure evidence base hemodynamics improved individualized medicine innovation member modifiable risk mortality optimal treatments personalized approach personalized care predictive modeling standardized care treatment as usual treatment effect treatment strategy

Acute Renal Failure with Renal Papillary Necrosis Address Adoption Adult Algorithms Anesthesia procedures Anesthesiology Area Under Curve Benchmarking Cardiac Cardiac Surgery procedures Cardiopulmonary Bypass Caring Characteristics Chronic Kidney Failure Clinical Clinical Trials Communication Complication Data Data Set Data Sources Databases Dialysis procedure EHR research Expenditure Feedback Future Goals Health Expenditures Health system Healthcare Hemoglobin Heterogeneity Hospital Societies Hospitals Hypotension Individual Infrastructure Injury to Kidney Intensive Care Units Intervention Intraoperative Care Kidney Knowledge Liquid substance Measures Michigan Multicenter Studies Natural experiment Nurses Operative Surgical Procedures Outcome Oxygen Pathology Patient risk Patients Pattern Patterns of Care Performance Perioperative Pharmaceutical Preparations Physiological Population Postdoctoral Fellow Postoperative Care Postoperative Period Precision therapeutics Procedures Process Provider Records Registries Reporting Research Review Literature Risk Risk Adjustment Risk Factors Risk Reduction Societies Source Standardization Techniques Thoracic Surgeon Translating Universities Update Validation Variant advanced analytics clinically relevant cohort cost data infrastructure evidence base hemodynamics improved individualized medicine innovation member modifiable risk mortality optimal treatments personalized approach personalized care predictive modeling standardized care treatment as usual treatment effect treatment strategy

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项目摘要

Project Summary Almost 300,000 patients undergo cardiac surgery in the U.S. annually, and up to 30% develop cardiac surgery associated acute kidney injury (CSA-AKI). The complication is potentially preventable and results in 3-4 additional intensive care unit (ICU) days, $10-40K added health expenditures per case, and up to 10-fold increased odds of mortality. In severe cases requiring dialysis, consequences are even greater. While efforts to identify targets for CSA-AKI risk-reducing interventions have focused on underlying patient risk and surgical details, the intraoperative and early ICU periods remain understudied sources of outcome variation. Intraoperative and early ICU periods present unique opportunities for reducing CSA-AKI due to (i) unique renal insults due to altered hemodynamics of cardiopulmonary bypass; (ii) major physiologic shifts and clinical interventions detailed in granular intraoperative and ICU data, and (iii) amenability to process change. A paradigm shift in how CSA-AKI is understood during these periods remains possible through the addition of detailed minute-to-minute intraoperative and early ICU data to factors in traditional prediction models, but requires advanced analytical approaches to identify patterns within the 25,000 physiologic, fluid, medication, and intervention data points available for each patient. The potential value of such patterns is emerging in recent studies, yet remains unvalidated in large, contemporary cardiac surgery populations. Moreover, for CSA-AKI prediction models to be maximally informative, risk-reducing modifiable processes of care are likely not “one size fits all”, as are commonly applied in healthcare despite important heterogeneity of treatment effects across diverse pathologies and procedures. Finally, efforts to translate evidence to practice often fail, due to poor communication of evidence-based, patient-specific benchmarking data to individual clinicians. We propose a multicenter study leveraging the integration of two mature, unique research and quality improvement collaboratives built upon national, standardized registries: the Multicenter Perioperative Outcomes Group (MPOG) and the Society for Thoracic Surgeons (STS) Adult Cardiac Database. MPOG uses nurse- validated, detailed minute-to-minute intraoperative and early ICU data from the EHR for research and quality improvement. Headquartered at University of Michigan and guided by Associate Research Director PI Mathis, MPOG has integrated 16 million patient records across >40 health systems in 22 states and provides monthly automated performance improvement benchmarking reports to 5,000 frontline anesthesiology clinicians. In addition, MPOG has integrated each member hospital’s STS clinical registry to create a unique national “MPOG- STS” dataset of 80,000 cardiac surgeries. We will (i) identify high-impact, modifiable intraoperative and early ICU processes of care associated with reduced CSA-AKI; (ii) estimate the impact of individualized treatment strategies versus standardized or usual care for reducing CSA-AKI and progression to CKD, and (iii) disseminate and assess the effect of precision feedback on CSA-AKI and relevant processes of care.

项目摘要每年在美国接受近30万名患者接受心脏手术，多达30％的患者患心脏手术相关的急性肾脏损伤（CSA-AKI）。并发症是可以预防的，导致3-4 额外的重症监护室（ICU）天，每例案件增加了10-40k美元的健康支出，最多10倍死亡率增加。在需要透析的严重病例中，后果甚至更大。努力确定CSA-AKI降低风险干预措施的目标是基本的患者风险和手术细节，术中和早期的ICU期间仍然可以理解结果变化的来源。术中和ICU早期时期为减少CSA-AKI的独特机会（i）独特的肾脏由于心肺旁路的血液动力学改变而引起的侮辱；（ii）重大的身体转移和临床粒状术中和ICU数据中详细介绍的干预措施，以及（iii）处理变化的能力。通过添加，在这些时期中了解CSA-AKI的范式转变详细的术中和早期ICU数据详细介绍了传统预测模型中的因素，但需要先进的分析方法，以识别25,000种生理，液体，药物的模式干预数据点可用于每个患者。这种模式的潜在价值正在近期出现在大型的当代心脏手术人群中，研究仍然没有验证。此外，对于CSA-AKI 预测模型是最多信息丰富的，降低风险的可修改过程的预测模型可能不是“一种尺寸适合所有人”，正如医疗保健目的地通常应用的重要异质性治疗效果的异质性多样化的病理和程序。最后，将证据转化为实践的努力经常因差而失败向单个临床医生向基于循证的，特定于患者的基准数据进行沟通。我们提出了一项多中心研究，利用了两个成熟，独特的研究和质量的整合建立在国家标准化登记处的改进协作：多中心围手术期结果组（MPOG）和胸外科医师协会（STS）成人心脏数据库。 MPOG使用护士 - 来自EHR的经过验证，详细的术中和早期ICU数据研究和质量的ICU数据改进。总部位于密歇根大学，并由副研究总监Pi Mathis指导， MPOG已在22个州的40个卫生系统中整合了1600万例患者记录，并提供月度对5,000个前线麻醉临床医生的自动绩效改进基准报告。此外，MPOG已将每个成员医院的STS临床注册表整合在一起，以创建独特的国家“ MPOG- 80,000个心脏手术的STS”数据集。我们将（i）确定高影响力，可修改的术中和早期与减少CSA-AKI相关的ICU护理过程；（ii）估计个性化治疗的影响策略与标准化或通常的护理，以减少CSA-AKI并发展为CKD，以及（iii）传播并评估精确反馈对CSA-AKI和相关护理过程的影响。