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:
- 金额:$ 66.4万
- 依托单位:
- 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:
- 关键词:Acute Renal Failure with Renal Papillary NecrosisAddressAdoptionAdultAlgorithmsAnesthesia proceduresAnesthesiologyArea Under CurveBenchmarkingCardiacCardiac Surgery proceduresCardiopulmonary BypassCaringCharacteristicsChronic Kidney FailureClinicalClinical TrialsCommunicationComplicationDataData SetData SourcesDatabasesDialysis procedureEHR researchExpenditureFeedbackFutureGoalsHealth ExpendituresHealth systemHealthcareHemoglobinHeterogeneityHospital SocietiesHospitalsHypotensionIndividualInfrastructureInjury to KidneyIntensive Care UnitsInterventionIntraoperative CareKidneyKnowledgeLiquid substanceMeasuresMichiganMulticenter StudiesNatural experimentNursesOperative Surgical ProceduresOutcomeOxygenPathologyPatient riskPatientsPatternPatterns of CarePerformancePerioperativePharmaceutical PreparationsPhysiologicalPopulationPostdoctoral FellowPostoperative CarePostoperative PeriodPrecision therapeuticsProceduresProcessProviderRecordsRegistriesReportingResearchReview LiteratureRiskRisk AdjustmentRisk FactorsRisk ReductionSocietiesSourceStandardizationTechniquesThoracic SurgeonTranslatingUniversitiesUpdateValidationVariantadvanced analyticsclinically relevantcohortcostdata infrastructureevidence basehemodynamicsimprovedindividualized medicineinnovationmembermodifiable riskmortalityoptimal treatmentspersonalized approachpersonalized carepredictive modelingstandardized caretreatment as usualtreatment effecttreatment strategy
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.
项目概要
美国每年有近 30 万名患者接受心脏手术,其中高达 30% 接受心脏手术
相关的急性肾损伤 (CSA-AKI) 该并发症是可以预防的,并会导致 3-4 例。
额外的重症监护病房 (ICU) 天数,每个病例增加 10-40,000 美元的医疗支出,最多增加 10 倍
在需要透析的严重情况下,死亡率的几率会增加。
确定 CSA-AKI 风险降低干预措施的目标,重点关注潜在的患者风险和手术
细节上,术中和早期 ICU 期间的结果变化来源仍未得到充分研究。
术中和早期 ICU 时期为减少 CSA-AKI 提供了独特的机会,因为 (i) 独特的肾脏
(ii) 主要的生理变化和临床
术中和 ICU 数据中详细说明的干预措施,以及 (iii) 处理变化的适应性。
通过添加以下内容,在这些时期如何理解 CSA-AKI 的范式转变仍然是可能的:
将详细的术中和早期 ICU 数据纳入传统预测模型中的因素,但是
需要先进的分析方法来识别 25,000 种生理、体液、药物和
每位患者可获得的干预数据点最近正在显现这种模式的潜在价值。
此外,对于 CSA-AKI 而言,该研究尚未在大型当代心脏手术人群中得到验证。
提供最大信息量、降低风险、可修改的护理过程的预测模型可能不是“一刀切”
适合所有人”,尽管治疗效果存在重要异质性,但通常应用于医疗保健领域
最后,由于不良的病理和程序,将证据转化为实践的努力常常失败。
向个人人员传达基于证据的、针对患者的基准数据。
我们提出了一项多中心研究,利用两个成熟、独特的研究和质量的整合
基于国家标准化登记的改进协作:多中心围手术期结果
小组 (MPOG) 和胸外科医生协会 (STS) 成人心脏数据库使用护士-
来自 EHR 的经过验证、详细的每分钟术中和早期 ICU 数据,用于研究和质量
总部位于密歇根大学,由副研究主任 PI Mathis 指导,
MPOG 整合了 22 个州超过 40 个卫生系统的 1600 万条患者记录,并每月提供
向 5,000 名一线麻醉学内部人员提供自动化绩效改进基准报告。
此外,MPOG还整合了各成员医院的STS临床登记,创建了独特的全国性“MPOG-
STS”数据集包含 80,000 例心脏手术,我们将 (i) 确定高影响力、可修改的术中和早期手术。
与 CSA-AKI 减少相关的 ICU 护理流程;(ii) 评估个体化治疗的影响
减少 CSA-AKI 和进展为 CKD 的策略与标准化或常规护理的比较,以及 (iii) 传播
并评估精确反馈对 CSA-AKI 和相关护理流程的影响。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
数据更新时间:{{ journalArticles.updateTime }}
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
数据更新时间:{{ journalArticles.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ monograph.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ sciAawards.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ conferencePapers.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ patent.updateTime }}
Michael Robert Mathis其他文献
Michael Robert Mathis的其他文献
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
{{ truncateString('Michael Robert Mathis', 18)}}的其他基金
Early Diagnosis of Heart Failure: A Perioperative Data-Driven Approach
心力衰竭的早期诊断:围手术期数据驱动的方法
- 批准号:
10421285 - 财政年份:2018
- 资助金额:
$ 66.4万 - 项目类别:
Early Diagnosis of Heart Failure: A Perioperative Data-Driven Approach
心力衰竭的早期诊断:围手术期数据驱动的方法
- 批准号:
9895469 - 财政年份:2018
- 资助金额:
$ 66.4万 - 项目类别:
相似国自然基金
本体驱动的地址数据空间语义建模与地址匹配方法
- 批准号:41901325
- 批准年份:2019
- 资助金额:22.0 万元
- 项目类别:青年科学基金项目
时空序列驱动的神经形态视觉目标识别算法研究
- 批准号:61906126
- 批准年份:2019
- 资助金额:24.0 万元
- 项目类别:青年科学基金项目
针对内存攻击对象的内存安全防御技术研究
- 批准号:61802432
- 批准年份:2018
- 资助金额:25.0 万元
- 项目类别:青年科学基金项目
大容量固态硬盘地址映射表优化设计与访存优化研究
- 批准号:61802133
- 批准年份:2018
- 资助金额:23.0 万元
- 项目类别:青年科学基金项目
IP地址驱动的多径路由及流量传输控制研究
- 批准号:61872252
- 批准年份:2018
- 资助金额:64.0 万元
- 项目类别:面上项目
相似海外基金
Developing a Precision Medicine Approach to Pediatric Sepsis-Associated Acute Kidney Injury: Identification of Unique Subphenotypes and Strategies for Bedside Implementation
开发针对小儿脓毒症相关急性肾损伤的精准医学方法:识别独特的亚表型和临床实施策略
- 批准号:
10721391 - 财政年份:2023
- 资助金额:
$ 66.4万 - 项目类别:
Novel Point-of-Care Device for Urinary Hepcidin to Detect Iron Deficiency in Children and Adolescents
用于检测儿童和青少年缺铁情况的新型尿铁调素护理点设备
- 批准号:
10597914 - 财政年份:2022
- 资助金额:
$ 66.4万 - 项目类别:
Novel Point-of-Care Device for Urinary Hepcidin to Detect Iron Deficiency in Children and Adolescents
用于检测儿童和青少年缺铁情况的新型尿铁调素护理点设备
- 批准号:
10709598 - 财政年份:2022
- 资助金额:
$ 66.4万 - 项目类别:
Hyperpolarized 13C Metabolic MRI for Noninvasive Monitoring of Kidney Injury
超极化 13C 代谢 MRI 用于无创监测肾损伤
- 批准号:
10449286 - 财政年份:2021
- 资助金额:
$ 66.4万 - 项目类别: