Goal-directed decision support system for treating perioperative fluid deficits

用于治疗围手术期液体缺乏的目标导向决策支持系统

• 批准号: 8781083
• 负责人: Chris Meador
• 金额: $ 22.5万
• 依托单位: ARCOS, INC
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-05 至 2016-03-04
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8781083
• 关键词: Adoption; Algorithms; Area; Asses; Blood; Burn injury; Cardiac Output; Cardiac Surgery procedures; Caregivers; Caring; Certified registered nurse anesthetist; Clinical; Clinical effectiveness; Communication; Computer software; Cost Savings; Decision Support Systems; Devices; Effectiveness; Ensure; Eye; Fluid Therapy; Goals; Guidelines; Hospitals; Human; Individual; Intestines; Intuition; Length; Length of Stay; Liquid substance; Marketing; Medical; Medical Device; Methods; Monitor; Operating Rooms; Operative Surgical Procedures; Orthopedic Surgery procedures; Outcome; Patients; Peer Review; Perioperative; Phase; Physiological; Protocols documentation; Publications; Recommendation; Recovery; Resuscitation; Simulate; Solutions; Structure; Surveys; System; Tablet Computer; Technology; Testing; Time; Validation; Visual Aid; Work; base; cost; design; evidence base; experience; graphical user interface; hemodynamics; high risk; improved; programs; prototype; public health relevance; simulation; standard of care; success; tool; trend; usability

DESCRIPTION (provided by applicant): Goal-directed decision support system for treating perioperative fluid deficits Gastro-intestinal, cardiac and orthopedic surgeries can result in significant blood and fluid losses. Inappropriate replacement of perioperative fluid losses leads to complications, which increase hospital length and almost double the cost of care. Goal-directed fluid therapy (GDFT) is an evidence-based, proven method of optimizing fluid therapy and improving clinical outcomes. Unfortunately, multiple surveys of anesthesiologists and peer reviewed publications indicate that GDFT is not widely practiced and is not considered the current standard of care. We are developing a decision support software-hardware system for GDFT that provides anesthesiologists and CRNAs an intuitive tool to optimize fluid therapy using proven algorithms. We hypothesize that our algorithmic decision support system will provide greater precision in managing perioperative fluid losses and enhance clinical workflow. This approach has high potential for improving surgical care and post-surgical recovery as well as reducing medical costs. The use of an algorithmic decision support system is fundamentally different from the U.S. standard of care, which remains largely based on intuition and "eyeballing" vital signs. The project has two aims: 1) develop an integrated Goal-Directed Decision Support System (GDDSS) for treating perioperative fluid deficits and 2) assess usability and workflow of the GDDSS. The integrated system will connect an operating room vital signs monitor and a cardiac output monitor with a bedside tablet computer. The tablet computer will generate real-time recommendations and will trend graphics that overlay physiological variables with fluid therapy, thereby providing a unique and intuitive visual aid for the caregiver to rapidly assess the effectiveness of fluid therapy. We will conduct a human factors study with anesthesiologists, residents and nurse anesthetists during a simulated high risk GI surgery case.

描述（由申请人提供）：用于治疗围手术期液体缺乏的目标导向决策支持系统胃肠道、心脏和骨科手术可能导致大量血液和液体流失。围手术期液体流失的不适当补充会导致并发症，这会增加住院时间，几乎使护理费用增加一倍。目标导向液体治疗（GDFT）是一种以证据为基础的，经过验证的优化液体治疗和改善临床结局的方法。不幸的是，对麻醉师和同行评审出版物的多项调查表明，GDFT并未得到广泛实践，也未被视为当前的护理标准。 我们正在为GDFT开发一个决策支持软硬件系统，为麻醉师和CRNA提供一个直观的工具，使用经过验证的算法优化液体治疗。我们假设我们的算法决策支持系统将在管理围手术期液体丢失方面提供更高的精度，并增强临床工作流程。这种方法在改善手术护理和术后恢复以及降低医疗成本方面具有很高的潜力。算法决策支持系统的使用与美国的护理标准有着根本的不同，后者在很大程度上仍然基于直觉和“目测”生命体征。 该项目有两个目标：1）开发用于治疗围手术期液体不足的集成目标导向决策支持系统（GDDSS），2）评估GDDSS的可用性和工作流程。集成系统将连接手术室生命体征监测仪和心输出量监测仪与床边平板电脑。平板电脑将生成实时建议，并将趋势图形与液体治疗的生理变量重叠，从而提供独特和直观的视觉辅助， 护理人员快速评估液体治疗的有效性。我们将在模拟高风险胃肠道手术病例中与麻醉师、住院医师和麻醉护士进行人为因素研究。