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: 8793444
• 负责人: Michael Simon Avidan
• 金额: $ 48.35万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8793444
• 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; Exercise; Family; General Anesthesia; Health; Health Professional; Healthcare; Hospitals; Impaired cognition; Individual; Intensive Care Units; Intervention; Length of Stay; Operative Surgical Procedures; Outcome; Patient Outcomes Assessments; Patients; Pattern; Personal Satisfaction; Phase; Physiological; Postoperative Complications; Postoperative Period; Prevention; Protocols documentation; Public Health; Quality of life; Randomized Controlled Trials; Recommendation; Rehabilitation therapy; 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; experience; falls; health related quality of life; high risk; hospital readmission; improved; inattention; mortality; nervous system disorder; older patient; pragmatic trial; prevent; public health priorities; 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）：谵妄是几种老年综合征之一，是最常见的术后并发症之一，影响高达70%的60岁以上手术患者。谵妄是一种急性变化，表现为注意力不集中和无法进行逻辑思考，并使患者及其家属深感痛苦。根据我们对1,000名手术患者的调查，超过30%的人担心会出现谵妄。谵妄患者不能有效地参与康复锻炼，并且容易患上其他老年综合征，如福尔斯。谵妄的发生和持续时间与更长的重症监护室和住院时间、持续的认知恶化、再入院和 死亡率上升。此外，谵妄带来了巨大的社会和经济负担，每位患者每年花费超过60，000美元。尽管谵妄对患者和社会的重要性，没有方法已被证明可以预防术后谵妄。此外，术后谵妄常常未被发现，手术患者出院后也没有系统的随访。在没有诊断谵妄或术后随访的情况下，我们在检测任何干预措施预防或治疗术后谵妄及其后遗症的有效性方面的能力有限。有越来越多的证据表明，脑电图引导全身麻醉可以减少术后谵妄。具体来说，我们的研究小组发现，深度麻醉时出现的脑电图模式受到抑制，与手术后谵妄和死亡的增加有关。因此，脑电图引导麻醉减轻老年性晕厥（ENGAGES）研究将比较两种麻醉方案减少术后谵妄的有效性。一个方案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。我们还希望确定麻醉方案对患者报告的健康相关生活质量结局的影响。在华盛顿大学，我们成功地实施了一项雄心勃勃的研究，在术前评估诊所招募患者，并在术后30天和1年时跟踪他们的健康和福祉。这将使我们能够评估术后谵妄的后果，并确定麻醉管理是否会影响患者报告的结果，如健康相关的生活质量。我们还将探讨对谵妄患者进行多组分安全干预是否可以预防下游不良事件，如福尔斯。ENGAGES研究-通过其结构化的麻醉方案，其彻底的谵妄评估方法，以及其跟踪患者术后健康和福祉的能力-准备为老年患者的护理做出重大贡献，这些患者有术后谵妄和其他不良后果的风险。

项目成果

Preoperative Assessment of Geriatric Patients.

• DOI: 10.1016/j.anclin.2015.10.013
• 发表时间: 2016-03-01
• 期刊: Anesthesiology clinics
• 作者: Knittel, Justin G;Wildes, Troy S
• 通讯作者: Wildes, Troy S

Assessing change in patient-reported quality of life after elective surgery: protocol for an observational comparison study.

• DOI: 10.12688/f1000research.8758.1
• 发表时间: 2016-01-01
• 期刊: F1000Research
• 作者: Kronzer, Vanessa L;Jerry, Michelle R;Avidan, Michael S
• 通讯作者: Avidan, Michael S

Ability of postoperative delirium to predict intermediate-term postoperative cognitive function in patients undergoing elective surgery at an academic medical centre: protocol for a prospective cohort study.

术后谵妄预测在学术医疗中心接受择期手术的患者术后中期认知功能的能力：前瞻性队列研究方案。

• DOI: 10.1136/bmjopen-2017-017079
• 发表时间: 2018
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Aranake-Chrisinger,Amrita;Cheng,JennyZhao;Muench,MaxwellR;Tang,Rose;Mickle,Angela;Maybrier,Hannah;Lin,Nan;Wildes,Troy;Lenze,Eric;Avidan,MichaelSimon
• 通讯作者: Avidan,MichaelSimon