PHEnylephrine versus NOrepinephrine in Major NONcardiac surgery (PHENOMeNON): Foundational Studies for a Pragmatic Randomized Clinical Trial.

摘要 背景：在美国，每天约有60，000名患者接受需要全身麻醉的手术 美国，其中60%需要静脉注射血管加压药来抵消全身麻醉- 诱发心血管抑制和低血压（低血压）。许多研究表明， 术中低血压的有害影响，包括心肌损伤、卒中和急性肾损伤。 治疗术中低血压的血管加压疗法，特别是去甲肾上腺素和 苯乙醯胺，被激烈地争论。需要更多的研究来更好地了解血管加压药的选择 血管加压药的选择对终末器官灌注结果的影响。 研究：拟议研究的目标是进行基础研究，以获得必要的 背景数据，并进行试点临床试验。第一个具体目标是进行定量分析。 评估多个机构的血管加压药实践模式和差异。这些数据将指导 目标2的抽样策略，探讨临床医生对血管加压药的态度和意见 采用混合方法在多个机构进行甄选。目标1和2为议定书的制定提供了信息， 一项初步研究，将去甲肾上腺素或苯肾上腺素作为一线血管加压药， 治疗目标3中密歇根大学（UM）进行的术中低血压。拟议研究 培训将为Janda博士提供过渡到独立研究员所需的技能。 候选人：Allison Janda博士是一名拥有麻醉学委员会认证的心胸麻醉师 和先进的围手术期超声心动图通过完成T32研究奖学金，博士。 Janda已经开始发展围手术期结局研究的专业知识， 临床试验设计。她的长期职业目标是改善对接受心脏和心脏病治疗的患者的护理， 通过更好地理解和避免围手术期终末器官损伤， 环境：UM是多中心围手术期结局组（MPOG）的协调中心， 由50多个拥有围手术期信息系统的机构组成的国际联盟。Sachin Kheterpal博士， 医学博士，工商管理硕士是一个共同的主要导师博士。 医学倡议咨询小组。医学博士丹尼尔克劳是博士的另一个共同主要的导师，是 慢性疼痛和疲劳研究中心主任，密歇根州研究所创始主任， 临床和健康研究。拟议的研究将在她的共同小学的指导下完成 导师，共同导师，包括博士迈克尔Fetters，医学博士，和博士Graciela Mentz，博士，和一个咨询小组， EHR数据研究、混合方法研究和临床试验专家。

ABSTRACT BACKGROUND: Approximately 60,000 patients undergo procedures requiring general anesthesia daily in the U.S., 60% of which require the administration of intravenous vasopressors to counteract general anesthesia- induced cardiovascular depression and low blood pressure (hypotension). Many studies have established the harmful effects of intraoperative hypotension, including myocardial injury, stroke, and acute kidney injury. Vasopressor therapies to treat intraoperative hypotension, specifically the choice between norepinephrine and phenylephrine, are debated vigorously. More studies are needed to better understand vasopressor selection and use and the impact of vasopressor selection on end-organ perfusion outcomes. RESEARCH: The goal of the proposed research is to conduct foundational studies to obtain essential background data and to conduct a pilot clinical trial. The first specific Aim is to perform a quantitative assessment of vasopressor practice patterns and variation across multiple institutions. This data will guide the sampling strategy of Aim 2, which explores attitudes and opinions of clinicians surrounding vasopressor selection at multiple institutions with a mixed methods approach. Aims 1 and 2 inform protocol development of a pilot study which allocates either norepinephrine or phenylephrine as the first-line vasopressor to be used to treat intraoperative hypotension conducted at the University of Michigan (UM) in Aim 3. The proposed research and training will provide Dr. Janda with the skills required to transition to an independent researcher. CANDIDATE: Dr. Allison Janda is a cardiothoracic anesthesiologist with board certification in anesthesiology and advanced perioperative echocardiography at UM. Through completion of a T32 Research Fellowship, Dr. Janda has begun to develop expertise in perioperative outcomes research, assessments of practice variation and clinical trials design. Her long-term career goal is to improve care for patients undergoing cardiac and major, non-cardiac surgery by better understanding and avoiding perioperative end-organ injury. ENVIRONMENT: UM is the coordinating center for the Multicenter Perioperative Outcomes Group (MPOG), an international consortium of over 50 institutions with perioperative information systems. Dr. Sachin Kheterpal, MD, MBA is a co-primary mentor for Dr. Janda, and is the Director for MPOG and member of the NIH Precision Medicine Initiative Advisory Panel. Dr. Daniel Clauw, MD is Dr. Janda’s other co-primary mentor and is the director of the Chronic Pain and Fatigue Research Center and founding director of the Michigan Institute for Clinical and Health Research. The proposed research will be completed under the guidance of her co-primary mentors, co-mentors including Dr. Michael Fetters, MD, and Dr. Graciela Mentz, PhD, and an advisory panel of experts in EHR data research, mixed methods research, and clinical trials.