Goal-directed decision support system for treating perioperative fluid deficits

描述（由申请人提供）：用于治疗围手术期液体不足的目标导向决策支持系统胃肠道、心脏和骨科手术可导致显著的血液和液体损失。围手术期液体流失的不当补充会导致并发症，从而增加住院时间，几乎使护理费用增加一倍。目标导向液体疗法（GDFT）是一种以证据为基础、经过验证的优化液体疗法和改善临床结果的方法。不幸的是，对麻醉师和同行评议出版物的多项调查表明，GDFT并未广泛实施，也不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来优化液体疗法。我们假设，我们的算法决策支持系统将提供更精确的管理围手术期液体流失和提高临床工作流程。这种方法在改善外科护理和术后恢复以及降低医疗费用方面具有很大的潜力。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，后者仍然主要基于直觉和“目测”生命体征。该项目有两个目的：1)开发一个综合的目标导向决策支持系统（GDDSS）来治疗围手术期体液不足；2)评估GDDSS的可用性和工作流程。该集成系统将把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连接起来。平板电脑将生成实时建议，并将趋势图形覆盖生理变量与流体治疗，从而提供独特和直观的视觉辅助

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.