Beth Israel Deaconess Medical Center

Brown SM, Rozenblum R, Aboumatar H, Fagan MB, Milic M, Lee BS, Turner K, Frosch DL. Defining patient and family engagement in the intensive care unit. Am J Respir Crit Care Med. 2015 Feb 1;191(3):358-60.

This project is part of a multi-pronged effort, funded by the Gordon & Betty Moore Foundation, to improve patient safety in the intensive care units. At present the effort has generated multiple separate research projects: one focusing on engaging patients and families in the ICU; another that identifies the factors that create a 'risky state' for the patient in the ICU; and others examining end-of-life care in the ICU. This work crosses disciplines between anesthesia and medicine, and relies on a team of physicians, nurses, systems experts, IT, and patient safety experts to share best practices in the elimination of preventable harm and critical care quality.

C. Buettner, R. Nir, S. Bertisch, C. Bernstein, A. Schain, M. Mittleman and R. Burstein. Simvastatin and Vitamin D for Migraine Prevention: A Randomized, Controlled Trial. Annals of Neurology 2015 78:970-981

It is the first study to show that simvastatin plus vitamin D is effective for prevention of headache in adults with episodic migraine. Given statins’ ability to repair endothelial dysfunction, this economical approach may also reduce the increased risk for vascular diseases among migraineurs.

Fish E, Novack V, Banner-Goodspeed VM, et al. The Esophageal Pressure-Guided Ventilation 2 (EPVent2) trial protocol: a multicentre, randomised clinical trial of mechanical ventilation guided by transpulmonary pressure. BMJ Open 2014;4:e006356.

This project investigates the efficacy of using esophageal manometry to guide mechanical ventilation in patients with early, moderate-to-severe Acute Respiratory Distress Syndrome, as compared to an empiric high PEEP strategy. We hypothesize that individual variations in pleural pressure are best managed by using patient-specific esophageal pressure measurements to deliver the amount of PEEP required for these critically ill patients. The pilot data from our single-center study were strong (Talmor D, Sarge T, Malhotra A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med 2008;359:2095–104.); this larger multi-center extends the investigation across 15 centers in the US and Canada. Trial completion is expected in 2016.

Matyal R, Mitchell JD, Hess PE, Chaudary B, Bose R, Jainandunsing JS, Wong V, Mahmood F. Simulator-based transesophageal echocardiographic training with motion analysis: a curriculum-based approach. Anesthesiology. 2014 Aug;121(2):389-99.

This Project utilized novel kinematic metrics to demonstrate the progression of skills for echo-naive anesthesiology trainees. 18 subjects were evaluated weekly during a 4 week intensive TEE training course that incorporated both online didactics and simulator-based training in twice weekly sessions. Peak movements and path length were both independent predictors of proficiency (P < 0.01) by multiple regression analysis. Trainees in their first week of the course had longer path length (637 mm [312 to 1,210]) than that of experts (349 mm [179 to 516]); P < 0.01. First week trainees also had more peak movements of the probe (17 [9 to 29]) than did experts (8 [2 to 12]); P < 0.01. Eight additional trainees underwent clinical assessment on performance of intraoperative TEE examinations. Compared with experts conducting exams in the same patients, novice trainees required more time (199 s [193 to 208] vs. 87 s [83 to 16]; P = 0.002) and performed more transitions throughout the examination (43 [36 to 53] vs. 21 [20 to 23]; P = 0.004). Simulator trained residents performed exams of moderate quality in the operating room and required more time and more transitions to complete the examination. Related projects demonstrate similar results for other cohorts of learners and effective knowledge transmission via online training modules.

Subramaniam B, Khabbaz KR, Heldt T, Lerner AB, Mittleman MA, Davis RB, Goldberger AL, Costa MD. Blood pressure variability: can nonlinear dynamics enhance risk assessment during cardiovascular surgery? J Cardiothorac Vasc Anesth. 2014 Apr;28(2):392-7.

Dynamic markers of intraoperative instability

We propose to analyze continuous BP fluctuations by using computational tools from nonlinear systems theory and relating these measures to Major Adverse Events. This variability will be used to define a novel BPV index, a promising first, real-time risk index. An accurate, dynamic risk stratification approach based on the individual patient’s own baseline and evolving pathophysiological characteristics may lead to better risk scoring systems and help physicians plan optimal clinical strategies.