Avidan and members of the ENGAGES team are awarded NIH grant
Oct 28, 2014
The Electroencephalograph Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) Study has been awarded a one-year $483,487 UH2 (1UH2AG050312-01) grant from the National Institute on Aging (NIA), with a possibility of receiving another four years of funding.
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. In a recent survey of 1,000 surgical patients, INQUIRI found that over 30% of respondents were worried about experiencing delirium. Delirious patients are unable to participate effectively in rehabilitation exercises and are susceptible to falls and other geriatric syndromes.
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 intervention to prevent or treat postoperative delirium and its sequelae.
There is mounting evidence that electroencephalography guidance of general anesthesia can decrease postoperative delirium. Specifically, INQUIRI 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 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. INQUIRI expects to determine the impact of the anesthetic protocols on patient reported outcomes of health-related quality of life.
INQUIRI has 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 enables the assessment of the consequences of postoperative delirium and the ability to determine whether anesthetic management can impact patient reported outcomes, such as health-related quality of life. In addition, the study will also measure the effectiveness of a multi-component safety intervention for delirious patients to prevent downstream adverse events, like falls.
The ENGAGES team consists of Michael Avidan, Dan Emmert, Will Godfrey, TJ Graetz, Rocco Huneke, Sharon Inouye, Eric Lenze, Nan Lin, Hannah Maybrier, Sherry McKinnon, Spencer Melby, Maxwell Muench, Eva Schmitt, Susy Stark, Tracey Stevens, Brian Torres, Troy Wildes and Anke Winter.
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