Showing 2 ideas for tag "risks"

Goal 2: Reduce Human Disease

Goal-directed versus Fixed-ratio plasma resuscitation in surgical (non-trauma) hemorrhage

For surgical patients meeting criteria for the critical RBC administration threshold (CAT) due to an associated coagulation disorder, which hemostatic resuscitation strategy (goal-directed versus ratio-based) is superior?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

Perioperative hemorrhage remains a significant concern. Coagulopathy frequently develops in the setting of surgical hemorrhage and the optimal strategy for addressing this issue remains a matter of debate.
Military experience suggests the application of ratio-based plasma transfusion practices may improve clinical outcomes in the setting of massive hemorrhage. However, numerous concerns (e.g. survival bias, uniqueness of a military population, risk for adverse events related to high-volume plasma transfusion) preclude the broad generalization of such strategies to non-trauma surgical populations.
Goal-directed hemostatic resuscitation strategies (e.g. coagulation management based upon the results of hemostasis testing) have shown promise in specific surgical environments such as cardiac surgery and liver transplantation. However, definitive direct comparisons between goal-directed strategies and alternative approaches such as fixed-ratio plasma transfusion have not been performed. Moreover, the role of such strategies in more heterogeneous surgical populations remains uncertain. To better define the optimal approach to plasma transfusion strategies in the setting of intraoperative (non-trauma) hemorrhage, we propose a multicenter clinical trial directly comparing fixed-ratio and goal-directed plasma resuscitation strategies in the operating room environment.

Feasibility and challenges of addressing this CQ or CC

Surgical patients with increased risk of hemorrhage may be targeted to improve subject recruitment (e.g. cardiac surgery, liver transplantation, aortic vascular surgery, multi-level instrumented spinal fusions or tumor resections, etc). Therefore, an adequately sized study population is likely to be present in a multicenter study and we believe such a trial would be feasible with NHLBI support.

To further enhance the feasibility of identifying a surgical population experiencing significant hemorrhage in a time-efficient manner, predictive algorithms such as the critical RBC administration threshold (CAT) could be also be employed.

The optimization of decisions related to plasma transfusion has the potential to improve not only clinical outcomes, but also healthcare resource utilization. Therefore, the outcomes of a trial in this domain could include both patient-important outcomes (e.g. mortality, bleeding complications), as well as outcomes related to healthcare utilization (e.g. total blood products consumed, hospital length of stay).

Name of idea submitter and other team members who worked on this idea Daryl J. Kor, MD and Walter H. Dzik, MD for the 2015 NHLBI State of the Science in Transfusion Medicine.

Voting

11 net votes
30 up votes
19 down votes
Active

Goal 2: Reduce Human Disease

How can we control environmental risks (smoking, obesity, activity levels)?

How can we control environmental risks (smoking, obesity, activity levels)?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

The topic of primary prevention has received considerable discussion by President Obama and others. We certainly support research into vaccinations, tobacco cessation, clean air and other measures to prevent lung disease. In addition, we would like to broaden the discussion to secondary prevention. For example, chronic obstructive pulmonary disease (COPD) affects roughly 10% of people over age 40 years with its victims commonly succumbing to cardiovascular disease and cancer. Although clearly cardiovascular disease and cancer are important topics, we advocate for further research into the underlying lung disease. Similarly, people with sleep apnea are at risk of cardiometabolic complications, but currently more effort is placed on managing the complications than the underlying cause.

Name of idea submitter and other team members who worked on this idea Research Advocacy Committee, American Thoracic Society

Voting

3 net votes
3 up votes
0 down votes
Active