Critical Care/Quality Improvement

CRITICAL CARE ANESTHESIOLOGY

PROJECT TITLE: Correlation of Hemoglobin Point-of-Care Testing and Serum Hemoglobin
PROJECT FACULTY: Allison Dalton, MD
PROJECT DESCRIPTION:
We seek to determine the correlation between the point-of-care measures of hemoglobin in the ORs and serum hemoglobin run in the lab at hemoglobin concentrations around the transfusion threshold. We will also consider how time from collection to running the sample changes the concentration of the hemoglobin measured by point-of-care devices.

PROJECT TITLE: Argatroban Dose Requirements in Critically Ill Patients with Heart Failure
PROJECT FACULTY: Allison Dalton, MD
PROJECT DESCRIPTION:
The primary outcome is to study the dose of argatroban at the time of the first two consecutive therapeutic activated partial thromboplast in times (aPTTs) in patients with heart failure and reduced ejection fractions compared to those without heart failure. Secondary outcomes are the percentage of aPTTs that are therapeutic, time to therapeutic aPTT, incidence of bleeding on or within the first 24 hours of discontinuation of argatroban, and the incidence of mortality associated with bleeding/thromboembolism or with other causes.

PROJECT TITLE: Observational Study Evaluating the Hemodynamic Relationship Between Volume Removal and Pulse Pressure Variation During Renal Replacement Therapy
PROJECT FACULTY: Aalok Kacha, MD
PROJECT DESCRIPTION:
Assessing the intravascular volume status of ICU patients is a continuous challenge in the management of their fluid balance. Despite the importance of this evaluation, there is no single objective measure to guide the clinician. Traditionally, fluid balance has been guided blood pressure, heart rate, pulmonary examinations, skin turgor, capillary refill, urine output, and chest radiograph. Dynamic indices of volume responsiveness are vastly superior to invasive pressure measurements (central venous pressure, pulmonary capillary wedge pressure) for the management of hypovolemic shock in mechanically ventilated patients. Pulse pressure variation (PPV) reflects the slope of the Starling curve at the patient’s current intravascular volume. We hypothesized that PPV may also guide volume removal during continuous venovenous hemofiltration or intermittent hemodialysis. We are conducting an observational study of patients undergoing renal replacement therapy to evaluate the utility of PPV in predicting negative fluid balance.

QUALITY IMPROVEMENT