Transfusion lung injury, ICU Health Systems.
Transfusion and Lung Injury (NIH SCCOR Grant to UCSF.
Principal Investigator for Project 2). This was one of only two SCCOR grants funded by the NIH ($16M over 5 years) to study the epidemiology, predictors, and mechanisms of transfusion related lung injury (TRALI). It includes a sophisticated tracking system to determine incidence, Intraoperative and ICU measurements of pulmonary function after transfusion, an animal model of TRALI, and basic investigations of neutrophil function in TRALI. I am responsible for the clinical portion, which includes work at both UCSF and the Mayo Clinic Rochester. A unique and challenging feature of the study looks at the effects of blood storage on lung function in healthy volunteers. We continue enrollment in the intraoperative portion of Project 2, which analyzes the pulmonary effects of transfusion in patients undergoing spine surgery. We hope to identify strategies to reduce the risk of lung injury in these patients, and identify neutrophil priming events. TRALI is now recognized as the leading cause of transfusion-related mortality, so this study has important implications for improving patient outcomes.
Reducing Variation in Resource Utilization: Participating Investigator (PI at UCSF)
PI: Michael Ong, MD (UCLA)
This is a study funded by the California Healthcare Foundation examining variability in utilization of ICU resources across the UC hospitals and Cedars Sinai Medical Center. I am a participating investigator, and the only intensivist on the project. We have developed a strategy to focus on congestive heart failure patients, and our first major publication is in revision in Circulation. UCSF has been identified as a superior performer in ICU utilization, and we are identifying the unique characteristics of the ICU’s at UCSF when compared to UCLA and others. We also challenge the commonly held beliefs of the Dartmouth Atlas that additional resource utilization in the last 6 months of life represents futile care. We will identify best practices that combine both quality care and efficient resource utilization.
Savel RH, Goldstein DO, Gropper, MA. Critical care checklists, the Keystone Project, and the Office for Human Research Protections: A case for streamlining the approval process in quality-improvement research. Crit Care Med; Jan;37(2):725-34, 2009.
Lipshutz AKM, Fee C, Schell H, Campbell L, Taylor J, Sharpe BA, Nguyen J, Gropper MA. Strategies for Success: A PDSA Analysis of Three QI Initiatives in Critical Care. Joint Commission Journal on Quality and Patient Safety; 34(8):435-444, 2008.
Lipshutz AKM, Gropper MA. Perioperative Glycemic Control: An Evidence-based Review. Anesthesiology; Feb;110(2):408-21, 2009.