Precision Resuscitation with Crystalloids in Sepsis (PRECISE trial)
Topic
Precision Resuscitation with Crystalloids in Sepsis (PRECISE trial)
Video Recording
Speaker
Sivasubramanium Bhavani, MD, MS, Emory University
Dr. Bhavani is a Pulmonary and Critical Care physician-scientist dedicated to applying machine learning to routine bedside measurements to identify precision approaches to sepsis. His interest in routine dynamic bedside measurements in sepsis started with body temperature. Although temperature is measured every four hours in all hospitalized patients, no one had previously applied machine learning algorithms to longitudinal temperature measurements to identify sepsis subgroups (i.e., temperature trajectories). His novel work on temperature trajectories in sepsis resulted in leading several multi-institutional collaborative projects and setting the foundation for multiple independent lab groups applying his innovative methodology. The temperature trajectory work has changed the paradigm for informatics research on body temperature in sepsis and provided an innovative framework that has been adopted by many scientists.
The temperature trajectory work led to an NIH Career Development Award, in which Dr. Bhavani discovered the vitals trajectory subphenotypes as a tool to guide a precision medicine approach to sepsis. His work on vital signs and dynamic subphenotypes has led to first-author publications in JAMA, Intensive Care Medicine, American Journal of Respiratory and Critical Care Medicine, Critical Care Medicine, and CHEST. Dr. Bhavani is collaborating with the Emory Digital Office to integrate the vitals trajectory algorithm into the electronic medical record (i.e., EPIC) in preparation for the Precision Resuscitation with Crystalloids in Sepsis (PRECISE) trial, set to launch later this year.
Featured Discussant
Derek Angus oversees UPMC’s clinical research, implementation science and data analytics, with a particular emphasis on UPMC’s learning health system initiatives. He also is associate vice chancellor for Healthcare Innovation at the University of Pittsburgh Schools of the Health Sciences. He is a distinguished professor and holds the Mitchell P. Fink Endowed Chair in Critical Care Medicine at the University of Pittsburgh, with secondary appointments in Medicine, Health Policy and Management, and Clinical and Translational Science. Since 2008, Dr. Angus has served as chair of the Department of Critical Care Medicine. Since 2015, he also has been the physician director of the UPMC ICU Service Center, responsible for the provision of ICU services across the 30-plus hospital system. He also is a senior editor at JAMA.
Dr. Angus is a world-renowned clinical, translational and health services researcher. His research interests include clinical, epidemiologic and translational studies of sepsis, pneumonia and multisystem organ failure as well as health services research of the organization and delivery of critical care services. Dr. Angus is a leader in developing and evaluating approaches to facilitate smarter decision making and faster learning in health care, including novel Bayesian adaptive platform trial designs, the application of machine learning to large-scale data, and the use of behavioral economics and decision psychology to support optimal decision making. He has led numerous NIH-funded multicenter studies, written several hundred papers and is a Clarivate Highly Cited Researcher.
Session Description
The Precision Resuscitation with Crystalloids in Sepsis (PRECISE) trial is a pragmatic, single-blinded, patient-level randomized controlled trial that will be conducted across the Emory Healthcare system, including tertiary academic, hybrid academic-community, and community hospitals. In the PRECISE trial, the team will apply their machine learning algorithm to identify a subset (Group D) of patients and randomize them to usual care or intervention, an electronic health record (EHR)-alert that nudges clinicians to use balanced crystalloids instead of normal saline, to evaluate a potential reduction in a 30-day mortality rate.