Established in 2021 by Department of Anesthesiology Chair Dr. Matthias Eikermann, the Digital Health Research Lab is comprised of a team of research fellows, a lead data scientist, and clinician scientists. In 2023, Director of Clinical Research Dr. Timothy Pulverteni and Lead Biostatistician Dr. Ibraheem Karaye joined the Digital Health Lab, bringing with them additional passion and expertise in improving health equity and perioperative medicine through research. With the new additions to the team and a newly renovated research space in the Henry and Lucy Moses Research Building, the Digital Health Lab team is in a unique position to continue making strides in retrospective research studies, clinical trials, and quality improvement initiatives.
\r\n\r\nWith its focus on observational research studies, the Digital Health Lab is working on a prolific study that is a follow-up to a 2023 article co-authored by Dr. Eikermann published in The Lancet Respiratory Medicine. Dr. Eikermann and his co-authors propose solutions to minimize sedation in the Intensive Care Unit to improve patients’ long-term outcomes. In the current retrospective study, the Digital Health Lab team is analyzing data for about 10,000 Montefiore Einstein patients who stayed in one of ten ICUs during the 2016 to 2023 period. The goal of the study is to analyze the effect of distress ICU experiences – pain, anxiety, agitation, and coma – on patients’ risk of adverse discharge to a nursing home or in-hospital death.
\r\n\r\nThe researchers’ preliminary findings have shown that neurocognitive distress during ICU experiences are associated with an increased risk of adverse discharge. This provides additional evidence that it is essential to treat patients’ underlying causes of agitation or discomfort while limiting sedation in the ICU.
\r\n\r\n“We have shown that patients in the intensive care unit receive too frequently and too much sedative agents, often for reasons that are not evidence-based,” Dr. Eikermann explained. “Reducing sedation by a symptom control-focused approach will help our patients recover faster and to a more complete level.”
\r\n\r\nThe Digital Health Lab is concurrently focused on a separate retrospective study analyzing the use of postoperative oral anticoagulation drugs to reduce the incidence of new-onset postoperative atrial fibrillation (POAF) on postoperative ischemic stroke after non-cardiac surgery. In partnership with cardiology and surgical colleagues, researchers in the Department of Anesthesiology analyzed a cohort of more than 250,000 patients. They found that for patients who do not receive postoperative anticoagulation medication, POAF is associated with a greater risk of postoperative ischemic stroke one year after surgery.
\r\n\r\nCritical Care Fellow Dr. Omid Azimaraghi, who is the first author on the study, said this research shows that post-operative new-onset atrial fibrillation is a predictable disease. As such, the team developed a prediction tool to identify patients at a high risk of POAF, considering nine preoperative factors. This prediction tool can be used to identify which patients require intensive postoperative monitoring to prevent stroke.
\r\n\r\n“We believe that our findings carry significant implications for the approximately 27 million patients undergoing non-cardiac surgical procedures annually,” Dr. Azimaraghi said. “These patients stand to benefit from intensive monitoring to detect POAF and prompt initiation of oral anticoagulant therapy.”
\r\n\r\nThe Department of Anesthesiology’s clinical research arm also extends to several randomized clinical trials, which are currently underway and managed by Dr. Pulverenti. One of the studies is testing whether suvorexant, a sleeping pill that is an orexin receptor antagonist, improves sleep in the cardiac ICU post-surgery. Through the clinical trial, the researchers are studying if suvorexant can promote sleep in the ICU after cardiothoracic surgery and ultimately reduce delirium in patients.
\r\n\r\nThe Digital Health Lab’s current second clinical trial, known as the PANDORA study, is a multi-center study sponsored by the National Institutes of Health. It is a randomized controlled trial examining the effects of a simple intervention — the administration of IV Tylenol in the ICU — on the incidence and severity of postoperative delirium following cardiac surgery.
\r\n\r\n\"In addition, we are looking at whether using acetaminophen as an alternative to opioids is effective for pain management postoperatively,” Dr. Pulverenti explained.
\r\n\r\nDr. Pulverenti’s role includes protocol development for the clinical trials, submitting documentation to the International Review Boards, and collecting data from patients through interviews and questionnaires. Dr. Pulverenti is also training the Digital Health Lab’s new Clinical Trials Specialist, Rafi Khandaker, who will help coordinate and administer the clinical trials managed by the department.
\r\n\r\nStarting next month, Dr. Pulverenti and other members of the Research Leadership Committee will hold monthly, department-wide research meetings. The committee also consists of Dr. Eikermann, Dr. Karaye, Research Fellow Dr. Maira Rudolph, Vice Chair of Perioperative Medicine Dr. Philipp Fassbender, Director of IT Innovation Dr. Ling Zhang, Attending Anesthesiologist Dr. Jerry Chao, and Attending Anesthesiologist Dr. Michael Kiyatkin. During the monthly meetings, committee members will present updates on the department’s research projects and encourage faculty and trainees to get involved in new research initiatives.
\r\n\r\n“We’re working to make the department’s research footprint even larger and to secure additional funding from both foundations and government agencies to continue to do high-quality research in perioperative care,” Dr. Pulverenti said.
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