Dr. Alexander Nagrebetsky’s Research Team
Email: anagrebetsky@mgh.harvard.edu
Overview
Dr. Nagrebetsky’s team conducts large-scale clinical and epidemiological studies on the incidence, clinical course, and prevention of perioperative pulmonary complications. Dr. Nagrebetsky has led the development of national and international guidelines on preoperative fasting as an intervention to prevent perioperative pulmonary aspiration. His team is quantifying the harm associated with aspiration and the potential side effects of the nearly universally excessive clear-liquid fasting.
Research Projects
The Million Anesthesia Cases Study (MACS)
The Million Anesthesia Cases Study, an APSF-funded project, addresses emerging concerns that preoperative clear liquid fasting is almost universally excessive and may be unnecessary. Such concerns have led to some hospitals abolishing clear liquid fasting in violation of societal guidelines. The MACS study aims to estimate the incidence and severity of prolonged preoperative fasting for clear liquids in a large and diverse sample of clinical settings, procedures, and patients. The researchers use these data to quantify adherence to the national guidelines and to test for an association between the duration of preoperative clear liquid fasting and (a) perioperative volume- and glycemia-related events and (b) the risk of perioperative pulmonary aspiration.
FEEDS Trial: Preoperative fasting vs. not fasting in critically ill patients
Dr. Nagrebetsky leads a large, pragmatic, multicenter clinical trial, conducted at 21 sites nationwide, that assesses the comparative effectiveness of two prevalent yet conflicting preoperative clinical practice patterns. Preoperative fasting in critically ill patients with a secure airway is common, but its utility and safety have been questioned. The FEEDS trial is designed to address the evidence gap in prevention of perioperative pulmonary aspiration in the critically ill and inform future practice guidelines.