Recovery from surgery can be challenging, even for patients in the best of health. Elizabeth Mahanna Gabrielli, M.D., an Associate Professor of Anesthesiology and researcher at the University of Miami Miller School of Medicine, wants to improve quality of life for patients undergoing surgery by preventing a common side effect, delirium.
“Delirium can be considered acute brain failure,” says Dr. Mahanna Gabrielli. “It can present as inattention, the inability to focus, lethargy, restlessness or even hallucinations.” Although it’s a temporary state lasting anywhere from two days to two weeks, delirium can be frightening for patients and their families.”
The memories a patient makes in a delirious state are real memories, says Dr. Mahanna Gabrielli. “When they hallucinate, if they are not sure where they are, if they think healthcare providers maybe are trying to hurt them, they remember that fear later. Patients can experience posttraumatic syndrome.”
Medical risks of delirium include increased risk of hospital-acquired infection, increased risks of fall, prolonged time in the intensive care unit, and long-term cognitive impairment, she says.
In her previous work as a National Institutes of Health T32 research fellow at the University of Pennsylvania, Dr. Mahanna Gabrielli focused on the role of frailty and genetic influences on the occurrence of postoperative delirium. Her recent work, supported by a Miami CTSI Pilot Award, looks at the role of altered sleep patterns in the development of delirium after surgery.
The body of research on delirium is vast, but does not reflect a diverse patient population, says Dr. Mahanna Gabrielli. Her CTSI pilot study is a first step in broadening the understanding of factors that increase risk of delirium for Hispanic and Latino patients.
Alberto Ramos, M.D., M.S.P.H., M.S., Professor of Neurology and Research Director of the Sleep Disorders Program at the Miller School, is a mentor to Dr. Mahanna Gabrielli. His previous research shows that Hispanic and Latino patients have a much higher risk of sleep disturbances and abnormal sleep patterns, compared to non-Hispanic white patients. Building on that work, Dr. Mahanna Gabrielli wants to find out if sleep patterns are associated with delirium.
“Sleep patterns are a risk factor I’m interested in because it’s something we can intervene upon,” says Dr. Mahanna Gabrielli. “My ultimate goal is to do an interventional trial where we would look at trying to strengthen the circadian rhythm and improve sleep patterns in order to reduce the incidence of delirium after the surgery.”
The CTSI pilot study was done to assess the feasibility of further research, says Dr. Mahanna Gabrielli. Working through the pandemic, she learned valuable lessons about how best to design her study, and she discovered connections that provide the foundation for deeper exploration.
Her team also discovered that sleep disturbances are very common in older Hispanic/Latino patients who are preparing to undergo heart surgery, more so than those who are not planning surgery.
“We were able to identify novel sleep metrics that can be used as intervention targets to prevent delirium in this high risk and understudied population,” says Dr. Ramos. “It has been gratifying to see Dr. Mahanna Gabrielli’s work come to fruition, and I look forward to seeing its evolution in coming projects.”
Using the data gathered from the CTSI pilot study, Dr. Mahanna Gabrielli plans to apply for an NIH Career Development (K) Award that would fund a larger study on sleep patterns and delirium in Hispanic and Latino patients.
Dr. Mahanna Gabrielli is also enrolled in the Master’s in Clinical and Translational Investigation, a graduate program designed by the CTSI to deliver individualized curriculum to its participants. “This program is unique in that it’s very specific for clinical researchers and translational researchers,” says Dr. Mahanna Gabrielli. “We’ve had courses on how to conduct a clinical trial, and team building, and research reproducibility.”
Involvement with the CTSI has also provided Dr. Mahanna Gabrielli, who joined the University of Miami in 2019, with invaluable resources and connections, she says. “Networking and making connections with different researchers and mentors at UM has greatly helped me to see my path towards success.”