Optimizing Vasopressor Delivery in Early Sepsis - PROJECT SUMMARY Candidate’s Long-Term Career Goal. Dr. Munroe’s goal is to become an independent physician-scientist leading clinical trials to improve sepsis survival and recovery. Through the training outlined in this F32 award, she will gain the skills necessary to perform advanced statistical analyses, conduct randomized surveys, and begin to design and develop clinical trials, which will be instrumental in her achieving this goal. Clinical Problem to be Addressed. Sepsis is a major cause of mortality and morbidity, leading to 1 in every 2 to 3 hospital deaths in the US and causing long-term impairment for many survivors. Vasopressors are broadly recommended to treat the most severe form of sepsis, septic shock, but the most effective method(s) for delivering vasopressors is unclear. Dr. Munroe’s early work has shown that there is wide variation in hospital policies on vasopressor administration routes and revealed that there is a lack of systematic knowledge about how vasopressors are administered in practice and how variation in these practices affects patient outcomes. Candidate Background. Dr. Munroe is a clinical Pulmonary and Critical Care fellow at the University of Michigan (U-M). She received her MD with Alpha Omega Alpha honors (2016), completed Internal Medicine residency (2019), and was selected to serve as Chief Resident (2019-2020) at the University of Chicago. She was recruited to U-M for fellowship in 2020, where she has begun to develop expertise in early sepsis management and vasopressor practices, with 4 first-author publications and 2 national conference presentations. Her Department has a strong commitment to supporting her academic career, including selecting her to join a T32 grant in June 2022. She is currently completing a Master’s in Health Care Research. Career Development Plan. Dr. Munroe proposes building on her early research experience and Master’s training to develop expertise in multi-level modeling, risk-adjustment, and survey design, as well as to pursue preliminary training in clinical trial development. Mentors. Her primary mentor is Dr. Hallie Prescott at the U-M, who has mentored 3 clinician-scientists on K awards. Dr. Munroe and Dr. Prescott have an excellent track record of success, working together since 2020. Aims. In the first aim, Dr. Munroe will assess practice patterns, outcomes, and complications of vasopressor administration routes in sepsis using two complementary, multi-hospital datasets—the NHLBI-funded CLOVERS trial and a diverse 69-hospital Michigan registry. In the second aim, she will expand on these findings by conducting a national randomized clinical vignette survey of ICU providers to determine factors associated with provider decisions about vasopressor administration. Deliverables for Aims. Dr. Munroe’s aims will lead to 2-3 first-author publications yearly and representation at 2 national conferences per year. The results will serve as pilot data for her K23 application, which will focus on conducting a pilot trial to optimize vasopressor delivery in early sepsis.
