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Dr. Samuel A. Tisherman to receive 2009 American Heart Association Lifetime Achievement Award in Trauma Resuscitation Science.
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Dr. Samuel A. Tisherman to receive 2009 American Heart Association Lifetime Achievement Award in Trauma Resuscitation Science.
In recognition of his years of leadership, service, and contributions to trauma resuscitation science, the American Heart Association has selected Dr. Sam Tisherman as the 2009 recipient of their Lifetime Achievement Award in Trauma Resuscitation Science.
Dr. Tisherman is an Associate Professor in the Departments of Critical Care Medicine and Surgery and Associate Director of the Safar Center for Resuscitation Research at the University of Pittsburgh School of Medicine. He completed medical school, a general surgery residency, and a surgical critical care fellowship at the University of Pittsburgh. He is board certified in Surgery and Surgical Critical Care. He has been a faculty member since 1994. Clinically, he is the Director of the Neurotrauma ICU at UPMC Presbyterian Hospital. He is heavily involved in educational programs for medical students, residents, and critical care fellows. He has been the Director of the Surgical Critical Care Fellowship since 1996. His laboratory research, which began when he was a medical student working with Dr. Peter Safar, has focused on novel approaches to management of severe hemorrhagic shock and cardiac arrest, with a special interest in therapeutic hypothermia. Along with Drs. Peter Safar and Pat Kochanek, he has worked on the development of Emergency Preservation and Resuscitation (EPR), a novel approach to the management of the exsanguinating trauma patient utilizing hypothermia to “buy time” for resuscitative surgery. He is currently planning a clinical trial of EPR. He is also involved in several other trauma-related clinical trials.
The Award will be presented during the 7th annual Resuscitation Science Symposium in Orlando, Florida, on Sunday, November 15.
http://scientificsessions.americanheart.org/portal/scientificsessions/ss/resssunday2009
Congratulations to Dr. Tisherman for this prestigious award!
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Title: |
Preload responsiveness is associated with increased interleukin-6 and lower organ yield from brain-dead donors |
Authors: |
Murugan R, Venkataraman R, Wahed AS, Elder M, Carter M, Madden NJ, Kellum JA, on behalf of HIDonOR Study Investigators. |
Author comments
and Summary: |
In the August 2009 issue of Critical Care Medicine, Drs Murugan et al. published an observational study involving resuscitation of brain dead organ donors. They concluded that preload responsiveness is common in brain-dead organ donors and is associated with higher inflammatory response and lower organ yield. They further noted that a controlled trial of preload optimization is warranted in brain-dead donors.
Following their earlier observation that higher inflammatory response in brain dead donors is associated with lower organ yield and shorter hospital-free recipient survival after transplantation, Dr Murugan and colleagues hypothesized that hemodynamic instability and inadequate donor resuscitation may contribute to a persistent pro-inflammatory state that could adversely affect organ function and number of organs recovered for transplantation. Therefore, they investigated whether a state of volume responsiveness is associated with increased inflammation and decreased organ yield per donor. Their observations support the notion that hypovolemia in deceased donors might aggravate the systemic inflammatory response following brain death.
Given that overzealous fluid administration could compromise cardiopulmonary function in some donors, accurate identification of who needs additional fluids and who does not is paramount. Conventional cardiovascular monitoring tools, such as central venous pressure and pulmonary artery occlusion pressure, may not provide an accurate assessment. Therefore, by using a very sensitive functional hemodynamic monitoring technique (Pulse Pressure Variation- a parameter that effectively predicts fluid responsiveness if greater than 13%), they show that inadequate resuscitation of organ donors is associated with higher inflammatory response and subsequent lower organ yield for transplantation. The potential ramification of their observations is that appropriate fluid resuscitation in deceased donors could decrease systemic inflammation and result in increased organ recovery.
Hemodynamic instability of organ donors is one reason for the limited number of organs procured per donor and carefully titrated fluid resuscitation can improve tissue perfusion, avoid organ edema, and has the potential to increase organ yield for transplantation. Based on the above study the investigators are conducting a large multicenter randomized controlled trial named “Monitoring Organ Donors to Improve Transplantation Results (MOnIToR)”, involving 960 organ donors from 9 organ procurement organizations throughout the US beginning this month. This study is being coordinated by the CRISMA laboratory in the department of critical care medicine at University of Pittsburgh. The investigators have hypothesized that if they optimize hemodynamics in brain death organ donors using pulse pressure variation then they can increase the quality and number of organs recovered and subsequently transplanted.
Correspondence: kellumja@upmc.edu |
| Source: |
http://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2009&issue=08000&article=00009&type=abstract |
| Links: |
https://crisma.upmc.com/MonitorStudy/default.asp |
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Pediatric Neurotrauma Center Annual Report outlines impressive accomplishments in research, clinical care, education, and advocacy
 Led by Dr. Michael J. Bell, the Pediatric Neurotrauma Center (PNTC) has released its 2009 annual report. Alongside impressive accomplishments in clinical care, education, and advocacy, the PNTC has also had a very successful research portfolio.< br />
The ongoing research within the PNTC continues to be the most extensive body of clinical research in childhood head injury across the country. Dozens of important projects are ongoing, including the only interventional study in childhood traumatic brain injury within the US (Pediatric Traumatic Brain Injury Consortium: Hypothermia, or “Cool Kids”). Two ancillary studies to this trial were approved by the Cool Kids Steering Committee and the DSMB, including measuring the effect of hypothermia on drug metabolism (Drs. Poloyac and Empey) and determining the effect of trauma on nutritional requirements (Dr. Rebecca Smith).
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American Thoracic Society highlights end-of-life research by Dr. Douglas White
Dr. Doug White is our Department’s newest recruit, and is the Director of the Program on Ethics and Critical Care Medicine at UPMC.
An August 2009 news release by ATS highlighted important research by Dr. White and colleagues, which found that there is no consensus among surrogates about whether physicians should routinely provide a recommendation regarding life support decisions for incapacitated patients. These findings suggest that physicians should ask surrogates whether they wish to receive a recommendation regarding life support decisions and should be flexible in their approach to decision-making.
ATS news release
Journal Link
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Drs. Jenkins, Dixon, and Kochanek co-edit Special Focus Issue of the Journal of Neurotrauma
Focusing on blast-induced traumatic brain injury and polytrauma, Drs. Jenkins, Dixon, and Kochanek of the Safar Center for Resuscitation Research co-edited the June 2009 issue of the Journal of Neurotrauma. They collaborated with Drs. Richard Bauman and Joseph Long from the Walter Reed Army Institute of Research on this issue, which featured several articles from the unique DARPA-funded PREVENT blast program.
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Pediatric CCM Divison to hold 4th annual Faculty Research Day on July 13
The Pediatric CCM Division will be holding its 4th annual Faculty Research Day, on Monday, July 13th in the PCCM Conference Room, 5th floor, Children’s Hospital of Pittsburgh, from 11:30am to 4:30 pm. The objective of this event is to inform new fellows about research and research-related educational opportunities from within the division. Following an introduction to the research environment by Dr. Patrick Kochanek, faculty will briefly highlight their research along with time for discussion. Lunch is provided and the event is open to all. For further information, please contact Dr. Ericka Fink at finkel@upmc.edu.
http://www.ccm.upmc.edu/clinical/pediatric.html
The full agenda
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JAMA editorial by Dr. John Kellum asks “International Differences in the Treatment of Sepsis – Are They Justified?”
In the June 17, 2009 issue of JAMA, Drs. John A. Kellum and Shigehiko Uchino, published the accompanying editorial to the EUPHAS trial, a preliminary, multicenter “blood purification” trial that tested the effectiveness of polymyxin B hemoperfusion for abdominal septic shock. They note that while treatment for acute myocardial infarction is similar in New York City and Tokyo, treatment of sepsis varies considerably, with hemoperfusion unavailable in New York City, but commonly given in Tokyo.
Kellum and Uchino further argue that the EUPHAS trial was prematurely and inappropriately stopped when the president of the trial’s ethics committee “declared it unethical to deprive a potentially beneficial therapy to a group of patients that carry high mortality." They reason that (1) EUPHAS was not designed as a definitive trial with a patient-centered endpoint, (2) the primary endpoint of EUPHAS was hemodynamic stability, not mortality, (3) the statistical difference for mortality would disappear if one patient had had a different outcome, (4) the EUPHAS investigators themselves concluded that “larger multicenter studies are indicated to confirm these encouraging findings in other patient populations”, and (5) “by failing to provide a definitive answer to the question of whether polymyxin B hemoperfusion is life saving, the oversight board has deprived millions of patients around the world of this therapy because few, if any, regulatory agencies would permit these results to be used for product approval.”
They conclude by offering a different ethical perspective, noting that “willful ignorance of the true effect of polymyxin B hemoperfusion, whatever it is, is unethical”, and that “to keep this promising therapy in the shadows of opinion and insufficient evidence would be to withhold potentially beneficial treatment from patients deprived of it, should it be effective, or to put patients at risk, should it be harmful.” Kellum and Uchino lastly note that “a much higher standard of evidence is necessary prior to declaring that further study of medical therapy is unethical”, and that “premature declaration of certainty serves to curtail the discovery of truth, and only by discovering the truth can the best care be provided for patients from Tokyo to New York and everywhere else.”
http://jama.ama-assn.org/cgi/content/full/301/23/2496
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| Dr. Rajesh Aneja presents heat shock response research at SHOCK society conference
At the June 2009 SHOCK society meeting in San Antonio, Texas, Dr. Rajesh Aneja delivered an oral presentation of his research on heat shock response. The session was moderated by Antonio De Maio, Ph.D., University of California San Diego and David Herndon, M.D., University of Texas Medical Branch Shriners Burns Hospital, Galveston, TX. Dr. Aneja and colleagues’ work focused on an enzyme called PARP-1.
Poly (ADP-ribose) polymerase-1 (PARP-1) is a highly conserved multifunctional enzyme, and its catalytic activity is stimulated by DNA breaks. Excessive PARP‑1 activation, subsequent depletion of nicotinamide adenine dinucleotide (NAD+) and adenosine triphosphate (ATP) constitutes a major cytotoxic pathway in inflammatory pathologies of diverse etiologies. On the contrary, induction of heat shock response and production of heat shock protein 70 (HSP-70) is a cytoprotective defense mechanism in inflammation. In Dr. Aneja and colleague’s study they showed that PARP-1 plays a pivotal role in modulating the heat shock response both through direct interaction with HSF-1 and poly (ADP-ribosylation).
http://www.shocksociety.org/shock2009/index.html
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CCM Research Fellows, Staff + Faculty mix volleyball and research
Taking advantage of recent good weather in Pittsburgh, Research Fellows, Staff, and Faculty have been taking volleyball breaks in Highland Park, a city area a few miles from the University of Pittsburgh. Data regarding who scored the most points are unclear at this time – future study and games are clearly indicated.
1st row (left to right):
Thomas Rimmele, mentor: John Kellum, research area: Extracorporal therapies in septic shock
Stephanie Millot, mentor: Paul Bocuse, research: Nouvelle cuisine
Florian Mayr, mentors: Sachin Yende & Derek Angus, research: Racial disparities in infection and sepsis
Judith Rella, mentor: Murat Kaynar, research: Matrix-metalloproteinases in sepsis
2nd row (left to right):
Xiaoyan Wen, mentor: John Kellum, research: Recovery from acute kidney injury
Yen-Lan Nguyen, mentors: Eric Milbrandt & Derek Angus, research: Volume-outcome relationships in critical illness
Zhiyong Peng, mentor: John Kellum, research: Hemoadsorption in sepsis
Nattachai Srisawat, mentor: John Kellum, research: Recovery from acute kidney injury
3rd row (left to right)
Hernando Gomez, mentors: Michael Pinsky & John Kellum, research: Functional hemodynamic monitoring, acid base models for outcome prediction
Jeff Bishop, lab technician in Kai Singbartl’s lab, makes everything work
John Kellum, Captain
Hongzhi Wang, mentor: John Kellum, research: Acute kidney injury
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Dr. Derek Angus to Co-Chair International Sepsis Forum 2009 Symposium
 Dr. Derek C. Angus will Co-Chair the November 2009 ISF Sepsis 2009 Symposium, with Dr. Tom van der Poll of the University of Amsterdam. The Symposium will be held in Amsterdam.
This year’s event will focus on: The Brain, Coagulation, Endocrine Dysfunction, Toll-like Receptors in Sepsis, and Critical Illness with an in-depth Update on Current Clinical Trials.
Several Pitt CCM Faculty are scheduled to present, including Drs. Hulya Bayir, Matthew Rosengart, and Mitchell Fink. The preliminary program and more information can be found here:
http://www.sepsisforum.org/conferences/sepsis/sepsisprogram.htm
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Mission of the Department of Critical Care Medicine is
to provide exemplary care for critically ill patients,
conduct cutting edge research related to life-threatening
acute medical problems, and educate tomorrow’s
leaders in the field of critical care medicine.