The Department of Critical Care Medicine’s research enterprise comprises some of the best known and most productive researchers in acute care medicine. Our faculty continues to provide innovation and leadership across the spectrum of critical care, from basic science to clinical trials and outcomes research. Our research activities are grouped into six primary domains: sepsis, resuscitation, computational biology, brain injury, organ dysfunction and support, and health services research. Our research enterprise comprises two large research centers: the Safar Center for Resuscitation Research, and the Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center as well as the new Center for Critical Care Nephrology (CCCN) and several smaller research programs and individual researchers. Our Multidisciplinary Acute Care Clinical Research Organization (MACRO) also performs industry-funded clinical trials and supports many National Institutes of Health (NIH) trials.
Beginning with some of the earliest and still most widely quoted epidemiologic research in sepsis, and extending through to new definitions of sepsis released in February 2016, our scientists researchers are pursuing the basic mechanisms and conducting multicenter clinical trials to test new approaches to improve short- and long-term outcomes for patients with sepsis. We have investigated the genetic and inflammatory profiles of thousands of patients and are studying different approaches to resuscitation, renal and respiratory support, and novel therapies to modify the immune response using either drugs and devices. We have explored therapeutic approaches in the pre-hospital setting, emergency department, and intensive care unit, to manipulate the immune response. We are also leading efforts to bring sepsis care into the age of personalized medicine, and to bring to bear computational biology along with the "omics package" to our translational research.
An important theme in our multidisciplinary department is resuscitation. Several of our investigators are studying resuscitation in various shock states including sepsis, cardiac arrest, trauma and hemorrhage, and organ donation. Furthermore, we have led the field in areas such as functional hemodynamic monitoring, medical emergency teams, and even suspended animation. Our funding for this research has come from diverse sourcing including the National Institutes of Health, Health Resources and Services Administration, Defense Advanced Research Projects Agency, Department of Defense, US Army and Navy, American Heart Association, Laerdal Foundation, Robert Wood Johnson Foundation, and numerous industry partners.
Our scientists are applying some of the most advanced techniques in systems modeling to problems in the field of critical care. We are using sophisticated computer simulations to unravel the mysteries of clinical problems from sepsis and hemorrhagic shock to mechanical ventilation and acute lung injury. Furthermore, we have exciting research programs using complexity analysis of patient vital sign monitoring aimed at developing early warning systems to detect clinical deteriorations in hospitalized patients. Finally, we are using our world-class WISER Simulation Center to study how best to train the next generation of intensivists and how to keep the current generation at the top of their game.
Beginning with the seminal and groundbreaking work of the late Peter Safar, brain injury, both ischemic and traumatic, has been a centerpiece of research within our department. Hypoxic-ischemic encephalopathy remains an incurable disease, and our researchers are studying both the causes of neuronal injury and life-saving treatments including gender specific approaches. Similar work is underway in traumatic brain injury and includes investigation into the mechanisms of cellular energy failure and the effect of novel therapies such as adenosine and other neuroprotective agents. Our investigators are leading multi-center pre-clinical studies funded by the U.S. Army to define new therapies for traumatic brain injury and are carrying out the first multi-center comparative effective study in pediatric traumatic brain injury in the world. Finally, we are seeking to discover ways to improve recovery after brain injury and to reduce caregiver burden.
As critical illness and injury results in a diverse spectrum of organ dysfunction, so too are the research interests of our faculty similary diversified. We have active research programs in brain, lung, heart, kidney, liver, and gastrointestinal dysfunction along with injury consequent to critical illness. Moreover, several of our investigators study the interplay between organ systems in health and disease such as heart-lung and kidney-lung interaction. Since critical care is supportive care, we have some of the world’s leading experts on the use of respiratory, cardiovascular and renal support. We are even studying emotional support in the wake of critical illness. Using applied physiology principles developed over the last 20 years by thought leaders from our department, we have spearheaded an international movement to approach assessment and management of acute cardiovascular insufficiency and acute renal injury. These applications have resulted in several published multi-center clinical trials and one U.S. Air Force-funded air evacuation clinical trial. Finally, we are breaking new ground by looking past the acute care episode and studying how patients recover from critical illness. Recovery from acute illness is largely uncharted territory but critically important for patient well-being. Whether recovering from neurological, respiratory, or renal injury or from immune suppression in sepsis, survival is strongly associated with the extent of recovery.
Our researchers are leading the field in the study of health care delivery, health policy and decision making in acute illness both in adults and children. We are studying novel approaches to organize, manage, and finance the care of acute illness in the United States and abroad using both traditional epidemiological methods and novel methods from sociology, behavioral economics, and the decision sciences. Funded by numerous federal and industry sources we are leaders in the field of comparative effectiveness research in acute illness, using randomized clinical trials, observational studies using electronic medical record data and large administrative datasets to examine strategies to reduce mortality, lower costs, and improve the patient and family experience in the ICU. We are also doing innovative work in the area of quality improvement and patient safety, partnering with health care providers to measure and improve their performance using emerging methods including advanced analytics and “big data.” As part of this line of research, the Department runs the University's Health Services Research Data Center (HSRDC) that enables secure, high-throughput HIPAA-compliant computing for health services research projects making use of large public health datasets. Currently the HSRDC services over 26 projects that represent over $44 million in federal and non-federal funding.
The Department is committed to helping junior faculty members interested in research compete successfully for extramural funding. Senior research faculty members act as mentors. The Department has a formal internal grant review process, which involves peer review of the scientific section and assistance from our pre-award grants administrator with preparation of budgets. This program has been successful in helping our young investigators, as well as our more experienced researchers, to write quality applications with a high probability of funding.