Nilesh Mehta, MD

Department	Anesthesia Critical Care Medicine Pediatric Critical Care Nutrition
Hospital Title	Associate in Critical Care Medicine
Academic Title	Assistant Professor of Anaesthesia, Harvard Medical School
Phone	617-355-7327
Fax	617-730-0453
Email	Nilesh Mehta
Location	300 Longwood Avenue Boston, MA 02115 Bader 634

Research Overview

His research focuses on the nutritional and metabolic aspects of critical illness in children. Currently involved in studies that:

a) examine current nutritional practices in the pediatric intensive care unit (PICU) and identify barriers that hinder optimal nutrient intake in this population;

b) measure resting energy expenditure and describe metabolic status of children during their PICU course and

c) investigate accurate bedside measures of body composition during critical illness.

Publications

• Mehta, N., Bechard, L., Leavitt, K., Duggan, C., Targeted Indirect Calorimetry in high risk critically ill children - The role of a critical care nutrition team. AJRCCM, 2008. 177: p. A982. 
   
• Mehta, N.M., Bechard, L., Leavitt, K., Duggan, C., Severe Weight Loss and Hypermetabolic Paroxysmal Dysautonomia Following Hypoxic Ischemic Brain Injury: The Role of Indirect Calorimetry in the Intensive Care Unit. J Par Ent Nutr (JPEN), Journal of Parenteral and Enteral Nutr., 2008. 32(3). 
   
• Mehta NM, Halwick DR, Dodson BL, Thompson JT and Arnold JH. Potential drug sequestration during ECMO - results from an ex vivo experiment. Intensive Care Med. 2007 June;33(6):1018-1024. 

Research Goals

1. To describe the metabolic stress response and energy expenditure in critically ill children. We have shown significant caloric imbalance in critically ill children, leading to both underfeeding and overfeeding.
    
2. To identify barriers to nutrition during critical illness and ensure successful enteral nutrition in the PICU. Implementing safe and timely feeding practices in the PICU is an important issue for patient safety and a standard of care.
    
3. To conduct multicenter trials aimed at optimizing nutrient intake and examining the effect of nutritional interventions on patient outcomes.

Translational Implications

1. Nutrition and metabolic changes during critical illness are poorly understood areas that influence outcomes.
    
2. The metabolic state during critical illness is variable and unpredictable. Accurate measurement of resting energy expenditure will allow optimal nutritional support and prevent underfeeding and overfeeding in these children. Indirect calorimetry is an important tool for guiding energy provision in the PICU.
    
3. Enteral nutrition is the preferred mode of nutrition during critical illness. However, there exist a variety of factors that hinder the use of this mode of nutrition in the PICU. Avoidable barriers to enteral nutrition need to be addressed at the bedside and multicenter efforts should aim to improve its successful application in the PICU. There are very little data to instruct best practices in this clinical area and nutritional support practices in pediatric intensive care units (PICU) are widely variable. Overall, research in nutritional intake and metabolic status has potential for improving outcomes from critical illness; and this will remain a key area of investigation in the coming years.

Awards, Honors and Grants

• Fred Lovejoy Resident Research Grant - awarded in January 2007 for clinical research aimed at examining body composition and intestinal adaptation in children with short bowel syndrome. 
   
• Young Investigator Award, awarded by the American Society of Critical Care Anesthesiologists for Outstanding Investigative Research. "Pharmacokinetic considerations during extracorporeal membrane oxygenation". ASCCA 2006 annual meeting, Chicago, IL.