Critical Care Medicine
In the Spotlight: Dr. Monica Kleinman featured as the Chair of the Pediatric Subcommittee of the American Heart Association
Dr. Kleinman has been a volunteer for the AHA's Emergency Cardiovascular Committee for more than 20 years. She has held leadership positions in the Massachusetts/Rhode Island region and served as the National Faculty for Pediatric Advanced Life Support for the past five years. In 2003 she was appointed to the National ECC's Pediatric Subcommittee, a group of experts that is responsible for revision of resuscitation guidelines and development of life support training materials. Dr. Kleinman's contributions include serving as an editor of the 2006 version of the Provider and Instructor Textbooks for Pediatric Advanced Life Support (PALS).
Beginning July 1, 2007 Dr. Kleinman will serve as the Chair of the Pediatric Subcommittee and will guide the AHA's evidence evaluation process in anticipation of the 2010 guidelines revision. She has also been named as co-chair of the Pediatric Task Force for the International Liaison Committee on Resuscitation (ILCOR), the international consortium that develops consensus statements on resuscitation science and treatment recommendations.
In the Spotlight: Dr. Robert Truog featured as the Chair of Harvard Embryonic Stem Cell Research
Last year Dr. Robert Truog was appointed by the Provost to serve as chair of the newly created Harvard Embryonic Stem Cell Research Oversight Committee (ESCRO). As stem cell research offers the promise of exceptional developments in cell biology and therapeutics over the coming decades, it also poses vexing ethical, legal, and political challenges. Truog's committee will have a leadership role in developing standards for the development and banking of stem cells, as well as for their use in controversial research such as the creation of human/animal chimeras.
Dr. Adrienne Randolph featured as the founder and Chair of the Pediatric Acute Lung Injury and Sepsis Investigator's (PALISI) Network
The PALISI Network was founded in 2002 and is a voluntary collaboration of clinical investigators across over 50 pediatric ICUs in the U.S. and Canada. These researchers have joined together to identify optimal supportive, preventive and therapeutic strategies for acute lung injury, sepsis, multi-organ failure, and other acute, life-threatening pulmonary or systemic inflammatory syndromes that affect infants and children. Dr. Randolph has been Chair of the PALISI Network since its inception.
The initial clinical trial that initiated the network was a randomized trial that assigned critically ill children to one of three mechanical ventilator weaning strategies to determine the best way to wean them from the mechanical ventilator support. This study was initiated at Boston Children's Hospital by Drs. Adrienne Randolph and John Arnold in the Medical-Surgical ICU with the assistance of the Respiratory Care Department in protocol development and testing. The study was funded by Ronald McDonald House Charities. The results of this trial were published in JAMA in 2002 (abstract). The trial results led to widespread use of the extubation readiness test to determine if children could be safely extubated from mechanical ventilator support.
One of the other three major studies that founded the PALISI Network was also initiated at Boston Children's Hospital and led by Drs. Martha Curley and John Arnold. This study of prone positioning for children with acute lung injury was funded by the National Institutes of Health. Results of this randomized trial revealed that prone positioning was an ineffective intervention in children with acute lung injury (abstract). The other two trials that initiated the network included a trial showing that intratracheal Calfactant to be beneficial for children with respiratory failure and acute lung injury (abstract), and a randomized trial comparing a high versus low target hemoglobin threshold that has been submitted for publication.
The PALISI Network's goal is to perform multi-center research studies to better describe disease processes and outcomes in pediatric patients and to evaluate interventions in this population. Since 1999, PALISI Network investigators have successfully conducted and published 4 large multicenter randomized controlled clinical trials including:
- A randomized clinical trial comparing two protocols (pressure support and volume support) to no protocol for weaning infants and children from mechanical ventilator support. Principal Investigator: Adrienne Randolph, MD, MSc, Children's Hospital, Boston. Published in JAMA 2002 Nov 27;288(20):2561-8. [abstract]
- A randomized clinical trial of prone positioning for acute lung injury in children. Principal Investigator: Martha Curley, RN, PhD, Children's Hospital, Boston. Published in JAMA. 2005 Jul 13;294(2):229-37. [abstract]
- A randomized clinical trial of calf-lung surfactant for acute lung injury. Principal Investigator: Doug Willson, MD, University of Virginia Children's Medical Center Published in JAMA. 2005 Jan 26;293(4):470-6. [abstract].
- A randomized trial of liberal versus restrictive hemoglobin target for stable critically ill children. Principal Investigator: Jacques Lacroix, MD, Hopital St. Justine, Montreal, Quebec, Canada. Published in New Engl J Med 2007; 356:1609-1619. [abstract]
The PALISI Network has also recently performed the largest multicenter observational study in pediatric critical care to date on anemia, blood loss and transfusion practices across 30 PICUs. The PALISI Network holds meetings twice per year in the winter and fall. For more information about the PALISI Network, visit the PALISI website.
In the Spotlight: Dr. Robert Graham featured as the Clinical Director of the CAPE Program
The Critical Care, Anesthesia, and Perioperative Extension (CAPE) Program is a comprehensive and longitudinal care practice group for children with significant special health care needs, technology dependence and medical complexities. Services include consultation and support to families and institutions who are considering homecare of ventilator assisted children, long-term coordination of care including home visits, and perioperative consultation and planning around critical care recovery and rehabilitation. Transitional care, coordination with community services, and education out-reach are also offered to improve the quality of life for these children and their families.
In the Spotlight: Dr. Gerhard Wolf serves as the Pediatric Medical Director of Boston MedFlight (BMF)
BMF's mission is to extend the tertiary care services of the major Boston hospitals to the citizens of Massachusetts and New England. Dr. Wolf has extensive experience in neonatal and pediatric transport medicine. In his role as pediatric medical director, he trains the flight crew in neonatal and pediatric critical care. Important neonatal and pediatric cases are reviewed and discussed with the BMF staff on a regular basis. Pediatric critical care training for the BMF flight crew also takes place during clinical rounds in the pediatric intensive care unit, as well as in the Children's Hospital simulator lab.