Research

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Nilesh  Mehta, MD

Nilesh Mehta
Department:
Anesthesiology Research
Division
Critical Care Medicine Research
Hospital Title:
Associate in Critical Care Medicine; Associate Medical Director, Medical Surgical ICU
Academic Title:
Assistant Professor of Anaesthesia, Harvard Medical School
Research Focus Area:
Nutritional and Metabolic Aspects of Critical Illness in Children
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Dr. Mehta has a keen interest in optimal nutrition therapy and its impact on outcomes in critically ill children. His scholarly pursuits have focused on describing the metabolic response to stress, energy and protein balance, changes in body composition and strategies to optimize nutrient intake in children with critical illness, injury and following surgery.

Research Overview

He is the Director of the multidisciplinary Pediatric Critical Care Nutrition Program. Dr. Mehta established this program in 2008 and leads a group of dieticians, bedside nurses, nurse practitioners, pharmacist, intensivists, gastroenterologists and pediatric surgeons to address issues related to nutrient delivery and metabolism in children admitted to the ICU. His group has systematically highlighted critical gaps in the field, and developed institutional and national guidelines for nutrition therapy during critical illness. Recent published studies from his group have described metabolic state after bone marrow transplantation and cardiac surgery with cardiopulmonary bypass; described innovative methods of metabolic measurement in the intensive care unit; described the importance of energy and protein imbalance; and illustrated the correlation between macronutrient intake and clinical outcomes during critical illness. Translational collaborative investigations with the molecular biology team at Forsyth Institute have yielded critical insights into the sequential changes in the oral microbiome in the PICU population. Overall, the critical care nutrition program continues to pursue an active and exciting research agenda.

 Dr. Mehta is the Principal Investigator of 2 large International Multicenter Studies of nutrition intake in mechanically ventilated children (2009, 2011) with over 70 participating PICUs from across the world and over 1700 subjects enrolled. The results of the first study highlighted a direct impact of nutrient intake on mortality and acquired infections in mechanically ventilated children. Dr. Mehta is the first author of A.S.P.E.N. national guidelines for nutrition therapy in critically ill children. He is currently the Chair of a national task force developing a novel approach to defining pediatric malnutrition.

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.

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.
  • Mehta NM, Arnold JH. Genetic polymorphisms in acute respiratory distress syndrome: new approach to an old problem. Crit Care Med. 2005 Oct;33(10):2443-5.
  • Mehta NM, Thomas RM. Antenatal screening for Rubella-Infection or Immunity? BMJ 2002 Jul 13;325(7355):90-1.
  • Mehta NM, Hartnoll G. Callosal agenesis in lipoma with congenital CMV. Pediatr Neurol, Apr2001, Vol 24/3, 222-4.
  • Mehta N, Demunter C, Habibi P, Nadel S and Britto J. Short-term propofol infusions in children. Lancet. 1999 Sep 4;354(9181):866-7.
  • Thomas RM, Mehta NM. Cases of congenital rubella may be the tip of the iceberg. BMJ 2002 Sep 14;325(7364):596B.
  • Mehta N, Stone J, Whitelaw A. Practical management of hyperinsulinism in infancy. Arch Dis Child Fetal Neonatal Ed. 2001 May;84(3):F218.
  • Mehta N, Macintosh I, Rivers R, Nadel S. Acute chest syndrome of sickle cell disease. J Pediatr. 2000 Oct; 137(4):589.
  • Mehta N, Reeve A and Britto J. How To: Guide- PICCs in children. Care of the critically ill, Aug. 1999 (15.5).
  • N M. Mehta and R M. Nicholl. Positioning of long lines. Arch Dis Child Fetal Neonatal Ed. 2002 Jan;86(1):F68-9.
  • A J Pollard, S Nadel, N Mehta, C De Munter, J Britto, P Habibi, M Levin. Are cuffed endotracheal tubes really indicated in the management of meningococcal disease? eArch Dis Child, 3/01/01.
  • Mehta NM, Arnold JH. Mechanical ventilation in pediatric respiratory failure. Curr Opin Crit Care, Jan 2004.
  • Mehta N, Levin M. Mgt and prevention of meningococcal disease. Hosp Prac 2000;35(8):75-86.
  • Mehta N and Whitelaw A. Comparison of Hemacue, Precision G and Hexokinase methods of blood glucose estimation (Abstract). Pediatr Res, April 1999.
  • Mehta N, Nadel S, Booy R, Galassini R, Morrisson A, Levin M. Reduction in Case Fatality Rate for Meningococcal Disease associated with improved Healthcare delivery. Pediatr Res, Apr 2000, Vol. 47. No.4, 271A.
  • Mehta N, Nadel S, Newport M, Booy R, Levin M. Association of Fatal Meningococcal Disease with possession of the Tumor Necrosis Factor alpha 2 Allele. Pediatr Res, Apr 2000, (47)4, 271A.
  • Hadzic N, Layton M, Baker A, Mehta N, Britto J, Mieli-Vergani G. Multiorgan and acute liver failure related to haemophagocytic lymphohistiocytosis in children. J Hepatol 2002;36 (Suppl.1):263
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