ABOUT THE RESEARCHER

OVERVIEW

Dr. Agus is engaged in clinical research activities that attempt to address unanswered questions concerning endocrine homeostasis in critically ill children. His most recent work has focused on investigation of the value of controlling blood sugar levels in critically ill children. Dr. Agus co-led the team, along with Dr. Vinay Nadkarni at CHOP, to complete HALF-PINT, a thirty-two-center randomized controlled trial of tight glucose control in medical-surgical (non-cardiac) patients in pediatric ICUs across the US and Canada. They sought to determine whether close management of blood sugar in a sick child will enhance and hasten recovery. The results were published in the New England Journal of Medicine (NEJM), and summarized by the United Kingdom’s National Institute for Health Research (NIHR).

He previously completed a prospective, randomized controlled trial of euglycemia in 980 post-operative cardiac surgery patients below three years of age at two centers. The technology developed in this trial, including use of continuous glucose monitoring and a computerized insulin algorithm, has enabled participants to have the lowest severe hypoglycemia rate of any published prospective trial to date in adults or pediatrics.

Dr. Agus and his group are also involved in several other areas of clinical research, including developing new devices for pediatric critical care, research in diabetic ketoacidosis, and adrenal insufficiency in the pediatric ICU.

BACKGROUND

Dr. Agus is a graduate of the University of Pennsylvania, both undergraduate and medical school. He trained in Pediatrics and Pediatric Endocrinology at Boston Children's Hospital, and in Pediatric Critical Care at Massachusetts General Hospital. He is the founding Division Chief of the Division of Medicine Critical Care within the Department of Medicine. The Division provides the clinical coverage of the 16-bed Medicine Intensive Care Unit (MICU) and the 12-bed Intermediate Care Program (ICP), both of which he is the founding Medical Director. He serves as Co-Medical Director of BCH Biocontainment Unit, supporting BCH's designation by CDC as an Ebola Treatment Center. Dr. Agus also serves as an Attending Physician in the Endocrinology Division, both in the hospital and in clinic. He has been elected into several honorary societies, including Society for Pediatric Research, American Pediatric Society, and American College of Critical Care Medicine. He holds the Endowed Chair in Critical Care.

PUBLICATIONS

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  1. Multicomponent Strategies to Prevent SARS-CoV-2 Transmission - Nine Overnight Youth Summer Camps, United States, June-August 2021. MMWR Morb Mortal Wkly Rep. 2021 Oct 08; 70(40):1420-1424. View abstract
  2. Enabling a learning healthcare system with automated computer protocols that produce replicable and personalized clinician actions. J Am Med Inform Assoc. 2021 06 12; 28(6):1330-1344. View abstract
  3. Performance of an Electronic Decision Support System as a Therapeutic Intervention During a Multicenter PICU Clinical Trial: Heart and Lung Failure-Pediatric Insulin Titration Trial (HALF-PINT). Chest. 2021 Sep; 160(3):919-928. View abstract
  4. Life-Threatening Hemoptysis in a Pediatric Referral Center. Crit Care Med. 2021 03 01; 49(3):e291-e303. View abstract
  5. Impact of a Clinical Documentation Integrity Program on Severity of Illness of Expired Patients. Hosp Pediatr. 2021 Mar; 11(3):298-302. View abstract
  6. Nurses' Perceptions of Workload Burden in Pediatric Critical Care. Am J Crit Care. 2021 01 01; 30(1):27-35. View abstract
  7. A Novel Framework Using Remote Telesimulation With Standardized Parents to Improve Research Staff Preparedness for Informed Consent in Pediatric Critical Care Research. Pediatr Crit Care Med. 2020 12; 21(12):e1042-e1051. View abstract
  8. Perspective of the Surviving Sepsis Campaign on the Management of Pediatric Sepsis in the Era of Coronavirus Disease 2019. Pediatr Crit Care Med. 2020 11; 21(11):e1031-e1037. View abstract
  9. Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with Coronavirus Disease 2019 in New York City. J Pediatr. 2020 Jul 16. View abstract
  10. Standardized Protocol Is Associated With a Decrease in Continuous Albuterol Use and Length of Stay in Critical Status Asthmaticus. Pediatr Crit Care Med. 2020 05; 21(5):451-460. View abstract
  11. Corticosteroids probably reduce sepsis-related 28-day mortality in adults - unclear effect in children. J Pediatr. 2020 05; 220:264-267. View abstract
  12. Early Enteral Nutrition Is Associated With Improved Clinical Outcomes in Critically Ill Children: A Secondary Analysis of Nutrition Support in the Heart and Lung Failure-Pediatric Insulin Titration Trial. Pediatr Crit Care Med. 2020 03; 21(3):213-221. View abstract
  13. Executive Summary: Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020 02; 21(2):186-195. View abstract
  14. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 02; 46(Suppl 1):10-67. View abstract
  15. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020 02; 21(2):e52-e106. View abstract
  16. Executive summary: surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 02; 46(Suppl 1):1-9. View abstract
  17. Long-Term Neurobehavioral and Quality of Life Outcomes of Critically Ill Children after Glycemic Control. J Pediatr. 2020 03; 218:57-63.e5. View abstract
  18. Outcomes Associated With Multiple Organ Dysfunction Syndrome in Critically Ill Children With Hyperglycemia. Pediatr Crit Care Med. 2019 12; 20(12):1147-1156. View abstract
  19. A National Approach to Pediatric Sepsis Surveillance. Pediatrics. 2019 12; 144(6). View abstract
  20. When Is Our Job Done? Evaluation of Long-Term Psychological Outcomes in Pediatric Critical Care. Pediatr Crit Care Med. 2019 11; 20(11):1099-1100. View abstract
  21. Executive Summary: Criteria for Critical Care of Infants and Children: PICU Admission, Discharge, and Triage Practice Statement and Levels of Care Guidance. Pediatrics. 2019 10; 144(4). View abstract
  22. Criteria for Critical Care Infants and Children: PICU Admission, Discharge, and Triage Practice Statement and Levels of Care Guidance. Pediatr Crit Care Med. 2019 09; 20(9):847-887. View abstract
  23. Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children. Crit Care Med. 2019 05; 47(5):706-714. View abstract
  24. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018 10; 19 Suppl 27:155-177. View abstract
  25. Adjusting Insulin Delivery to Activity (AIDA) clinical trial: Effects of activity-based insulin profiles on glucose control in children with type 1 diabetes. Pediatr Diabetes. 2018 12; 19(8):1451-1458. View abstract
  26. Glucocorticoid Equipoise. Crit Care Med. 2018 04; 46(4):493. View abstract
  27. Beyond Survival: Pediatric Critical Care Interventional Trial Outcome Measure Preferences of Families and Healthcare Professionals. Pediatr Crit Care Med. 2018 02; 19(2):e105-e111. View abstract
  28. The authors reply. Pediatr Crit Care Med. 2017 12; 18(12):1191. View abstract
  29. Acute Kidney Injury After Pediatric Cardiac Surgery: A Secondary Analysis of the Safe Pediatric Euglycemia After Cardiac Surgery Trial. Pediatr Crit Care Med. 2017 Jul; 18(7):638-646. View abstract
  30. Tight Glycemic Control in Critically Ill Children. N Engl J Med. 2017 06 08; 376(23):e48. View abstract
  31. Pediatric intermediate care and pediatric intensive care units: PICU metrics and an analysis of patients that use both. J Crit Care. 2017 10; 41:268-274. View abstract
  32. Primary Outcome Measures in Pediatric Septic Shock Trials: A Systematic Review. Pediatr Crit Care Med. 2017 Mar; 18(3):e146-e154. View abstract
  33. Suspected Cerebral Edema in Diabetic Ketoacidosis: Is There Still a Role for Head CT in Treatment Decisions? Pediatr Crit Care Med. 2017 Mar; 18(3):207-212. View abstract
  34. Pediatric Multiple Organ Dysfunction Syndrome: Promising Therapies. Pediatr Crit Care Med. 2017 Mar; 18(3_suppl Suppl 1):S67-S82. View abstract
  35. Tight Glycemic Control in Critically Ill Children. N Engl J Med. 2017 02 23; 376(8):729-741. View abstract
  36. A Critical Asthma Standardized Clinical and Management Plan Reduces Duration of Critical Asthma Therapy. Hosp Pediatr. 2017 02; 7(2):79-87. View abstract
  37. Design and rationale of Heart and Lung Failure - Pediatric INsulin Titration Trial (HALF-PINT): A randomized clinical trial of tight glycemic control in hyperglycemic critically ill children. Contemp Clin Trials. 2017 02; 53:178-187. View abstract
  38. Endocrinologic Diseases in Pediatric Cardiac Intensive Care. Pediatr Crit Care Med. 2016 08; 17(8 Suppl 1):S296-301. View abstract
  39. Tight Glycemic Control in the Pediatric Intensive Care Unit. J Pediatr Intensive Care. 2016 Dec; 5(4):198-204. View abstract
  40. Impact of Tight Glycemic Control on Neurodevelopmental Outcomes at 1 Year of Age for Children with Congenital Heart Disease: A Randomized Controlled Trial. J Pediatr. 2016 07; 174:193-198.e2. View abstract
  41. Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Hormone Replacement Therapy. Pediatr Crit Care Med. 2016 Mar; 17(3 Suppl 1):S59-68. View abstract
  42. Triage of Intermediate-Care Patients in Pediatric Hospitals. Hosp Pediatr. 2015 Oct; 5(10):542-7. View abstract
  43. Practice Patterns in Pediatric Critical Care Medicine: Results of a Workforce Survey. Pediatr Crit Care Med. 2015 Oct; 16(8):e308-12. View abstract
  44. Tight Glycemic Control With Insulin Does Not Affect Skeletal Muscle Degradation During the Early Postoperative Period Following Pediatric Cardiac Surgery. Pediatr Crit Care Med. 2015 Jul; 16(6):515-21. View abstract
  45. Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage? J Pediatr Endocrinol Metab. 2014 Nov; 27(11-12):1077-88. View abstract
  46. The relationship between TSH and systemic inflammation in extremely preterm newborns. Endocrine. 2015 Mar; 48(2):595-602. View abstract
  47. Tight glycemic control in the ICU - is the earth flat? Crit Care. 2014 Jun 27; 18(3):159. View abstract
  48. Tight glycemic control after pediatric cardiac surgery in high-risk patient populations: a secondary analysis of the safe pediatric euglycemia after cardiac surgery trial. Circulation. 2014 Jun 03; 129(22):2297-304. View abstract
  49. The authors reply. Pediatr Crit Care Med. 2014 Mar; 15(3):285-6. View abstract
  50. Tight glucose control in critically ill children--a systematic review and meta-analysis. Pediatr Diabetes. 2014 Mar; 15(2):75-83. View abstract
  51. Tight glycemic control in children--is the target in sight? N Engl J Med. 2014 Jan 09; 370(2):168-9. View abstract
  52. Association between Technical Performance Scores and neurodevelopmental outcomes after congenital cardiac surgery. J Thorac Cardiovasc Surg. 2014 Jul; 148(1):232-237.e3. View abstract
  53. Increasing use of hypertonic saline over mannitol in the treatment of symptomatic cerebral edema in pediatric diabetic ketoacidosis: an 11-year retrospective analysis of mortality*. Pediatr Crit Care Med. 2013 Sep; 14(7):694-700. View abstract
  54. Measuring and reporting glycemic control in clinical trials: building a path to consensus. Crit Care. 2013 Jun 14; 17(3):155. View abstract
  55. Clinical equipoise regarding glycemic control: a survey of pediatric intensivist perceptions. Pediatr Crit Care Med. 2013 Feb; 14(2):123-9. View abstract
  56. Design and rationale of safe pediatric euglycemia after cardiac surgery: a randomized controlled trial of tight glycemic control after pediatric cardiac surgery. Pediatr Crit Care Med. 2013 Feb; 14(2):148-56. View abstract
  57. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med. 2012 Dec; 40(12):3251-76. View abstract
  58. Cardiac parameters in children recovered from acute illness as measured by electrical cardiometry and comparisons to the literature. J Clin Monit Comput. 2013 Feb; 27(1):81-91. View abstract
  59. Closed-loop insulin therapy improves glycemic control in children aged <7 years: a randomized controlled trial. Diabetes Care. 2013 Feb; 36(2):222-7. View abstract
  60. Tight glycemic control versus standard care after pediatric cardiac surgery. N Engl J Med. 2012 Sep 27; 367(13):1208-19. View abstract
  61. Value of continuous glucose monitoring for minimizing severe hypoglycemia during tight glycemic control. Pediatr Crit Care Med. 2011 Nov; 12(6):643-8. View abstract
  62. Non-invasive cardiac output and oxygen delivery measurement in an infant with critical anemia. J Clin Monit Comput. 2011 Apr; 25(2):113-9. View abstract
  63. Clinical utility of Abbott Precision Xceed Pro® ketone meter in diabetic patients. Pediatr Diabetes. 2011 Nov; 12(7):649-55. View abstract
  64. Use of a continuous glucose sensor in an extracorporeal life support circuit. J Diabetes Sci Technol. 2011 Jan 01; 5(1):93-8. View abstract
  65. Utility of immediate hemoglobin A1c in children with type I diabetes mellitus. Pediatr Diabetes. 2010 Nov; 11(7):450-4. View abstract
  66. Extreme stress hyperglycemia during acute illness in a pediatric emergency department. Pediatr Emerg Care. 2010 Sep; 26(9):626-32. View abstract
  67. Endocrine emergencies. Fleisher GR, Ludwig S, editors. Textbook of Pediatric Emergency Medicine. 2009. View abstract
  68. Thyroid function in the critically ill newborn and child. Curr Opin Pediatr. 2009 Aug; 21(4):536-40. View abstract
  69. Congenital myasthenic syndrome with episodic apnea. Pediatr Neurol. 2009 Jul; 41(1):42-5. View abstract
  70. Pediatrics: Intensive insulin therapy in critically ill children. Nat Rev Endocrinol. 2009 Jul; 5(7):360-2. View abstract
  71. Choline acetyltransferase deficiency causing congenital myasthenic syndrome with episodic apnea. Pediatr Neurol. 2009; 41:42-45. View abstract
  72. Critical illness hyperglycemia: is failure of the beta-cell to meet extreme insulin demand indicative of dysfunction? Crit Care. 2009; 13(2):129. View abstract
  73. Critical illness hyperglycemia: is failure of the beta-cell to meet extreme insulin demand indicative of dysfunction?. Critical Care. 2009; 13:129. View abstract
  74. The correlation and level of agreement between end-tidal and blood gas pCO2 in children with respiratory distress: a retrospective analysis. BMC Pediatr. 2009 Mar 12; 9:20. View abstract
  75. ICU Insulin delivery algorithms: Why so many? How to choose?. J Diab Sci Tech. 2009; 3(1):125-140. View abstract
  76. Intensive Care Unit Insulin Delivery Algorithms: Why So Many? How to Choose? J Diabetes Sci Technol. 2009 Jan; 3(1):125-140. View abstract
  77. Association between intraoperative and early postoperative glucose levels and adverse outcomes after complex congenital heart surgery. Circulation. 2008 Nov 25; 118(22):2235-42. View abstract
  78. The effect of insulin infusion upon protein metabolism in neonates on extracorporeal life support. Ann Surg. 2006 Oct; 244(4):536-44. View abstract
  79. Continuous Glucose Monitoring in Pediatric Patients on Extracorporeal Life Support. American Academy of Pediatrics. 2006. View abstract
  80. Real-time continuous glucose monitoring in pediatric patients during and after cardiac surgery. Pediatrics. 2006 Sep; 118(3):1176-84. View abstract
  81. Adrenal insufficiency in the critically ill neonate and child. Curr Opin Pediatr. 2006 Aug; 18(4):448-53. View abstract
  82. Continuous non-invasive end-tidal CO2 monitoring in pediatric inpatients with diabetic ketoacidosis. Pediatr Diabetes. 2006 Aug; 7(4):196-200. View abstract
  83. Nutritional Support of the Critically Ill Child. Wheeler DS, Wong HR, Shanley TP, editors. Pediatric Critical Care Medicine: Basic Science and Clinical Evidence. 2005. View abstract
  84. Continuous glucose monitoring in pediatric cardiac surgery patients. European Society of Pediatric Endocrinology and Lawson Wilkins Pediatric Endocrine Society. 2005. View abstract
  85. Benefits of immediate hemoglobin A1c results in pediatric type 1 diabetes patients. European Society of Pediatric Endocrinology and Lawson Wilkins Pediatric Endocrine Society. 2005. View abstract
  86. Benefits of immediate hemoglobin A1c results in pediatric type 1 diabetes patients. Hormone Research. 2005; 64(S1). View abstract
  87. Diabetic ketoacidosis in children. Pediatr Clin North Am. 2005 Aug; 52(4):1147-63, ix. View abstract
  88. The effects of insulin on protein metabolism in critically ill neonates. Endocrine Society. 2005. View abstract
  89. The first use of live continuous glucose monitoring in patients on extracorporeal life support. Diabetes Technol Ther. 2005 Jun; 7(3):431-9. View abstract
  90. One step forward: an advance in understanding of adrenal insufficiency in the pediatric critically ill. Crit Care Med. 2005 Apr; 33(4):911-2. View abstract
  91. Endocrine emergencies. Fleisher GR, Ludwig S, editors. Textbook of Pediatric Emergency Medicine. 2004. View abstract
  92. Clowning in the pediatric intensive care unit. Lindheim J, editor. The Art and Joy of Hospital Clowning: The Jeannie Lindheim Hospital Clown Training Process. 2004. View abstract
  93. Intravenous insulin decreases protein breakdown in infants on extracorporeal membrane oxygenation. J Pediatr Surg. 2004 Jun; 39(6):839-44; discussion 839-44. View abstract
  94. The first use of live continuous glucose monitoring in critically ill neonates. American Diabetes Association. 2004. View abstract
  95. Continuous non-invasive CO2 monitoring in pediatric inpatients with diabetic ketoacidosis. American Diabetes Association. 2004. View abstract
  96. Critically low hormone and catecholamine concentrations in the primed extracorporeal life support circuit. ASAIO J. 2004 Jan-Feb; 50(1):65-7. View abstract
  97. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 38-2003. A 12-year-old girl with fever and coma. New England Journal of Medicine. 2003; 349(24):2341-9. View abstract
  98. Intravenous Insulin Improves Protein Breakdown in Infants on Extracorporeal Membrane Oxygenation. Journal of the American College of Surgeons. 2003; 197(3):S48. View abstract
  99. Technical evaluation of a glucose and oxygen sensor in an extracorporeal circuit. ECMO & Advanced Therapies for Respiratory Failure. 2003. View abstract
  100. Continuous glucose monitoring in an extracorporeal circuit. ECMO & Advanced Therapies for Respiratory Failure. 2003. View abstract
  101. Continuous analyte monitor and method of using same. 2002. View abstract
  102. Nutritional support of the critically ill child. Curr Opin Pediatr. 2002 Aug; 14(4):470-81. View abstract
  103. Effect of hyperinsulinemic clamp on protein catabolism in critically ill neonates. Lawson Wilkins Pediatric Endocrine Society at Society for Pediatric Research. 2002. View abstract
  104. Cardiovascular actions of magnesium. Crit Care Clin. 2001 Jan; 17(1):175-86. View abstract
  105. The hormonal response to critical illness. Radovick S, MacGillivray MH, editors. Trends in Pediatric Endocrinology. 2001. View abstract
  106. Dietary composition and physiologic adaptations to energy restriction. Am J Clin Nutr. 2000 Apr; 71(4):901-7. View abstract
  107. The effect of growth hormone treatment on the insulin-like growth factor axis in a child with nonislet cell tumor hypoglycemia. J Clin Endocrinol Metab. 1996 Mar; 81(3):1141-6. View abstract
  108. Non-islet-cell tumor associated with hypoglycemia in a child: successful long-term therapy with growth hormone. J Pediatr. 1995 Sep; 127(3):403-7. View abstract