Critical Care

Research in the Division of Pediatric Critical Care Medicine is comprised of both basic science and clinical research components. The basic science research component, directed by Dr. Susan Vannucci, focuses on experimental models of injury to the developing brain and heart, such as hypoxia-ischemia, hypoglycemia, and cardiac arrest and CPR. The research laboratory has expertise in all of these paradigms and current studies are investigating neuro- and cardio-protective intervention strategies that can be translated into clinical practice in the PICU. As the tissue damage from each of these insults originates from a deficit in energy supply, current research examines the efficacy of providing adequate and appropriate substrates to serve as energetic fuels to the hypoxic, ischemic, or hypoglycemic animal. Through biochemical, cellular and molecular measurements of tissue energy status as well as markers of inflammation and cell death, our studies are able to assess the effects of our interventions.

Prevention of cell death is an important first step, however current studies tell us that lasting preservation of function is the real test of protection. To pursue these answers our research laboratory collaborates with Dr. Holly Moore in the Department of Psychiatry to assess behavior in each of our experimental paradigms. Through the ongoing establishment of a lifespan behavioral outcome core program for rodents, we are able to assess brain injury and recovery in immature animals throughout their development.

Investigations into mechanisms of cell death at a molecular level are being carried out in a series of in vitro cell culture by Dr. Michael Wilhelm. Dr. Wilhelm studies the specific proteins that function in cells as scaffolds to integrate enzyme cascades specific to cell death pathways triggered by different signals. Our laboratory is currently set up to apply the results of these cellular and molecular biology studies in cultured neurons to questions in immature rodents, and ultimately infants and children.

The division also has a number of clinical research studies underway. Dr. Marilyn Morris is studying mechanisms to deal with informed consent for emergency clinical trials. She has developed a mechanism to conduct these trials in a way that is acceptable to parents of clinically ill children and complies with federal regulations for research with a waiver of informed consent. Dr George Hardart's research focuses on theoretical and empirical research in medical decision-making and the role of the family in that decision-making process.

Other major clinical research themes of the division include clinical studies on cerebral and cardiopulmonary resuscitation including the use of hypothermia, use of renal replacement therapies in the management of fluid balance and inflammatory states, use of amiodarone in resuscitation, use of vasopressin in shock states, sepsis models and the inflammatory cascade, neurologic monitoring after single ventricle surgery, central line sepsis and others.