Dr. Burg has for over 25 years conducted a federally funded program of research on the pathways by which stress and emotional factors contribute to risk for hypertension and cardiovascular disease, and contribute to prognosis after acute cardiac events. In the context of clinical trials, he has also investigated how best to address this risk, using new models of care delivery. His current interests extend to post-traumatic stress in Veterans returning from conflicts in Iraq and Afghanistan, and early surveillance for cardiovascular disease risk associated with this disorder.
Individuals of all ages now use social media. Print media such as The New York Times and The Wall Street Journal have embraced social media. However, medical journals have not followed suit. Many anesthesiologists do not stay current with the medical literature once they leave their residency. My research is designed to examine techniques that allow physicians to stay up to date with medical research.
Dr. Schonberger's NIH funded research investigates ways of integrating perioperative encounters into long-term cardiovascular risk-factor reduction. Present studies have examined predictive models for identifying poorly controlled hypertension and the effectiveness of patient interventions. Dr. Schonberger's other research includes informatics work, health services research, and ways to improve extra-corporeal membrane oxygenation.
Kirk Shelley & Aymen Awad Alian
Our lab is dedicated to the investigation of cardiopulmonary and autonomic physiology through the use of non-invasive monitors. This is accomplished through carefully documented clinical observations during surgical procedures (e.g. scoliosis, craniofacial, laparoscopic and shoulder surgery). We also perform normal volunteer studies under a wide variety conditions (e.g. lower body negative pressure, blood withdrawal & replacement, positioning & respiratory maneuvers).
In recent years our focus has been on the pulse oximeter and peripheral venous pressure waveforms. The collected waveforms are then analyzed using digital signal processing. The primary goal is a better understanding of the underlying physiology. The secondary goal is the use of this understanding to develop new methods of patient monitoring. This work so far has generated over 100 research abstracts, 40 peer reviewed papers, and numerous patents.
Most recent efforts have been focused on integrating our research findings into the larger field of functional hemodynamics which combined with early goal directed therapy has been shown to improve patient outcomes. Functional hemodynamics is an exciting approach to the care of patients based upon the principle that the individual patient needs to be optimized to their specific cardiac, pulmonary, and vascular physiology. A key advance has been the recognition that the interactions, between the respiratory, cardiac and autonomic systems, lead to important clues regarding the status of each.
During my 23 years as a researcher and clinician, I have gained expertise and knowledge in the field of cardiovascular medicine as it applies to anesthesiology and critical care. My experience in clinical research also includes leadership responsibilities as Director of Clinical Research at Weill Medical College of Cornell, at Duke University Medical Center, and more recently, at Yale University School of Medicine. A few examples of our research include investigating microthrombotic events and factors that exacerbate perioperative ischemic complication in major vascular surgery, in open-heart surgery, in the setting of ventricular assist device implantation, and in obstetric and pediatric surgery. We are also involved with several multicenter trials in cardiac surgery including: A Prospective, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Safety and Efficacy of Preoperative Antithrombin Supplementation in Patients Undergoing High-Risk Cardiac Surgery with Cardiopulmonary Bypass. Grifols Therapeutics Inc. A Double-Blind, Randomized, Placebo-Controlled Study of Levosimendan in Patients with Left Ventricular Systolic Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass. Tenax Therapeutics TRICS-III: Transfusion Requirements in Cardiac Surgery. An International, Multi-Centre, Randomized Controlled Trial to Assess Transfusion Thresholds in Patients Undergoing Cardiac Surgery. Canadian Institutes of Health Research (CIHR) Peer-Reviewed Operating Grant. Lastly, we are both committed and excited about the future of research in the Department of Anesthesiology and are invested in our mission and vision, which is guided by a highly experience group physician-scientist known as the Senior Research Board (Drs. Roberta Hines, Paul Barash, Mathew Burg, Manuel Fontes, Paul Heerdt, Lance Lichtor, Laura Niklason, Albert Perrino, David Silverman, Kirk Shelley).
Dr. Meng’s clinical research has been focusing on the following aspects.
Improving patient outcome via optimization of tissue perfusion and oxygenation. Tissue ischemia & hypoxia is one of the root causes of certain perioperative morbidities. Timely detection and correction of tissue ischemia & hypoxia contribute to an improved outcome. The first step of this query is the capacity to reliably monitor tissue perfusion and oxygenation. The advent of tissue oximetry based on near-infrared spectroscopy (NIRS) enables the clinician to monitor tissue oxygenation continuously and non-invasively at the patient’s bedside. Research has been done to understand how the perioperative factors affect cerebral oxygenation monitored using NIRS. Investigation has also been done to understand how intraoperative tissue oxygenation of different tissue beds, cerebral vs. muscular, is associated with postoperative outcome. Yet, the fundamental step of this query is to test if tissue oxygenation – guided care improves the patient outcome in high-risk scenarios. Even though outcome research has been done previously, various methodological limitations exist. The future research should address the definition of an individual patient’s baseline value, the threshold for intervention, the differential diagnosis of tissue hypoxia, and the patient populations that benefit from tissue oxygenation monitoring.
Improving patient outcome via choosing the appropriate anesthetic technique. The aspects of anesthetic technique include, but not limited to, monitored anesthesia care vs. general anesthesia, laryngeal mask airway vs. endotracheal tube, inhalational vs. intravenous agent, the strategies of hemodynamic management, and the mode and setting of mechanical ventilation. The available evidence has suggested an association between anesthetic technique and patient outcome. However, due to the multiplicity of the aspects of anesthetic technique and the complexity of randomized controlled trial in clinical setting, much work is needed to better understand the effect of different aspects of anesthetic technique on patient outcome.
Paul M. Heerdt
Over the past 25+ years, the vast majority of my research has been within 3 broad categories: a) cardiopulmonary adaptation to the stresses of anesthesia and surgery; b) evaluation of hemodynamic monitoring devices; and c) development of novel neuromuscular blocking drugs. Studies involving cardiopulmonary physiology have been conducted in both the laboratory and clinic, with an emphasis upon a systems biology approach that incorporates functional and molecular aspects of adaptation. Most recently, my laboratory has been incorporating aging and working with analytic approaches for quantifying the efficiency of mechanical coupling between the heart and circulation during acute and chronic pulmonary hypertension. Device evaluations have been largely focused upon methods for monitoring blood flow and tissue perfusion; recent studies have involved experimental models of shock. Our drug development program also involves both laboratory and clinical work, with investigation focused on a novel class of drugs that undergo “molecular inactivation” by the amino acid cysteine. This research has resulted in the design and synthesis of a series of molecules, one of which was recently evaluated for safety and efficacy in a clinical trial.