Critical Care; Inflammation; Pediatrics; Extracorporeal Membrane Oxygenation; Sepsis; Acute Lung Injury
John Giuliano, M.D, has focused his research interests around inflammation and the host’s response to sepsis/acute lung injury. To this end, he is involved in a translational research project looking at the role angiopoietins play in capillary leak from pediatric sepsis. Additionally, he is looking at the incidence of morbidity and mortality in pediatric patients admitted to the ICU with influenza. He is investigating the use of an antiseptic-impregnated central line dressing to see if it reduces catheter associated blood stream infections. Finally, he is involved with improving the morbidity and mortality associated with pediatric endotracheal intubation.
Specialized Terms: Pediatric sepsis; Acute lung injury and the inflammatory response; Pediatric transport medicine; Pediatric endotracheal intubation
Extensive Research Description
John Giuliano, M.D, research interest has centered around our body’s inflammatory response to infection. His main interest lies in the release of vascular growth factors called angiopoietins. He has shown that ang-2 is significantly elevated when children with septic shock are admitted to the PICU and that these levels peak around day 2 of illness. This growth factor may play a role in the capillary leak phenomena seen in these patients. Along similar lines, he is studying plasma biomarkers released when children have severe influenza infections. He is also be conducting a RTC comparing CHG-impregnated dressings to the current clear dressings used to cover central lines in children. Reports on the biopatch, a CHG disk, have demonstrated significant skin irritation in this population without clear reductions in infection. Since many children with severe sepsis require an advanced airway, Dr. Giuliano is also investigating ways to improve the morbidity and mortality associated with this high risk procedure.
- Describing the temporal kinetics of angiopoietin levels in children with varying degrees of sepsis.
- Evaluating the biomarker profile of critically ill children with influenza infection
- Understanding pediatric medication pharmacokinetics
- Evaluating whether chlorhexidine-impregnated central line dressings in children reduce blood stream infections without causing skin breakdown
- Reducing tracheal intubation associated events in children
- Giuliano Jr. JS, Tran K, Li FY, Northrup V, Tala JA, Bhandari V. The Temporal Kinetics of Circulating Angiopoietin Levels in Children with Sepsis. Pediatr Crit Care Med 2014; 15(1):e1-8
- Thompson C, Shabanova V, Giuliano Jr. JS. The SNAP index does not correlate with the State Behavioral Scale in intubated and sedated children. Paediatr Anaesth 2013; 23(12):1174-9
- Sanchez-Pinto N, Giuliano Jr. JS, Schwartz H, Garrett L, Gothard MD, Kantak A, Bigham MT. The Impact of Postintubation Chest Radiograph During Pediatric and Neonatal Critical Care Transport. Pediatr Crit Care Med 2013; 14(5):e213-e217.
- Giuliano Jr. JS, Faustino EVS, Li S, Pinto MG, Canarie MF, Carroll CL for the Northeast Pediatric Critical Care Research Consortium (NEPCCRC). Corticosteroid Therapy in Critically Ill Pediatric Asthmatic Patients. Pediatr Crit Care Med 2013; 14(5):467-70.
- Sanders Jr. RC, Giuliano Jr. JS, Sullivan J, Brown III CA, Walls RM, Nadkarni V, Nishisaki A. Level of Trainee and Tracheal Intubation Outcomes. Pediatrics 2013; 131(3): e821-8. Epub 2013 Feb 11.
- Kline-Krammes S, Reed C, Giuliano Jr. JS, Schwartz HP, Forbes M, Pope J, Besunder J, Gothard MD, Russell K, Bigham MT. Heliox in Children with Croup: A Strategy to Hasten Improvement. Air Med J 2012; 31(3): 131-7.
- Kandil S, Schmenk H, Northrup V, Bigham, MT, Giuliano Jr. JS. Pediatric Transport Triage Using the Transport Risk Assessment in Pediatrics (TRAP) Score. Prehospital Emergency Care 2012; 16(3):366-73. Epub 2012 Mar 23.
- Randolph AG, Vaughn F, Sullivan R, Rubinson L, Thompson BT, Yoon G, Smoot E, Rice TW, Loftis LL, Helfaer M, Doctor A, Paden M, Flori H, Babbitt C, Graciano AL, Gedeit R, Sanders RC, Giuliano JS, Zimmerman J, Uyeki TM, and the Pediatric Acute Lung Injury and Sepsis Investigator’s Network and the National Heart, Lung and Blood Institute ARDS Clinical Trials Network. Critically Ill Children During the 2009-2010 Influenza Pandemic in the United States. Pediatrics 2011; 128(6):e1450-8. Epub 2011 Nov 7.
- Wheeler DS, Giuliano JS Jr, Lahni PM, Denenberg A, Wong HR, Zingarelli B. The immunomodulatory effects of albumin in vitro and in vivo. Adv Pharmacol Sci 2011;2011:691928. Epub 2011 Apr 26.
- Giuliano Jr. JS, Lahni PM, Bigham MT, Manning PB, Nelson DP, Wong HR, Wheeler DS. Plasma Angiopoietin-2 Levels Increase in Children Following Cardiopulmonary Bypass. Intensive Care Med 2008; 34(10):1851-7.
- Abboud PA, Lahni PM, Page K, Giuliano Jr. JS, Harmon K, Dunsmore KE, Wong HR, Wheeler DS. The Role of Endogenously Produced Extracellular Heat Shock Protein 72 in Mononuclear Cell Reprogramming. Shock 2008; 30(3):285-92.
- Giuliano Jr. JS, Lahni PM, Wong HR, Carcillo JA, Sukhatme VA, Parikh SM, Wheeler DS. Admission Angiopoietin Levels in Children with Septic Shock. Shock 2007;28(6):650-654.
- Nishisaki A, Turner DA, Brown CA 3rd, Walls RM, Nadkarni VM; National Emergency Airway Registry for Children (NEAR4KIDS); Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. A National Emergency Airway Registry for children: landscape of tracheal intubation in 15 PICUs. Crit Care Med 2013; 41(3): 874-85
- Wong HR, Weiss SL, Giuliano Jr. JS, Wainwright MS, Cvijanovich NZ, Thomas NJ, Allen GL, Anas N, Bigham MT, Hall M, Freishtat RJ, Sen A, Meyer K, Checchia PA, Shanley TP, Nowak J, Quansey M, Chopra A, Fitzgerald JC, Gedeit R, Banschbach S, Beckman E, Lahni P, Hart K, Lindsell CJ. Testing the Prognostic Accuracy of the Updated Pediatric Sepsis Biomarker Risk Model. PLoS ONE 2014; 9(1):e86242
- Joyce CN, Giuliano Jr. JS, Gothard MD, Schwartz HP, Bigham MT. Specialty Pediatric Transport in Primary Care or Urgent Care Settings. Air Med J 2014; 33(2):71-75
- Wong HR, Weiss SL, Giuliano Jr. JS, Wainwright MS, Cvijanovich NZ, Thomas NJ, Allen GL, Anas N, Bigham MT, Hall M, Freishtat RJ, Sen A, Meyer K, Checchia PA, Shanley TP, Nowak J, Quansey M, Chopra A, Fitzgerald JC, Gedeit R, Banschbach S, Beckman E, Harmon K, Lahni PL, Lindsell CJ. The Temporal Version of the Pediatric Sepsis Biomarker Risk Model. PLoS ONE 2014; 9(3):e92121
- Lang SM, Giuliano Jr. JS, Carroll CL, Rosenkrantz TS, Eisenfeld L. Neonatal/ Infant Validations Study of the CAS Model 740 Non-Invasive Blood Pressure Monitor with Orion/MaxIQ NIBP Module. Blood Press Monit 2014; 19(3): 180-2
- Ferdinands JM, Olsho LE, Agan AA, Bhat N, Sullivan RM, Hall M, Mourani PM, Thompson M, Randolph AG on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Effectiveness of Influenza Vaccine Against Life-threatening RT-PCR-confirmed Influenza Illness in US Children, 2010-1012. J Infect Dis 2014; 210(5):674-83. Mar 26 [Epub ahead of print]
- Nett S, Emeriaud G, Jarvis JD, Montgomery V, Nadkarni V, Nishisaki A for the NEAR4KIDS Investigators and PALISI Network. Site-Level Variance for Adverse Tracheal Intubation-Associated Events Across 15 North American PICUs: A Report From National Emergency Airway Registry for Children. Pediatr Crit Care Med 2014; 15(4):306-13. Mar 31. [Epub ahead of print]
- Higgerson R, Olsho L, Christie LA, Rehder K, Doksum T, Gedeit R, Giuliano Jr. JS, Brennan B, Wendlandt R, Randolph A. Variability in IRBs regarding parental acceptance of passive consent. Pediatrics 2014; 134(2):e496-503. July 7 [Epub ahead of print]
- Li S, Rehder K, Giuliano Jr. JS, Apkon M, Kamat P, Nadkarni VM, Napolitano N, Thompson AE, Tucker C, Nishisaki A for the NEAR4KIDS and PALISI Network Investigators. Development of a Quality Improvement Bundle to Reduce Tracheal Intubation Associated Events in Pediatric ICUs. Am J Med Qual 2014. Aug 20. [Epub ahead of print]
- Lang SM, Syed MA, Dziura J, Rocco E, Kirshbom P, Bhandari V, Giuliano Jr JS. The Effect of Modified Ultrafiltration on Angiopoietins in Pediatric Cardiothoracic Surgery. Ann Thorac Surg 2014;98(5): 1699-704
- Wang K, Bhandari V, Giuliano Jr. JS, O’Hern CS, Shattuck MD, Kirby M. Angiopoietin-1, Angiopoietin-2 and Bicarbonate as Diagnostic Biomarkers in Children with Severe Sepsis. PLoS One 2014; 9(9): e108461
- Wheeler DS, Bigham MT, Lahni PM, Giuliano Jr. JS, Nelson DP, Manning PB, Wong HR. The Extracellular Stress Response to Pediatric Cardiopulmonary Bypass. J Pediatr Intensive Care 2014; 3(1): 9-16
- Graciano AL, Tamburro R, Thompson AE, Fiadjoe J, Nadkarni VM, Nishisaki A. [for the National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigator (PALISI) Network Investigators; for the National Emergency Airway Registry for Children NEAR4KIDS Investigators and Pediatric Acute Lung Injury and Sepsis Investigator PALISI Network Investigators.] Incidence and associated factors of difficult tracheal intubations in pediatric ICUs: a report from National Emergency Airway Registry for Children: NEAR4KIDS. Intensive Care Med. 2014; 40(11): 1659-69
- Tarquinio KM, Howell JD, Montgomery V, Turner DA, Hsing D, Parker M, Brown III CA, Walls RM, Nadkarni V, Nishisaki A, for the National Emergency Airway Registry for Children (NEAR4KIDS) investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Investigators. Current Medication Practice and Tracheal Intubation Safety Outcomes from a Prospective Multicenter Observational Cohort Study. Pediatr Crit Care Med 2015; 16(3):210-8 Jan 9. [Epub ahead of print]
- Smith KA, Gothard MD, Schwartz HP, Giuliano Jr. JS, Forbes M, Bigham MT. Risk Factors for Failed Intubation in Pediatric and Neonatal Critical Care Specialty Transport. Prehosp Emerg Care 2015; 19(1): 17-22
- Weiss SL, Fitzgerald JC, Pappachan J, Wheeler D, Jaramillo-Bustamante JC, Salloo A, Singhi SC, Erickson S, Roy JA, Bush JL, Nadkarni VM, Thomas NJ; for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Global Epidemiology of Pediatric Severe Sepsis: the Sepsis PRevalence OUtcomes, and Therapies Study. Am J Respir Crit Care Med. 2015; 191(10):1147-57. Mar 3 [Epub ahead of print]
- Weiss SL, Fitzgerald JC, Maffei FA, Kane JM, Rodriguez-Nunez A, Hsing DD, Franzon D, Kee SY, Bush JL, Roy JA, Thomas NJ, Nadkarni VM; for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study. Crit Care. 2015; 19:325