What are the determinants of persistent respiratory failure in children? Are obese children at greater risk for prolonged mechanical ventilation than non-obese children? Does BMI affect the time to recovery of lung function in obese children with ARDS? What is the pathogenesis and molecular contributors of obesity on respiratory failure in critical illness?
Can novel therapeutics including cell-based therapy be tested in patients with severe acute lung injury (P/F <200) and shock (need for vasopressors) since these are the patients with the highest mortality (> 30%) based on NHLBI ARDS Network data?
Does early cognitive rehabilitation (while on vent) improve long term cognitive function in ALI survivors?
We know that vasopressin layered on to norepinephrine treatment for septic shock tends to produce better outcomes (VASST trial, Russell et al) than norepinephrine alone. We still need to know if norepinephrine should be first line or if vasopressin should be first line (and perhaps monotherapy) for septic shock.
An individual metric to inform about the additive and not individual impact of comorbidities on critical illness and peri-operative mortality. For instance, we know the impact of COPD or MI or CKD on mortality after hemicolectomy, but not necessarily the additive impact of all three.
Does early mobilization, i.e. as soon as mechanical ventilation begins, improve long term outcomes in ALI survivors??
Does the addition of albumin to fluid conservative management of ALI (ARDSnet FACTT trial protocol, Wiedemann et al) further shorten ventilator time and/or improve survival?
Density mapping of the need and flow of patients requiring acute care surgery vis-a-vis inter-facility transfer, care hand-off failures, post-acute care resource mismatch to articulate a funding plan resource allocation and development akin to what has been done for trauma care.
What is the relation of environmental factors such as cigarette smoke exposure to the risk of developing acute lung injury as well as the outcome from acute lung injury and sepsis?
Large scale implementation of “change of culture” studies by which to revamp the approach to early removal of sedation and mechanical ventilation, coupled with monitoring of the brain and early mobility.
Do different hemoglobin transfusion thresholds alter outcomes in children with ARDS? What is the optimal *minimum* transfusion threshold for children with ARDS? What patient-centered outcomes can be affected by transfusion strategies: ventilator free days, time to organ function recovery, duration of intensive care stay, survival?
Respiratory failure in sepsis is almost universal and leads to worse clinical outcomes, yet it is poorly understood. Recent epidemics of pulmonary failure from respiratory viruses (e.g. influenza, SARS, MERS, etc) makes understanding molecular determinants of respiratory failure and the associated inflammatory and physiologic responses, critical for improving the health of our nation and potentially mitigating future ...more »