Critical Care research began in 1994 with outcome research by department chair Kristen Price, M.D. A four-year multicenter collaborative study resulted in the development and validation of a statistical model that more accurately predicts mortality in cancer patients who are admitted to the intensive care unit. Price has published a similar model for the outcomes of critically ill patients who have undergone bone marrow transplantation. Her current efforts are focused on outcome of acute leukemia patients who have respiratory failure and require mechanical ventilation. The mortality in these patients is very high yet little research has been done in this area. Price is currently the primary investigator in a prospective study to identify prognostic indicators at the time of intubation and mechanical ventilation in acute leukemia patients. Identifying these predictors can aid the intensivists and the oncologists in determining survival chances in this patient population. Outcome studies are crucial in oncologic Critical Care. With the largest ICU in any comprehensive cancer center, we have a unique opportunity to investigate outcome patterns in this complex patient population.
The department has developed a system of investigation whereby problems are identified from clinical observational studies and quality improvement initiatives, and then potential solutions are identified and tested in both animal models and clinical trials. This approach is typified by the perioperative renal preservation and salvage project which, has been completed after four years of work. Other clinical avenues for investigation are outlined by Joseph Nates, M.D. His areas of research have been fundamentally linked to his clinical practice. As a result he has moved from his original basic and clinical sciences research in neuro-trauma to oncological critical care. The latter includes the development of an outcomes research program and studies in this area; a few of these studies have been completed with the presentation and publication of the abstracts. Other areas of research have been and continue to be ICU administration, high frequency ventilation in ARDS, thromboelastographic description of coagulation abnormalities in SIRS/sepsis, nutritional assessment by indirect calorimetry and infection control.
In summary, the department's mission is to facilitate the oncology research in this institution by:
- Describing patterns of medical and surgical critical illness specific to the cancer population and predicting outcome in the ICU
- Finding new ways to predict those patients at greatest risk of treatment toxicity
- Developing techniques of organ function preservation in order to allow patients to tolerate increasingly toxic cancer treatments
- Providing expert physiological measurement to collaborators as they measure the efficacy of their own novel treatments