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Pediatric Critical Care Fellowship

Research

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Research training is an integral part of the Fellowship. In addition to the 12 months of dedicated time for research, all Fellows have ample time and opportunity to pursue research activities during several clinical rotations. Fellows are expected to participate in a core curriculum of lectures in the basics of research, including study design, data analysis, and preparation of manuscripts and grants. There are opportunities for translational research (bench and animal laboratory) and/or clinical research. Presentations at national conferences are encouraged and facilitated.

Current Research in the Division

The Division of Critical Care Medicine (CCM) in Miami Children's Hospital (MCH) has conducted both basic and clinical research in various aspects of pulmonary critical care. Our Fellowship program requires participation of the Fellows in planning, performance, analysis and publication of research projects.  To satisfy Board certification requirement, each Fellow also must, at least, publish one article in a Peer Reviewed Journal, as the first author. To facilitate this endeavor, the Division's Faculty, including the Attending Physicians, Scientists (a Ph.D. Physiologist, and a D. Pharm, Pharmacologist) provide mentorship and assistance in planning, execution, analyses and publication of the research data. Our lines of Research in CCM include a variety of interrelated subjects, including:
 

1) Animal models on respiratory support modalities for critically ill neonatal or pediatric patients. This includes experimental methods of ventilatory support, such as Intratracheal Pulmonary Ventilation (ITPV) and replacement of lung's gas-exchange functions by Arterio-Venous Extra Corporeal Membrane Oxygenation (AV-ECMO) in rabbits and lambs.

2) Prevention of Barotrauma during mechanical ventilation by maintaining a high level of
arterial CO2, at relatively low inspiratory pressures and volumes in small and large animal models (rats and dogs). These studies simulate a well-established pulmonary critical care condition, known as Permissive Hypercapnia.
 
3)  Developmental aspects of Hyperoxia and weaning from Oxygen Therapy in a neonatal rat model. These studies investigate the safety of neonatal oxygen therapy on multiple organ systems, growth rate and brain development.

4)  Development of an adult rat model to study pathophysiology and pharmacology during pulmonary critical care conditions. Using this model, we have studied gender differences in anesthesia, oxygenation and ventilatory requirements involving hyperoxia, hypoxia, hypercapnia, and hypothermia. Currently, we are using this rat model to study the effects of various drugs, or treatment modalities during endotoxin-induced sepsis.

5)  In vitro studies designed to answer mechanic questions during respiratory support, such as loss of water in ECMO circuit, or pressure changes in closed versus open-bridge ECMO, as well as reduction in airway pressures, and/or humidity during ITPV, by using an artificial lung.

6)  Molecular aspects of pulmonary and multiple organ injury in both adult and neonatal rat models. In these studies multiple gene expressions are used as early markers of cell injury, and/or repair.

7)  Prospective and retrospective clinical studies involving critically ill neonatal and pediatric patients.

Research interests of the Division include intratracheal pulmonary ventilation (ITPV), hypoxic/hyperoxic lung and other organ injury, arterio-venous ECMO, genomics of sepsis and resuscitation. Fellows have the opportunity to work with several animal models, including rat, rabbit and sheep. The use of the MCH Pediatric Human Patient Simulator is also another option that has been used for ventilation studies at the Hospital.