Department of Critical Care Medicine
School of Medicine Queen's University
 

Research


The Department of Critical Care Medicine at Queen’s University conducts a wide range of clinical research, both peer reviewed academic studies and industry sponsored clinical trials.

Research Director: Dr. Muscedere

Research Coordinators: Tracy Boyd, Ilinica Georgescu and Miranda Hunt

Researchers of the Department of Critical Care Medicine, their profiles and selected publications:

Dr. Muscedere is the ICU Research Director at Kingston General Hospital. He is the co-chair of the Canadian Critical Care Society (CCCS) and the Canadian Critical Care Trials Group (CCCTG) Knowledge Translation Committee. Dr. Muscedere has extensive experience in clinical research, both in investigator initiated and industry sponsored research. His major research interests are Ventilator Associated Pneumonia (VAP), Infection in Critically Ill Patients, Knowledge Translation, Clinical Practice Guidelines and implementation of best practice in the ICU. Current activities include the implementation of a CIHR funded national Critical Care Knowledge Translation Network (aC3KTion Net) and revision of the Canadian Guidelines for the Prevention, Diagnosis and Treatment of VAP. Recently he has assumed the role of Scientific Director for the National Centers of Excellence (NCE) funded Technology Evaluation in the Elderly Network (TVN). This is a national network dedicated to improving the care of frail elderly patients with life limiting illnesses.

J. Muscedere, T. Sinuff, D.K. Heyland, P. M. Dodek, S. P. Keenan, G. Wood MD, X. Jiang, A.G. Day, D. Laporta, M. Klompas for the Canadian Critical Care Trials Group. The Clinical Impact and Preventability of Ventilator-Associated Conditions in Critically Ill Mechanically Ventilated Patients. Chest, In Publication

 

Muscedere J, Ofner M, Kumar A, Long J, Lamontagne F, Cook D, McGeer A, Chant C, Marshall J, Jouvet P, Fowler R for the ICU-FLU Group and the Canadian Critical Care Trials Group. The Occurrence and Impact of Bacterial and Fungal organisms Complicating Critical Care Illness Associated with Influenza A (H1N1) infection. CHEST, 2013; 144: 39-47.

 

Muscedere J., Shorr A.F., Jiang X., Day A., Heyland D.K. for the Canadian Critical Care Trials Group. Adequacy of Antibiotic Therapy for Ventilator Associated Pneumonia: An Important Determinant of Outcome,Journal of Critical Care2102; 27(3): 322. Epub ahead of Print:http://dx.doi.org/10.1016/j.jcrc.2011.09.004

 

Muscedere J.Considerations in the design of antibacterial trials for Ventilator Associated Pneumonia. Clinical Investigation 2011; 1(8):  1083 – 1093. Rewa, K. MaKechnie, D. Laporta, X. Jiang. Heyland D.K. Sub-Glottic Secretion for the prevention of ventilator associated pneumonia; A systematic review and meta-analysis. Critical Care Medicine, 2011; 39(8): 1985-1991.

 

Muscedere J., Day A., Heyland D.K. Mortality, attributable mortality and time to clinical event analysis as endpoints for trials of Ventilator Associated Pneumonia and Hospital Acquired Pneumonia. Clinical Infectious Diseases. 51 Suppl 1:S120-5, 2010.

 

Muscedere J. Ventilator Associated Pneumonia and Mortality; the controversy continues. Critical Care Medicine. 2009; 37: 2845- 2846.

 

Muscedere J, DodekP., Keenan S., Fowler R., CookD., Heyland D. for the VAP Guidelines Committee and the Canadian Critical Care Trials Group. Comprehensive Evidence-Based Clinical Practice Guidelines for Ventilator Associated Pneumonia: Prevention. J of Critical Care, 2008; 23: 126-137.

 

Muscedere J, DodekP., Keenan S., Fowler R., CookD., Heyland D. for the VAP Guidelines Committee and the Canadian Critical Care Trials Group. Comprehensive Evidence-Based Clinical Practice Guidelines for Ventilator Associated Pneumonia: Diagnosis and Treatment. J of Critical Care, 2008; 23: 138-147.

 
Dr. Drover's research interests primarily relate to nutrition in the critically ill. He has been involved in the development and ongoing maintenance of the Canadian clinical practice guidelines for nutrition in the critically ill patient. These updated guidelines are available at: www.criticalcarenutrition.com  One specific area of interest within nutrition is the possible efficacy of immune modulating ingredients in therapeutic diets. He has also collaborated on various other multicenter studies that have been conducted in the ICU. He has also done work in the area of surgical airway for the critically ill patient.

McClave SA, Kushner RF, Van Way CW, Cave MC, DeLegge MH, DiBiase JK, Dickerson RN, Drover JW, Frazier TH, Fujioka K, Gallagher D, Hurt RT, Kaplan LM, Kiraly LN, Martindale R, McClain CJ, Ochoa J. Summation Recommendations and Future Considerations. Journal of Parenteral and Enteral Nutrition, 2011; 88S-96S.

Drover JW, Dhaliwal R, Weitzel L, Wischmeyer PE, Ochoa JB, Heyland DK. The perioperative use of arginine supplemented diets: A systematic review. J Am Coll Surg, 2011; 212: 385-399 

Dickerson RN, Drover JW.  Monitoring Nutrition Therapy in the Critically Ill Obese Patient.  Journal of Parenteral and Enteral Nutrition, 2011; 35: 44S-51S.

Kushner RF, Drover JW.  Current Strategies of Critical Care Assessment and Therapy of the Obese Patient.  (Hypocaloric Feeding):  What are we doing and what do we need to do?  Journal of Parenteral and Enteral Nutrition, 2011; 35: 36S-43S.

Drover JW, Dhaliwal R, Weitzel L, Wischmeyer PE, Ochoa JB, Heyland DK. The perioperative use of arginine supplemented diets: A systematic review. J Am Coll Surg, 2011; 212: 385-399.

Dr. Galvin’s academic interests include respiratory physiology, mechanical ventilation and lung protective strategies. She has a particular interest in lung injury prevention and is currently conducting in a PSI funded multicentre observational study, investigating risk factors for acute lung injury among patients admitted to Critical Care.  Having a Master Degree in Clinical Trials (LSHTM), she has a keen interest in clinical research methodology and is a reviewer for the American Journal of Respiratory and Critical Medicine. 

Galvin I, Steel AC, Ferguson ND, Davies M, Pinto R. Partial Liquid Ventilation for Adults with Acute   Lung Injury. Cochrane Systematic Review (In press)

Galvin I, Ferguson ND. Acute Lung Injury in the ICU – Focus on Prevention, Annual Update in Intensive Care and Emergency Medicine .2011 Springer Publications

Thomas AN, Galvin I. Equipment Related Patient Safety Incidents as Reported to the National Patient Safety Agency. Anaesthesia. 2008 Nov; 63(11):1193-7.

Galvin I, Nirmalan M. The role of gravity and non-gravitational factors in determining pulmonary ventilation perfusion distribution. British Journal of Intensive Care 200818(4):135-141.

Galvin I, Drummond GB, Nirmalan M. Distribution of blood flow and ventilation in the lung: gravity is not the only factor. British Journal of Anaesthesia.2007.Apr; 98(4): 420-8.

Galvin I, Krishnamoorthy R, Saad RS. Management of ARDS complicated by bilateral pneumothoraces with high frequency oscillatory ventilation in an adult. British Journal of Anaesthesia.2004.Sep; 93(3):454.

Dr. Heffernan received his Master’s of Clinical epidemiology from Memorial University, Newfoundland. Dr. Heffernan’s primary academic interests include research in the epidemiology of asthma and socioeconomic predictors of health. He also has a keen interest in pursuing research in pleural disease and mechanical ventilation.

Publications:
Socioeconomic status, asthma, and emergency department use in Ontario, Canada

Master’s Dissertation,  Memorial University of Newfoundland, 2011

Socioeconomic deprivation, asthma, and emergency department use in Ontario, Canada: A Poisson regression analysis. Paul M. Heffernan, Andrew Day, Miao Wang, Miu Lam, Diane Lougheed. Chest 2011 140:4 227A

Socioeconomic Status and Asthma in Ontario: An Analysis of Regional Variation in Emergency Department Visits and Hospitalizations. Paul M Heffernan, Andrew Day, Mui Lam, M Diane Lougheed, Canadian Respiratory Journal, Volume 17, Supplement B, page 14B, 2010

Dr Heyland has a variety of research interests which include 3 CIHR-funded programs of research in nutrition, infection, and end of life care. Related to end of life care research, he chairs a multidisciplinary end of life research group known as the CAnadian Researchers at the End of LifeNETwork (CARENET, www.thecarenet.ca), a New Emerging Team funded by the Canadian Institutes of Health Research.  In the area of nutrition, in addition to conducting primary studies related to critical care nutrition, he has conducted over 30 systematic reviews of the literature.  His efforts culminated in the production of clinical practice guidelines that were endorsed by all pertinent national societies and have been recognized by numerous international societies (see www.criticalcarenutrition.com). Subsequently, working in a multidisciplinary research group, he has been working to standardize (and improve) nutrition support practice in ICUs across Canada and around the world.  Every year for the last 3 years, they have conducted international audits of nutrition practice and more than 200 ICUs from around the world sign up for that initiative every year.  At the same time, he has developed and initiated a multi-center randomized trial entitled:  REducing Deaths due to OXidative Stress (The REDOXS©Study).  This trial will enroll 1200 critically ill patients and randomize them to receive glutamine and antioxidant supplementation or placebo.  His prior work related to infection includes conducting a randomized trial to examine the effect of empiric broad-spectrum antibiotics and invasive diagnostic techniques in patients with a suspicion of ventilator-associated pneumonia (>30 centers, 740 patients, >$2.5 million).  The results of this trial have been published in the New England Journal of Medicine with several secondary analyses published in lead critical care journals.  One of these secondary observations was an analyses that showed that critically ill patients with suspected VAP that growCandida species from the endotracheal aspirates have a much worse outcome than expected, or when compared to patients that grow pathogenic bacteria.  He has then developed a program of research to establish whether these kinds of patients should be treated with antifungals and we’ve received over $350,000 of funding to conduct a pilot study.

Overall, Dr. Heyland has published approximately 205 peer-reviewed papers, raised more than $72 million in external grant support including more than $32 million from CIHR, and given > 205 international presentations.

Heyland DK, Pichora D, Dodek P, Lamontagne F, You JJ, Barwich D et al. The development and validation of a questionnaire to audit advance care planning. J Palliative Care Med 2012;2(5). (in press)

Funk L, Stadjuhar K, Cohen R, Heyland DK, Williams A. Legitimising and rationalizing in talk about satisfaction with formal health care among bereaved family members. Social Health Illn 2012, 5 Mar (in press).

Rewa O, Muscedere J, Reynolds S, Jiang X, Heyland DK. Staphylococcus epidermidis catheter-related bloodstream infections and their association with acute phase markers of inflammation in

the intensive care unit: An observational study. Can J Infect Disease 2012 (in press).

Davies AR, Morrison SS, Bailey MJ, Bellomo R, Cooper DJ, Doig GS, Finfer SR, Heyland DK, for the ENTERIC Study Investigators and the ANZICS Clinical Trials Group. A multi-centre randomized controlled trial comparing early nasojejunal with nasogastric nutrition in critical illness.” Crit Care Med 2012 (in press).

Reynolds S, Shorr A, Muscedere J, Jiang X, Heyland DK. Longitudinal changes in procalcitonin in a heterogeneous group of critically ill patients. Crit Care Med 2012 (in press).

Petrof E, Dhaliwal R, Heyland DK et al. Probiotics in the critically ill: A systematic review of the randomized trial evidence. Crit Care Med 2012 (in press).

 

Dr. Ilan’s research has focused on patient safety and quality improvement (1, 2). In particular, he has described patterns of adherence to evidence-based practices in the ICU (3, 4), and implemented system-based interventions to address relevant barriers. In addition, he studied the effectiveness of a complementary patient safety event reporting system in the ICU (5), as well as handoff communication patterns among critical care physicians (6).

1. Ilan R, Fowler RA. Brief history of patient safety culture and science. J Crit Care. 2005;20(1):2-5.

2. Ilan R, Donchin Y. Creating patient safety capacity in a nation's health system: A comparison between Israel and Canada. Isr J Health Policy Res. 2012 2012/05/23;1(1):10.1186/2045-4015-1-19.

3. Ilan R, Fowler RA, Geerts R, Pinto R, Sibbald WJ, Martin CM. Knowledge translation in critical care: Factors associated with prescription of commonly recommended best practices for critically ill patients. Crit Care Med. 2007;35(7):1696-702.

4. Cload B, Day AG, Ilan R. Evaluation of unnecessary central venous catheters in critically ill patients: A prospective observational study. Can J Anesth. 2010;57(9):830-5.

5. Ilan R, Squires M, Panopoulos C, Day A. Increasing patient safety event reporting in 2 intensive care units: A prospective interventional study. J Crit Care. 2011;26(4):431.e11,431.e18.

6. Ilan R, LeBaron CD, Christianson MK, Heyland DK, Day A, Cohen MD. Handover patterns: An observational study of critical care physicians. BMC Health Serv Res. 2012;12(11).


Dr. Maslove - Please go to the following link: http://www.conduitlab.org/  

 

Dr. Messenger has conducted research on Emergency Department Procedural Sedation and Analgesia.  He is also active as a collaborator on national guidelines for vasopressor & inotrope use in Emergency Departments as well as for therapeutic hypothermia following cardiac arrest.  He serves as a peer reviewer for a several national and international medical journals.

Howes D, Messenger DW.  Is faster still better in therapeutic hypothermia? [editorial].  Critical Care2011. 15(3): 162.

Sivilotti MLA, Messenger DW, VanVlymen J, Dungey PE, Murray HE.  A comparative evaluation of capnometry versus pulse oximetry for the detection of respiratory events during procedural sedation and analgesia on room air.  Canadian Journal of Emergency Medicine 2010; 12(5): 397-404.

Messenger DW, Murray HE, Dungey PE, VanVlymen J, Sivilotti MLA.  Subdissociative-dose ketamine versus fentanyl for analgesia during propofol procedural sedation: a randomized clinical trial. Academic Emergency Medicine 2008; 15(10): 877-886.

Messenger DWSivilotti MLA.  “Procedural Sedation and Analgesia.” Chapter 54 in Evidence-Based Emergency Medicine.  Rowe BH (ed.), 1st Ed.  Oxford: Blackwell Publishing. 2008.