Diffuse alveolar hemorrhage is thought to be a common complication after hematopoetic stem cell transplant (HSCT).   However, diagnostic criteria are highly variable and often subjective.  We are working on a systematic approach to the diagnosis and management of DAH after HSCT.

Team:  Chris Kapp, Ann Parker, Emily Brigham, Rachael Fornwalt, R Scott Stephens
Funding:  Pulmonary and Critical Care Medicine

The Discovery Research Network – Influenza Observational Study is a multi-center observational study performed under the auspices of the Discovery Research Network of the Society of Critical Care Medicine Program in Emergency Preparedness (Discovery-PREP), an academic network examining emergency treatment processes. The primary goal of the Discovery Research Network – Influenza Observational Study is to evaluate the feasibility of initiating rapid multi-center data collection in the midst of a public health emergency and to establish a research response capability for future epidemics or pandemics.  The secondary aim of the study is to describe the clinical epidemiology and microbiology profiles of patients with severe influenza infection.

Team: R. Scott Stephens, Adam Sapirstein (ACCM) and the Discovery-PREP investigators, led by Perren Cobb (USC).
Funding: FDA-BARDA

Novel anti-tumor agents are rapidly being introduced into clinical oncologic practice, including a variety of immune checkpoint inhibitors.   Though effective against some tumors, these agents can cause severe off-target effects, including severe pneumonitis.  We are interested in characterizing the clinical presentation of checkpoint inhibitor-induced pneumonitis, including bronchoalveolar lavage characteristics, and in developing animal models to allow basic investigations into mechanisms and treatments.

Team: Karthik Suresh, Franco D’Alessio

There is increasing utilization of extracorporeal membrane oxygenation (ECMO) in critical care worldwide, but little is known about neurological monitoring, neuroprognostication and neurologic outcomes in ECMO patients. Our aim is to characterize this population using multimodal non-invasive and predominantly bedside neurologic monitoring.

Team: R. Scott Stephens, Sung-Min Cho (Neurocritical Care), Romer Geocadin (Neurocritical Care), Wendy Ziai (Neurocritical Care), Jose Suarez (Neurocritical Care), Glenn Whitman (Cardiac Surgery/Cardiovascular Surgical Intensive Care Unit), Chun Woo (Dan) Choi (Cardiac Surgery).

Extracorporeal Membrane Oxygenation (ECMO) is increasingly used to support patients with severe ARDS and refractory cardiogenic shock.  The available data on ECMO are inconclusive, and further studies are needed.  The goal of the North American ECMONet is to develop a multi-center platform to design and undertake multicenter studies of ECMO for respiratory failure and cardiac failure.

Team: R. Scott Stephens and the North American ECMONet.

The Oncology Critical Care Research Network (ONCCC-R-NET) is a novel multicenter effort to establish and maintain a global collaborative infrastructure for oncologic critical care research.   Other member centers include MD Anderson Cancer Center, Sloan Kettering Cancer Center, Washington University in St. Louis, Duke University, and Princess Margaret Hospital (Toronto).

Team: R. Scott Stephens and the ONCCC-R-NET Investigators.  http://www.oncccrnet.org/

Hematopoetic Stem Cell Transplant (HSCT) is an important treatment modality for hematologic diseases, both malignant and non-malignant.   Historically, HSCT has been complicated by high rates of respiratory failure and acute respiratory distress syndrome (ARDS), both associated with a high mortality.  There are significant differences between ARDS after HSCT and “typical” ARDS, including not only a different spectrum of causative pathogens, but a different putative pathophysiology.  In “typical” ARDS, neutrophils and platelets are thought to play a key role in the development of lung injury. However, when ARDS develops after HSCT, patients are frequently profoundly neutropenic and profoundly thrombocytopenic.   We are interested in further characterizing the pathophysiology of ARDS after HSCT.  Additionally, at Johns Hopkins, we perform a large number of non-myeloablative haploidentical bone marrow transplants, rather than the myeloablative full matched transplants performed at other institutions.  We are in the process of exploring the incidence and outcomes of respiratory failure after HSCT in this particular population, data not previously described.

Team:  R. Scott Stephens, Christian Merlo, Amy DeZern (Hematologic Malignancies)
Funding: Pulmonary and Critical Care Medicine

The SAGE study is a multi-center prospective observational study examining patient characteristics, management strategies, and outcomes in patients with moderate-to-severe ARDS (P:F < 150).  19 centers collected data on >2000 patients.  Primary data analysis is underway.  Additionally, as a SAGE site, we have the opportunity to propose and conduct ancillary studies using the large and comprehensive SAGE dataset. 

Team: R. Scott Stephens and the SAGE Investigators, led by Pauline Park (Michigan), Nida Qadir (UCLA), Raquel Bartz (Duke), and Michelle Gong (Montefiore).