Critical Care Research
Although our research activities are largely clinically oriented, members of the division have collaborated and continue to work with established laboratory researchers.
Research Activities
Jill M. Chollette, M.D.
Dr. Jill Cholette’s research focus is related to blood conservation and modification and its impact on inflammation, immunomodulation, thrombosis, and clinical outcomes in children undergoing palliation and surgical repair of congenital heart defects. Dr. Cholette is part of a multi-disciplinary team of pediatric intensivists, cardiologists, anesthesiologists and cardiac surgeons performing clinical research regarding the perioperative care of these vulnerable infants and children.
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Washed v. standard blood cell transfusions in pediatric cardiac surgery: impact on post-operative inflammation as evidenced by the IL-6 to IL-10 ratio.
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A prospective randomized controlled trial of 170 neonates, infants and children randomized to receive either washed or unwashed leukoreduced, irradiated blood cell products for cardiopulmonary bypass and hospital admission. This pilot study is powered to explore the immunomodulatory and inflammatory impact of blood cell modification by washing, but examines clinical outcome measures as well.
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Post-operative infusion of intra-operative cell salvage reduces allogeneic blood product transfusions and volume resuscitation in pediatric cardiac surgery and improves clinical outcomes.
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A prospective randomized controlled trial of neonates and infants having cardiac surgery with cardiopulmonary bypass. These children are randomized to receive intraoperatively collected washed cell saver red blood cells v. standard volume replacement with allogeneic blood cells and/or crystalloid/colloid infusions post-operation as volume replacement. Clinical outcome measures and inflammatory/immunomodulatory markers will be compared between each group.
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Calcium replacement and its association with thrombosis in infants following cardiac surgery.
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Preliminary evidence suggests an association between the maintenance of supratherapeutic calcium levels and continuous calcium replacement and worse clinical outcomes and thrombosis in neonates and young infants following cardiac surgery. This retrospective chart review will test for a correlation between total calcium dose and clinical outcomes.
Active Research Support
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University of Rochester Strong Children’s Research Center Research Development Award: 2008-2010, $21,000
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“Washed versus Standard Transfusions in Pediatric Cardiac Surgery”
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The goal of this study is to decrease the inflammatory and immunomodulatory effect of allogeneic blood cell transfusions on pediatric patients undergoing open heart surgery, and to improve clinical outcomes.
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University of Rochester Strong Children’s Research Center Research Development Award: 2010-2011, $25,000
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“Post-operative infusion of intra-operative cell salvage reduces allogeneic blood product transfusions and volume resuscitation in pediatric cardiac surgery and improves clinical outcomes”.
Publications
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Cholette J, Rubenstein J, Powers K, Alfieris G, Lerner N. Cyanotic children undergoing open heart surgery do not appear to benefit from higher hemoglobin levels: Results of a restrictive v. liberal RBC transfusion strategy. Crit Care Med 2010; 37(12S):A434.
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Alfieris GM, Gangemi JJ, Schiralli M, Swartz M, Cholette JM. Modified repair of Truncus Arteriosus to Maintain Pulmonary Artery Architecture. Annals of Thoracic Surgery 2010; in press (#222315).
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Cholette JM, Rubenstein JS, Alfieris GM, Powers KS, Eaton MP, Children with single ventricle physiology do not benefit from higher hemoglobin levels following cavopulmonary connection: Results of a prospective, randomized controlled trial of a restrictive v. liberal red cell transfusion strategy. Pediatric Critical Care Medicine 2010; in press.
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Cholette JM, Mamikonian L, Alfieris GM, Blumberg N, Lerner NB. Aspirin resistance following pediatric cardiac surgery. Thrombosis Research 2010; in press (TR-D-09-00420R2).
Kate Guernsey Ackerman, M.D.
(Associate Professor of Pediatrics, Associate Professor of Biomedical Genetics)
Dr. Ackerman’s research is focused on understanding specific aspects of organogenesis that are pertinent for understanding developmental mechanisms of human structural birth defects. The major focus is on the development of the diaphragm and the early lung to improve understanding of human congenital diaphragmatic defects.
Dr. Ackerman’s research mainly utilizes mouse genetic approaches to understand mechanisms of development. As genes that are necessary for diaphragm development often have other important functions, null mice are rarely useful as models. The laboratory focuses on using conditional gene deletion, in vitro gene modification, and other technologies to investigate the effects of the altered gene dosage on development. Since current diaphragm development models are limited, the laboratory looks for new models by forward genetic screening of mice with ENU induced mutations or of relatively inbred swine populations with perinatal lethality. New models will be used for investigation of developmental mechanism (mice) or for developing improved surgical and medical therapies (swine).
Since the laboratory has a focus on human disease, we also evaluate candidate disease genes for sequence changes in affected patients. We enjoy building collaborations with clinicians and other research labs world wide.
Visit Dr. Ackerman's lab site for more information.
Active Research Support
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Transcription Factor Analysis in a Congenital Diaphragmatic Hernia Model (R01, Principal Investigator)
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Screen for Identification of Important Human Birth Defect Models in Swine (R21, Principal Investigator)
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Prediction, Validation, and Functional Assessment of Candidate CDH Genes in Animal Models- Genes Important in Early Embryonic Diaphragm Development will be ones perturbed in CDH (P01 (Donahoe), Co-Investigator)
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Genetic Epidemiology of Life Threatening Influenza in Children (R01 (Randolph), Site PI)
Members of the division collaborate actively within the Department of Pediatrics, the School of Medicine and Dentistry, the University, and industry.