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.
Jill M. Cholette, M.D.
Dr. Jill Cholette’s research focus is related to blood conservation and modification and the impact of blood transfusions on inflammation, immune-modulation, thrombosis, and clinical outcomes in critically ill children. Dr. Cholette is part of a multi-disciplinary team of pediatric intensivists, cardiologists, anesthesiologists and cardiac surgeons performing clinical research regarding the peri-operative care of children with congenital heart disease.
Dr. Cholette’s research explores the optimal hemoglobin level and transfusion threshold for critically ill infants and children with complex cyanotic cardiac defects. She has completed the only prospective randomized clinical trial exploring a liberal v. restrictive red blood cell transfusion strategy in children with single ventricle physiology, the results demonstrating that a restrictive strategy is tolerated. A prospective randomized clinical trial of neonates and infants undergoing palliative and surgical repairs, randomized to different transfusion strategies, is currently being performed.
In addition, Dr. Cholette has studied the impact of post-operative infusion of intra-operative collected cell saver blood salvaged from the surgical field on children immediately following cardiac surgery. Children prospectively randomized to receive cell saver blood received fewer red blood cell and coagulant product transfusions. Furthermore, Dr. Cholette has explored whether modification of blood cell products transfused to children following cardiac surgery with cardiopulmonary bypass can reduce the inflammatory and immune-response in the recipient.
The primary aim of Dr. Cholette’s research is to provide data regarding the safety and efficacy of blood conservation and modification transfusion strategies in critically ill children with complex cardiac defects, with the goal of improving the clinical outcomes of these children.
Prospective randomized controlled clinical trial comparing a restrictive v. liberal transfusion strategy in neonates and infants undergoing surgery for congenital heart disease. Principle Investigator: J.M. Cholette
Previous Research Support
University of Rochester Strong Children’s Research Center Research Development Award: 2008-2010, $21,000
“Washed versus Standard Transfusions in Pediatric Cardiac Surgery”
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.
University of Rochester Strong Children’s Research Center Research Development Award: 2010-2011, $25,000
“Post-operative infusion of intra-operative cell salvage reduces allogeneic blood product transfusions and volume resuscitation in pediatric cardiac surgery and improves clinical outcomes.”
Cholette JM, Powers KS, Alfieris GM, Angona R, Henrichs K, Masel D, Daugherty EL, Blumberg N. Cell Saver for volume replacement in children following cardiopulmonary bypass reduces the number of RBC and blood product transfusions and donor exposures. Pediatric Critical Care Medicine 2013;14(2): 137-147.
Swartz MF, Schiralli MP, Cholette JM, Angona R, Alfieris GM. The effect of repeat sternotomy during right ventricular outflow tract reconstruction. Congenital Heart Disease 2013 in press.
Cholette JM, Henrichs KF, Powers KS, Alfieris GM, Phipps R, Spinelli S, Daugherty LE, Nazarian E, Rubenstein J, Swartz M, Gensini F, Eaton M, Sweeney D, Lerner NB, Blumberg N. Washing Blood Transfused in Pediatric Open Heart Surgery Reduces Post-Operative Inflammation and Immunomodulation: Results of a Prospective Randomized Controlled Trial. Pediatr Crit Care Med 2012; 13(3): 290-299.
Swartz MF, Cholette JM, Meagher CC, Gensini F, Alfieris GM. Decreased Incidence of Supravalvar Pulmonary Stenosis Following Arterial Switch Operation. Circulation 2012; 126(11 S1):118-22.
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. Pediatr Crit Care Med 2011;12(1):39-45.
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.
Active Research Support
Transcription Factor Analysis in a Congenital Diaphragmatic Hernia Model (R01, Principal Investigator)
Screen for Identification of Important Human Birth Defect Models in Swine (R21, Principal Investigator)
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)
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.