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Emergency Critical Care is a rapidly growing sub-specialty within Emergency Medicine. This unique experience allows emergency medicine physicians to master the treatment of critically ill patients. By providing intensive treatment options to patients in the Emergency Department, patients can receive treatment much earlier in their hospital stay. Intensivists believe that early access to care will improve clinical outcomes.
Dr. Slesinger has focused much of his research on the diagnosis and treatment of sepsis. He is a member of the ED Sepsis Team, a group of physicians and scientists within the department that have focused their efforts on improving identification tools and treatment strategies to reduce mortality of septic patients. Over the past decade, the incidence of sepsis has risen at an alarming rate, affecting as many people as acute myocardial infarctions, with a mortality rate above 30%. The ED Sepsis Team, consisting of Andrew Sama, MD, Todd L. Slesinger, MD, Jason Z. D’Amore, MD, Mary Frances Ward, RN, ANP and Haichao Wang, PhD, has made many strides in clinical, translational, and basic science research to improve the current medical knowledge regarding sepsis. Haichao Wang, PhD, has found many correlations between cytokines and inflammation and sepsis ex vivo. The clinicians, Dr. D’Amore, and Dr. Slesinger hope to apply this knowledge, in vivo, to improve the diagnostic tools and treatment strategies currently available to identify sepsis and improve mortality in patients presenting to the ED.
Over the past several years, the ED Sepsis Team has received several grants to expand their research efforts. Dr. Wang, an NIH R01 funded investigator, has received external funding to continue his cytokine research to better understand the pathophysiology behind sepsis and septic shock. Dr. D’Amore is currently funded by the Feinstein Institute for Medical Research for his study entitled, “The Role of HMGB1 and Fetuin in the Development and Progression of Clinical Sepsis”. By applying the knowledge that Dr. Wang has generated regarding the underlying mechanisms behind cytokine levels during sepsis, Dr. D’Amore wishes to create a diagnostic tool that will allow clinicians to determine the stage of disease progression a particular patient may be at based on their serum cytokine levels.
For the next several years, the Department of Emergency Medicine will participate in a large, multi-center randomized trial funded by the NIH and coordinated by the University of Pittsburgh Departments of Critical Care and Emergency Medicine. The study, entitled “the Protocolized Care for Early Septic Shock” (ProCESS), hopes to replicate the positive results produced from a previous randomized, single-center trial which showed a significant improvement in mortality and clinical outcomes through the use of a standardized protocol which calls for early, intensive therapy to prevent future negative consequences. The study, not only hopes to determine if the implication of a protocolized resuscitation strategy within the first 6 hours of ED presentation will improve outcomes, but will also measure the concentrations over time of several markers for sepsis-related organ dysfunction to better measure the effectiveness of protocolized resuscitation. Lastly, since the cost of protocolized resuscitation is quite high, the study aims to determine the cost-effectiveness of this strategy compared to other modes of treatment. If successful, the investigators of this study feel that the results will revolutionize the treatment of the critically ill.
If you are interested in the Critical Care Fellowship Program, please contact Todd L. Slesinger, MD at tslesinger@yahoo.com.