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Associate Professor Kiran Shekar

Site Coordinator (Secondment)

Prince Charles Hospital Northside Clinical Unit
Faculty of Medicine

ATH - Associate Professor

Prince Charles Hospital Northside Clinical Unit
Faculty of Medicine
k.shekar@uq.edu.au

Overview

Shekar is a Senior Intensive Care Specialist and the Director of Research in the Adult Intensive Care Service at the Prince Charles Hospital. He holds academic appointments as Associate Professor at the University of Queensland, Adjunct Professor at Queensland University of Technology and Associate Professor at Bond University, Gold Coast. Shekar is the recipient of the Metro North Hospital and Health Service Clinician Research Fellowship. Shekar specialises in the design and conduct of both pre-clinical and clinical studies. His ongoing research programs, “The NO Tube Project” and “ The Budget ICU Project”, bring together clinicians, multidisciplinary allied health professionals, engineers, scientists, health economists, industry and policy experts to minimise the burden of invasive mechanical ventilation in intensive care units and to improve access to intensive care services around the world. His current body of research includes the pathophysiology of cardiorespiratory failure, sepsis and extracorporeal life support (ECLS). Shekar has significant experience in conducting mechanistic research in large animal models of lung injury, mechanical ventilation, sepsis and ECLS. His pioneering work in drug pharmacokinetics in adult patients on ECLS was recognised globally. He is the chief investigator of an ongoing international multi-centre clinical study that aims to develop drug dosing guidelines for ECLS patients. Shekar has secured over $9.5 million in grant funding, published over 190 peer-reviewed articles, 60 conference abstracts, 10 book chapters and has delivered over 80 national and international lectures. He regularly reviews articles for leading journals and competitive grant applications. He is routinely involved with bedside teaching and simulation exercises, as well as supervision of RHD students. Shekar has collaborated extensively both nationally and internationally. He is a member of the Scientific Committee of the International ECMO Network. He is the global research lead for Extracorporeal Life Support Organisation (ELSO) Education Taskforce and is a member of the Asia-Pacific ELSO Steering and Education Committee. He is also the Chair of the global ELSO COVID-19 working group. Shekar contributes to the Australia and New Zealand Intensive Care Society COVID-19 Guideline Committee and is the Co-Chair of the National COVID-19 Clinical Evidence Taskforce Hospital and Acute Care Panel. He has significant experience with Clinical Information Systems (CIS) and is the Chair of the CIS Special User Group in Queensland.

Research Interests

  • Extracorporeal membrane oxygenation
  • Respiratory failure and minimising the burden of invasive mechanical ventilation
  • PK/PD on Extracorporeal membrane oxygenation support
  • Cardiogenic Shock and Mechanical Circulatory Support
  • Microcirculation on temporary Mechanical Circulatory Support
  • Building a budget intensive care unit to improve intensive care access in resource poor countries
  • Standardising ECMO education to bridge the variability in global ECMO outcomes

Publications

  • Journal Article: Cannabis use disorders and outcome of admission to intensive care: A retrospective multi-centre cohort study

    Renger, Laura, Dhanani, Jayesh, Milford, Elissa, Tabah, Alexis, Shekar, Kiran, Ramanan, Mahesh and Laupland, Kevin B. (2024). Cannabis use disorders and outcome of admission to intensive care: A retrospective multi-centre cohort study. Journal of Critical Care, 80 154504, 154504. doi: 10.1016/j.jcrc.2023.154504

  • Journal Article: Achievement of therapeutic antibiotic exposures using Bayesian dosing software in critically unwell children and adults with sepsis

    Chai, Gene G., Tu, Quyen, Cotta, Menino O., Bauer, Michelle J., Balch, Ross, Okafor, Charles, Comans, Tracy, Kruger, Peter, Meyer, Jason, Shekar, Kiran, Brady, Kara, Fourie, Cheryl, Sharp, Natalie, Vlad, Luminita, Whiley, David, Ungerer, Jacobus P. J., McWhinney, Brett C., Farkas, Andras, Paterson, David L., Clark, Julia E., Hajkowicz, Krispin, Raman, Sainath, Bialasiewicz, Seweryn, Lipman, Jeffrey, Forde, Brian M., Harris, Patrick N. A., Schlapbach, Luregn J., Coin, Lachlan, Roberts, Jason A. and Irwin, Adam D. (2024). Achievement of therapeutic antibiotic exposures using Bayesian dosing software in critically unwell children and adults with sepsis. Intensive Care Medicine, 1-9. doi: 10.1007/s00134-024-07353-3

  • Journal Article: Ventilatory strategies during venovenous ECMO in ARDS: PEEPing at the elephant in the room

    Ling, Ryan Ruiyang, Ramanathan, Kollengode and Shekar, Kiran (2024). Ventilatory strategies during venovenous ECMO in ARDS: PEEPing at the elephant in the room. Journal of Critical Care, 79 154407, 154407. doi: 10.1016/j.jcrc.2023.154407

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Grants

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Supervision

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Available Projects

  • The NO TUBE Project

    Induced coma and breathing machines have become synonymous with intensive care units (ICU). Breathing machines are undoubtedly life-saving in many situations where a person can’t breathe for themselves independently. A tube is placed in wind pipe through the back of the mouth and the patient is put on a breathing machine to achieve this. This buys time for caring team to fix the underlying problems that may have necessitated the breathing tube. Despite it being one of the most potent life sustaining technology available, it is also a leading cause of distress for patients and families in ICU, with survivors reporting long term physical and psychological sequalae. Although technology has improved and we have learnt how to use these breathing machines better, the risks and high costs remain.

    Non-invasive alternatives such as nasal high flow oxygen delivery systems or pressurised face masks are usually used as first line treatment. This research intends to extend the benefits of these less invasive breathing support systems by adding nitric oxide gas to the oxygen-air mix. Nitric oxide gas delivered through the nose increases oxygen levels in blood and may help a patient avoid a breathing tube and induced coma. Equally, this project will expolore the efficacy of extarcoporeal respirtatory support technologies such as extracorporeal membrane oxygenation and extracoprporeal carbon dioxide removal in minimsing the need for invasive mechancial ventilation. In addition, the faesiblity and efficacy of biphasic cuirass ventilation(also termed negative pressure breathing) in minimisng the burden of invaisve mechanical ventilation will also be tested. These approaches may redefine our current management of respiratory failure, reduce distress for patients and allow them to be autonomous, maintain dignity, talk, eat and exercise while they recover. This may also lead to substantial reduction in health care costs.

  • Cardiac protection during veno-arterial extracorporeal membrane oxygenation

    Advances in medical therapies in the last three decades have failed to improve mortality from cardiogenic shock (CS). This is despite the rapid uptake of TCS technologies, most notably V-A ECMO and percutaneous ventricular assist devices. Encouraging outcomes have been reported in selected group of CS patients with the use of veno-arterial extracorporeal membrane oxygenation (V-A ECMO). However, the CS population supported with V-A ECMO is quite heterogenous. While approximately 60% of patients have sufficient cardiac recovery to wean from V-A ECMO, 40% of patients survive to hospital discharge and this attrition is largely due to persistent heart failure. Most acute CS patients are not candidates for durable MCS or heart transplant, and therefore it is of critical importance to minimise secondary cardiac injury and maximise cardiac recovery during V-A ECMO. However, the current setup and use of V-A ECMO results in increased LV workload, potentially leading to progressive LV distension, loss of aortic valve opening, intra-cardiac blood stasis and thrombosis, with subendocardial ischemic injury and compromised cardiac recovery. Equally, significant impairment of microcirculation seen in CS and V-A ECMO patients, combined with blood component damage and activation of the endothelium, as well as coagulation and inflammatory systems may all lead to further cardiac injury. Therefore, merely replacing the native pump (patient’s own heart) with a non-pulsatile, continuous flow pump (V-A ECMO), without optimising the microcirculation and unloading the LV, may result in suboptimal outcomes.

    To overcome this, we may have to look beyond traditional haemodynamic monitoring and measurements to achieve this goal. In the future, holistic monitoring during V-A ECMO may include continuous monitoring of cardiac mechanics and output, pulmonary pressures, haemostasis, microcirculation and brain tissue oxygenation. Defining CS patient populations that stand to benefit most in clinical studies, thereby enriching those studies is also a key priority moving forward. Equally, measuring quality and process metrics for ECMO is critical to making improvements in an ECMO program. This project takes a holistic look at V-A ECMO to systematically investigate this eveolving area to improve patient outcomes.

  • Lung protection during venovenous extracorporeal membrane oxygenation

    Although minimizing risks of ventilator-induced lung injury on venovenous ECMO is paramount, the risks/benefits of strategies employed to minimize ventilator-induced lung injury also merit due consideration. This research involves systematic invetsigation of topics espcially the use of partial or total liquid ventilation to minimsie iatrogenic lung injury on V-V ECMO and to provide best lung healing conditions.

View all Available Projects

Publications

Book Chapter

  • Ethical challenges and quality assurance of extracorporeal membrane oxygenation

    Ramanathan, Kollengode, Shekar, Kiran and Dhundi, Ujwal (2023). Ethical challenges and quality assurance of extracorporeal membrane oxygenation. Cardiopulmonary bypass: advances in extracorporeal life support. (pp. 1023-1031) Amsterdam: Academic Press. doi: 10.1016/b978-0-443-18918-0.00065-6

  • Extracorporeal life support in accidental hypothermia

    Mitra, Saikat, Swol, Justyna, Ramanathan, Kollengode and Shekar, Kiran (2023). Extracorporeal life support in accidental hypothermia. Cardiopulmonary bypass: advances in extracorporeal life support. (pp. 1187-1195) edited by Kaan Kırali, Joseph S. Coselli and Afksendiyos Kalangos. Amsterdam, Netherlands: Elsevier. doi: 10.1016/b978-0-443-18918-0.00076-0

  • Inflammatory protection and management during extracorporeal membrane oxygenation

    Worku, Elliott T., Ki, Katrina and Shekar, Kiran (2023). Inflammatory protection and management during extracorporeal membrane oxygenation. Cardiopulmonary Bypass. (pp. 1003-1020) London, United Kingdom: Academic Press. doi: 10.1016/b978-0-443-18918-0.00064-4

  • List of contributors: volume II

    Abutaka, Ahmad, Acton, Matthew, Agerstrand, Cara, Akhmerov, Akbarshakh, Akin, Ibrahim, Aksüt, Mehmet, Alinier, Guillaume, Altınay, Adile Ece, Andreasson, Anders, Aslan, Hacı, Aydın, Sibel, Behnes, Michael, Belliato, Mirko, Benazzo, Alberto, Benk, Christoph, Beyersdorf, Friedhelm, Bohman, J. Kyle, Brehm, Christoph, Brixius, Sam, Brunsvold, Melissa E., Bulander, Robert E., Çelik, Mevlüt, Chatterjee, Subhasis, Chen, Yih-Sharng, Chien, Jung-Yien, Chung, Jayer, Clark, Joseph B., Davarci, Orhun, Dhaliwal, Bhalinder ... Yerli, Ismail (2023). List of contributors: volume II. Cardiopulmonary Bypass. (pp. xxxv-xxxix) Elsevier. doi: 10.1016/b978-0-443-18918-0.00106-6

  • Pharmacology

    Kirk, Christa Jefferis, Abdul-Aziz, Mohd H., Roberts, Jason A., Valencia, Eleonore, Watt, Kevin, MacLaren, Graeme and Shekar, Kiran (2022). Pharmacology. Extracorporeal life support: The ELSO red book. (pp. 643-654) edited by Graeme Maclaren, Daniel Brodie, Roberto Lorusso, Giles Peek, Ravi Thiagarajan and Leen Vercaemst. Ann Arbor, MI, United States: Extracorporeal Life Support Organization.

  • Challenges of antimicrobial therapy in ECMO patients

    Cheng, Vesa, Abdul-Aziz, Mohd H. and Shekar, Kiran (2022). Challenges of antimicrobial therapy in ECMO patients. Extracorporeal membrane oxygenation: an interdisciplinary problem-based learning approach. (pp. 191-200) edited by Marc O. Maybauer. Oxford, United Kingdom: Oxford University Press. doi: 10.1093/med/9780197521304.003.0018

  • Pharmacological considerations for analgesia and sedation of ECMO patients

    Chew, Joshua, Cheng, Vesa and Shekar, Kiran (2022). Pharmacological considerations for analgesia and sedation of ECMO patients. Extracorporeal Membrane Oxygenation. (pp. 179-190) edited by Marc O. Maybauer. Oxford, United Kingdom: Oxford University Press. doi: 10.1093/med/9780197521304.003.0017

  • Antibiotic dosing during extracorporeal membrane oxygenation

    Abdul-Aziz, M. H., Shekar, Kiran and Roberts, Jason A. (2018). Antibiotic dosing during extracorporeal membrane oxygenation. Antibiotic Pharmacokinetic/Pharmacodynamic Considerations in the Critically Ill. (pp. 151-171) edited by Andrew A. Udy, Jason A. Roberts and Jeffrey Lipman. Gateway East, Singapore: Springer . doi: 10.1007/978-981-10-5336-8_8

  • Optimizing the patient and timing of the introduction of mechanical circulatory and extracorporeal respiratory support

    Shekar, Kiran, Obonyo, Nchafatso and Fraser, John F. (2018). Optimizing the patient and timing of the introduction of mechanical circulatory and extracorporeal respiratory support. Mechanical circulatory and respiratory support. (pp. 441-468) edited by Shaun D. Gregory, Michael C. Stevens and John F. Fraser. London, United Kingdom: Academic Press. doi: 10.1016/B978-0-12-810491-0.00014-X

Journal Article

Conference Publication

  • Packed Red Cell Age Associated With Adverse Cardiovascular Changes in an Ovine Model of Septic Shock Resuscitation

    Fanning, Jonathon P., Obonyo, Nchafatso G., Tung, John-Paul, Byrne, Liam, Simonova, Gabriela, Diab, Sara, Dunster, Kimble, Passmore, Margaret, Boon, Ai-Ching, See Hoe, Louise, Engkilde-Pedersen, Sanne, Esguerra-Lallen, Arlanna, Hashairi Fauzi, Mohd, Pretti Pimenta, Leticia, Millar, Jonathan, Anstey, Christopher, van Haren, Frank, Cullen, Louise, Suen, Jacky, Shekar, Kiran, Maitland, Kathryn and Fraser, John (2018). Packed Red Cell Age Associated With Adverse Cardiovascular Changes in an Ovine Model of Septic Shock Resuscitation. American Heart Association's 2018 Scientific Sessions, Chicago, IL United States, 10-12 November 2018. Philadelphia, PA United States: Lippincott Williams & Wilkins. doi: 10.1161/circ.138.suppl_1.17116

  • Fluid resuscitation with 0.9% saline impairs myocardial contractility in an ovine model of endotoxemic shock

    Obonyo, N., Byrne, L., Shiino, K., Diab, S., Dunster, K., Passmore, M., Boon, A.C., See Hoe, L., Pedersen, S., Fauzi, M., Pimenta, L., Van Haren, F., Shekar, K., Anstey, C., Tung, J.P., Cullen, L., Platts, D., Chan, J., Maitland, K. and Fraser, J. (2018). Fluid resuscitation with 0.9% saline impairs myocardial contractility in an ovine model of endotoxemic shock. 9th Congress of the World Federation of Pediatric Intensive & Critical Care Societies (WFPICCS 2018), Singapore, 9-13 June 2018. Philadelphia, PA United States: Lippincott Williams & Wilkins. doi: 10.1097/01.pcc.0000538016.15507.8c

  • Does dosing of ceftriaxone in critically ill patients on ECMO need to change? A pharmacokinetics study

    Cheng, V., Shekar, K., Abdul-Aziz, M. H., Buscher, H., Corley, A., Diehl, A., Gilder, A., Jarrett, P., Lye, I., McGuinness, S., Parke, R., Pellegrino, V., Reynolds, C., Wallis, S. C., Welch, S., Zacharias, D., Fraser, J. F. and Roberts, J. A. (2018). Does dosing of ceftriaxone in critically ill patients on ECMO need to change? A pharmacokinetics study. European Society of Intensive Care Medicine Annual Congress, Paris, France, 20-24 October 2018. Heidelberg, Germany: Springer.

  • Does dosing of piperacillin-tazobactam in critically ill patients on ECMO need to change? A pharmacokinetics study

    Cheng, V., Shekar, K., Abdul-Aziz, M.H., Buscher, H., Corley, A., Diehl, A., Gilder, E., Jarrett, P., Lye, I., McGuinness, S., Parke, R., Pellegrino, V., Reynolds, C., Wallis, S. C., Welch, S., Zacharias, D., Fraser, J. F. and Roberts, J. A. (2018). Does dosing of piperacillin-tazobactam in critically ill patients on ECMO need to change? A pharmacokinetics study. European Society of Intensive Care Medicine Annual Congress, Paris, France, 20-24 October 2018. Heidelberg, Germany: Springer.

  • Fluid resuscitation with 0.9% saline impairs myocardial contractility in an ovine model of endotoxaemic shock

    See Hoe, L., Obonyo, N., Byrne, L., Shiino, K., Diab, S., Dunster, K., Passmore, M., Boon, C., Engkilde-Pedersen, S., Esguerra, A., Fauzi, M., Pretti Pimenta, L., Simonova, G., Van Haren, F., Shekar, K., Anstey, C., Tung, J., Cullen, L., Platts, D., Chan, J., Maitland, K. and Fraser, J. (2018). Fluid resuscitation with 0.9% saline impairs myocardial contractility in an ovine model of endotoxaemic shock. 66th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, the International Society for Heart Research Australasian Section Annual Scientific Meeting and the 12th Annual Australia and New Zealand Endovascular Therapies Meeting, Brisbane, Australia, 2-5 August 2018. Chatswood, NSW, Australia: Elsevier. doi: 10.1016/j.hlc.2018.06.129

  • Packed red cell age associated with adverse cardiovascular changes in an ovine model of septic shock resuscitation

    Fanning, Jonathon P., Obonyo, Nchafatso G., Tung, John-Paul, Byrne, Liam, Simonova, Gabriela, Diab, Sara, Dunster, Kimble, Passmore, Margaret, Boon, Ai-Ching, Hoe, See Louise, Engkilde-Pedersen, Sanne, Esguerra-Lallen, Arlanna, Fauzi, Hashairi Mohd, Pretti, Pimenta Leticia, Millar, Jonathan, Anstey, Christopher, van Haren, Frank, Cullen, Louise, Suen, Jacky, Shekar, Kiran, Maitland, Kathryn and Fraser, John (2018). Packed red cell age associated with adverse cardiovascular changes in an ovine model of septic shock resuscitation. -, -, 2018. Philadelphia, PA United States: Lippincott Williams & Wilkins.

  • Potential posaconazole sequestration during extracorporeal membrane oxygentation: Results from an ex-vivo experiment

    Lyster, H., Pitt, T., Maunz, O., Saez, D. Garcia, Tiller, J., Leaver, N., Roberts, J., Shekar, K., Brown, D., Mills, J., Carby, M., Simon, A. and Reed, A. (2017). Potential posaconazole sequestration during extracorporeal membrane oxygentation: Results from an ex-vivo experiment. 37th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT), San Diego, CA United States, 5-8 April 2017. Philadelphia, PA United States: Elsevier. doi: 10.1016/j.healun.2017.01.055

  • Evidence of ECMO induced changes to haemostasis in an ovine model

    Foley, S., Fung, L., Simonova, G., Solano, C., Diab, S., Dunster, K., McDonald, C., Shekar, K. and Fraser, J. (2014). Evidence of ECMO induced changes to haemostasis in an ovine model. 38th Australian and New Zealand Scientific Meeting on Intensive Care and the 19th Annual Paediatric and Neonatal intensive Care Conference, Hobart, Australia, October, 2013. Philadelphia, United States: Elsevier. doi: 10.1016/j.aucc.2013.10.057

  • Feasibility of a novel echocardiographic imaging technique, intracatheter echocardiography, to guide venovenous extracorporeal membrane oxygenation cannulae placement in a validated ovine model

    Platts, D., Hilton, A., Diab, S., MacDonald, C., Tunbridge, M., Chemonges, S., Dunster, K., Shekar, K., Burstow, D. and Fraser, J. (2013). Feasibility of a novel echocardiographic imaging technique, intracatheter echocardiography, to guide venovenous extracorporeal membrane oxygenation cannulae placement in a validated ovine model. CSANZ 2013: 61st Annual Scientific Meeting of the Cardiac Society of Australia and New Zealand; in conjunction with the 37th Annual Scientific Meeting of the International Society for Heart Research, Gold Coast, QLD, Australia, 8-11 August, 2013. Chatswood, NSW, Australia: Elsevier Australia. doi: 10.1016/j.hlc.2013.05.429

  • The impact of continuous flow from venovenous extracorporeal membrane oxygenation cannulae on tricuspid valve geometry and function

    Platts, D., Diab, S., MacDonald, M., Chemonges, S., Dunster, K., Shekar, K., Burstow, D., Mullany, D. and Fraser, D. (2013). The impact of continuous flow from venovenous extracorporeal membrane oxygenation cannulae on tricuspid valve geometry and function. 2013 ANZSCTS Annual Scientific Meeting, Darwin, NT Australia, 22 - 25 August 2013. Chatswood, NSW Australia: Elsevier Australia. doi: 10.1016/j.hlc.2013.05.474

  • Altered antibiotic pharmacokinetics during extracorporeal membrane oxygenation may cause therapeutic failure

    Shekar, K., Diab, S., McDonald, C., Fisquet, S., Dunster, K., Fung, L., Platts, D., Ghassabian, S., Barnett, A., Roberts, J., Smith, M. and Fraser, J. (2012). Altered antibiotic pharmacokinetics during extracorporeal membrane oxygenation may cause therapeutic failure. Cardiac Society of Australia and New Zealand Annual Scientific Meeting and the International Society for Heart Research Australasian Section Annual Scientific Meeting, Brisbane, QLD, Australia, 16-19 August 2012. Chatswood, NSW, Australia: Elsevier. doi: 10.1016/j.hlc.2012.05.581

  • Altered antibiotic pharmacokinetics during extracorporeal membrane oxygenation may cause therapeutic failure

    Shekar, K., Mcdonald, C., Fisquet, S., Barnett, A., Ghassabian, S., Fung, L., Roberts, J., Smith, M. and Fraser, J. (2012). Altered antibiotic pharmacokinetics during extracorporeal membrane oxygenation may cause therapeutic failure. Cardiac Society of Australia and New Zealand Annual Scientific Meeting and the International Society for Heart Research Australasian Section Annual Scientific Meetin, Brisbane, QLD Australia, 16-19 August 2012. Chatswood, NSW Australia: Elsevier. doi: 10.1016/j.hlc.2012.05.584

  • Extracorporeal lessons from sheep

    Fung, Y.L., Diab, S., Dunster, K., Foley, S.R., McDonald, C.I., Passmore, M., Platts, D., Simonova, G., Shekar, K., Stewart, D. and Fraser, J.F. (2012). Extracorporeal lessons from sheep. 32nd International Congress of the International Society of Blood Transfusion in joint cooperation with the 10th Congress of AMMTAC, Cancun, Mexico, 7-12 July 2012. Oxford, United Kingdom: Wiley-Blackwell Publishing. doi: 10.1111/j.1423-0410.2012.01615_1.x

  • Is morphine superior to fentanyl for analgesia during extracorporeal membrane oxygenation in adult patients?

    Shekar, K., Mcdonald, C., Fisquet, S., Barnett, A., Ghassabian, S., Fung, L., Roberts, J., Smith, M. and Fraser, J. (2012). Is morphine superior to fentanyl for analgesia during extracorporeal membrane oxygenation in adult patients?. Cardiac Society of Australia and New Zealand Annual Scientific Meeting and the International Society for Heart Research Australasian Section Annual Scientific Meeting, Brisbane, QLD Australia, 16-19 August 2012. Chatswood, NSW Australia: Elsevier. doi: 10.1016/j.hlc.2012.05.585

Other Outputs

PhD and MPhil Supervision

Current Supervision

  • Protecting the Lung during ECLS in the Acute respiratory failurE (PLEASE)

    Doctor Philosophy — Principal Advisor

    Other advisors:

  • Single Hand Used inTubaTing Laryngoscope Evaluation (SHUTTLE) Project

    Doctor Philosophy — Associate Advisor

    Other advisors:

Completed Supervision

Possible Research Projects

Note for students: The possible research projects listed on this page may not be comprehensive or up to date. Always feel free to contact the staff for more information, and also with your own research ideas.

  • The NO TUBE Project

    Induced coma and breathing machines have become synonymous with intensive care units (ICU). Breathing machines are undoubtedly life-saving in many situations where a person can’t breathe for themselves independently. A tube is placed in wind pipe through the back of the mouth and the patient is put on a breathing machine to achieve this. This buys time for caring team to fix the underlying problems that may have necessitated the breathing tube. Despite it being one of the most potent life sustaining technology available, it is also a leading cause of distress for patients and families in ICU, with survivors reporting long term physical and psychological sequalae. Although technology has improved and we have learnt how to use these breathing machines better, the risks and high costs remain.

    Non-invasive alternatives such as nasal high flow oxygen delivery systems or pressurised face masks are usually used as first line treatment. This research intends to extend the benefits of these less invasive breathing support systems by adding nitric oxide gas to the oxygen-air mix. Nitric oxide gas delivered through the nose increases oxygen levels in blood and may help a patient avoid a breathing tube and induced coma. Equally, this project will expolore the efficacy of extarcoporeal respirtatory support technologies such as extracorporeal membrane oxygenation and extracoprporeal carbon dioxide removal in minimsing the need for invasive mechancial ventilation. In addition, the faesiblity and efficacy of biphasic cuirass ventilation(also termed negative pressure breathing) in minimisng the burden of invaisve mechanical ventilation will also be tested. These approaches may redefine our current management of respiratory failure, reduce distress for patients and allow them to be autonomous, maintain dignity, talk, eat and exercise while they recover. This may also lead to substantial reduction in health care costs.

  • Cardiac protection during veno-arterial extracorporeal membrane oxygenation

    Advances in medical therapies in the last three decades have failed to improve mortality from cardiogenic shock (CS). This is despite the rapid uptake of TCS technologies, most notably V-A ECMO and percutaneous ventricular assist devices. Encouraging outcomes have been reported in selected group of CS patients with the use of veno-arterial extracorporeal membrane oxygenation (V-A ECMO). However, the CS population supported with V-A ECMO is quite heterogenous. While approximately 60% of patients have sufficient cardiac recovery to wean from V-A ECMO, 40% of patients survive to hospital discharge and this attrition is largely due to persistent heart failure. Most acute CS patients are not candidates for durable MCS or heart transplant, and therefore it is of critical importance to minimise secondary cardiac injury and maximise cardiac recovery during V-A ECMO. However, the current setup and use of V-A ECMO results in increased LV workload, potentially leading to progressive LV distension, loss of aortic valve opening, intra-cardiac blood stasis and thrombosis, with subendocardial ischemic injury and compromised cardiac recovery. Equally, significant impairment of microcirculation seen in CS and V-A ECMO patients, combined with blood component damage and activation of the endothelium, as well as coagulation and inflammatory systems may all lead to further cardiac injury. Therefore, merely replacing the native pump (patient’s own heart) with a non-pulsatile, continuous flow pump (V-A ECMO), without optimising the microcirculation and unloading the LV, may result in suboptimal outcomes.

    To overcome this, we may have to look beyond traditional haemodynamic monitoring and measurements to achieve this goal. In the future, holistic monitoring during V-A ECMO may include continuous monitoring of cardiac mechanics and output, pulmonary pressures, haemostasis, microcirculation and brain tissue oxygenation. Defining CS patient populations that stand to benefit most in clinical studies, thereby enriching those studies is also a key priority moving forward. Equally, measuring quality and process metrics for ECMO is critical to making improvements in an ECMO program. This project takes a holistic look at V-A ECMO to systematically investigate this eveolving area to improve patient outcomes.

  • Lung protection during venovenous extracorporeal membrane oxygenation

    Although minimizing risks of ventilator-induced lung injury on venovenous ECMO is paramount, the risks/benefits of strategies employed to minimize ventilator-induced lung injury also merit due consideration. This research involves systematic invetsigation of topics espcially the use of partial or total liquid ventilation to minimsie iatrogenic lung injury on V-V ECMO and to provide best lung healing conditions.

  • Standardising ECMO education to bridge the variability in global ECMO outcomes

    Please contact A/Prof Kiran Shekar further details

  • Building a budget ICU

    There is signfiacant global inequity when it comes to intensive care reseources and it is estimated that moe than half the world population may not have access to quality intensive care servcies. This project will bring in clinicians, engineeers, sceintists , health economists, industry partners, policy makers and philanthropists to help develop modular budget intensive care unit systems to help address this and make ICU avaialble to the massess. Just like budget airlines trasnformed civil aviation, this project aims to transform intensive care around the world.

    Please contact me A/Prof Kiran Shekar further details

  • Optimising microcirculation post cardiac surgery to improve cardiac surgical outcomes

    Please contact A/Prof Kiran Shekar further details

  • Use of AI guided pathways to minimise low-flow time in ECMO assisted CPR

    Please contact A/Prof Kiran Shekar further details

  • The ECMO PK project : Understanding PK/PD on ECMO to improve patient outcomes

    Extracorporeal membrane oxygenation (ECMO) is a supportive therapy and its success depends on optimal drug therapy along with other supportive care. Emerging evidence suggests significant interactions between the drug and the device resulting in altered pharmacokinetics (PK) of vital drugs which may be further complicated by the PK changes that occur in the context of critical illness. Such PK alterations are complex and challenging to investigate in critically ill patients on ECMO and necessitate mechanistic research. The aim of this project is to investigate each of circuit, drug and critical illness factors that affect drug PK during ECMO.

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ORCID: 0000-0002-1239-7514

Scopus ID: 25633010300

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