Critical Care Center News

The Mass General Critical Care Center welcomed Dr. Richard S. Hotchkiss as the First Annual Pontoppidan Visiting Professor, September 1, 2011.

The First Annual Henning Pontoppidan Visiting Professorship

"Emerging Concepts in the Pathophysiology and Therapy of Sepsis"

01/Sep/2011

Dr. Perren Cobb

Henning Pontoppidan, M.D.

Henning Pontoppidan, M.D.

Henning Pontoppidan was born in Copenhagen,Denmark, in 1925. He graduated from the Medical School of the University of Copenhagen in 1952. During the exceptionally severe polio epidemic in Scandinavia that year, he participated as an intern in the manual ventilation of children and adults with respiratory failure. The number who required artificial respiration far exceeded the few available iron lungs or had failed to respond to conventional forms of treatment. Our present understanding of the physiology of respiratory failure and the therapeutic implications were greatly accelerated by the experience gained during the 1952 epidemic. They were put to good use when New England was hit by an equally severe poliomyelitis epidemic in the summer and fall of 1955.

In 1949, Pontoppidan married Yonna Sahmel, an American citizen with Danish roots. Their first daughter, Michaela, was born in Hjorring, Denmark in the fall of 1952. The couple decided to immigrate to the United States, and, after a stormy North Atlantic crossing aboard the M.S. Oslofjord, he arrived in New York with his wife and one-year old daughter. He soon obtained a position as resident in anesthesiology at the Massachusetts General Hospital (MGH). Although above military draft age, after two months residency in the United States, he was drafted into the U.S. Army and was allowed several months deferment to obtain further training. In May of 1955, as a first lieutenant, he reported for officer’s field training duty in Fort Sam Houston, Texas. He was then assigned to Fort Ord Army Hospital in California as chief of the anesthesia section with the rank of Captain. His second daughter, Marianne, was born at the Fort Ord Hospital in October of 1955.

Upon completion of his military service, Dr. Pontoppidan returned to Boston to complete his residency in anesthesiology at MGH. His third daughter, Lisa, was born in 1957, and, shortly after, the family of five moved to the town of Weston, Massachusetts. Later that year he joined the Anesthesia staff at MGH, and was appointed Medical Director of Oxygen Therapy (later to become known as the Respiratory Care Department) when that position became vacant in 1959. This permitted him to pursue his interest in respiratory pathophysiology and care.

In 1960 the hospital supported 174 patients on mechanical ventilation with a 21% survival rate. Dr. Pontoppidan noted an unacceptable variance in patient care and the challenges of managing patients scattered across many units. It also became evident that respiratory failure was a common feature among a large segment of critically ill patients and contributed to the high mortality rate. For these reasons, Dr. Pontoppidan received approval to create a specialized unit for patients with respiratory failure. When established in 1961 as the first of its kind in the United States, the Respiratory Intensive Care Unit(RICU) was a 5-bed multidisciplinary ICU that cost the patient $150 per day in its original Phillips House location. Continuous observation and care by dedicated nurses prevented accidental breathing circuit disconnections and other “plumbing errors” that elsewhere were responsible for preventable deaths. Then, as now, outstanding residents-in-training were equally critical to optimized patient outcomes. Dr. Pontoppidan later wrote, “There is no question that during the first year of operation we were scrutinized (as if under a magnifying glass)…there was no room for error, and none occurred.” Eight years later, the RICU moved to a modern 12-bed facility in Jackson 4 and then to its current location on Ellison 4 in 1999, reincarnated as the Surgical ICU(SICU).

As the reputation of the RICU grew, it generated an interest among members of the medical community who were facing the same problems. The RICU was fortunate to have residents from other teaching hospitals as well as several fully trained foreign surgeons and internists applying for a fellowship to join the unit, some for as long as six months to a year. Upon their return to their parent institutions they helped incorporate unique features of the RICU structure.

From the beginning Dr. Pontoppidan insisted that clinical research projects into acute respiratory failure become a routine part of patient management. Funding was modest to start with, consisting of grants of a few thousand dollars from the MGH general research fund. Several important research publications resulted from these clinical studies, leading to modifications in patient care. In 1965, the experience gained in the RICU was published in the classic Respiratory Care, better known simply as the “red book,” and long regarded as the “bible” of acute respiratory care. A follow-up by Dr. Pontoppidan, et al, Acute Respiratory Failure was published in 1972. In 1978 the research greatly intensified when the RICU was designated a NIH Specialized Center of Research (SCOR) in Acute Respiratory Failure. Dr. Warren Zapol served as the principal investigator. Further research grant support flowed from the RICU participation in clinical trials of extracorporeal membrane oxygenation (ECMO). Under Dr. Pontoppidan’s leadership, the RICU was also the clinical home for research in the treatment of Acute Respiratory Distress Syndrome (ARDS).

Dr. Pontoppidan was instrumental in the formation of the MGH Critical Care Committee, and served as it’s chair for about ten years. One task of the CCC was to assist the physicians and nursing staff as they faced increasingly frequent ethical issues created by continuing care of hopelessly ill patients. To help with these decisions, the CCC formed the “Optimum Care Committee.” Led by a psychiatrist, it included a senior surgeon, a senior oncologist, and representatives from the nursing and administrative staff. The conclusions of the committee could not be overruled. This approach led to the reduction in tension, and irresolvable conflicts never occurred.

In addition to leadership in Boston, Dr. Pontoppidan was one of the founding members of the Society of Critical Care Medicine in 1972. His numerous contributions to the literature influenced critical care globally. He retired in 1992 and is currently Honorary Anesthetist at the Massachusetts General Hospital and Reginald Jenny Professor (Emeritus) of Anesthesia at Harvard Medical School.

Richard S. Hotchkiss, M.D.

Richard S. Hotchkiss, M.D.

Richard S. Hotchkiss, M.D.

Richard Samuel Hotchkiss, a native of Dallas, Texas, grew up in Virginia. His father, a thoracic surgeon, provided the young Richard his first exposure to medicine. Dr. Hotchkiss studied at the University of Virginia where he received both his undergraduate and medical degrees (inducted into the Phi Beta Kappa and Alpha Omega Alpha Honor Societies). He was President of his undergraduate class during his first two years. He trained in two specialties, first in Internal Medicine at Emory University School of Medicine (where he was also Chief Resident) and then in Anesthesia at the MGH. Dr. Hotchkiss pursued his interest in critical care as a Fellow at the University of Virginia and then as a Senior Fellow in the Respiratory Intensive Care Unit, directed by Dr. Henning Pontoppidan. Dr. Hotchkiss moved finally in 1987 to the Department of Anesthesiology at Washington University in St. Louis where he has remained, climbing the ranks to Professor in the Departments of Anesthesiology, Medicine, Surgery, and Molecular Biology & Pharmacology.

Dr. Hotchkiss has had a long, successful career as an investigator studying the pathophysiology of sepsis. His many contributions are documented in over 140 publications. A seminal observation from his laboratory was the identification of extensive apoptotic death of immune effector cells in patients dying of sepsis. This discovery led to the concept that apoptosis-induced immunosuppression is an important pathogenic mechanism in sepsis, a finding that has changed the paradigm in search of new therapeutic approaches to this major threat to public health. A review article on sepsis by Drs. Hotchkiss and Irene Karl helped define and promulgate this concept and is now the sixth most cited review article in the New England Journal of Medicine in the last decade.

Dr. Hotchkiss has been continuously funded by the National Institutes of Health for approximately 20 years and is the recipient of a number of prestigious awards, including the NIH Research Career Development Award (1995) and the NIGMS Merit Award (2003). Additional honors include serving as President of the Shock Society for which he received the Distinguished Service Award of the Society in 2007. Most recently, Washington University in St. Louis honored him with its Distinguished Investigator Award in 2008.

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