Clinical trial results warrant additional studies on the potential benefits of dexmedetomidine during ICU stays after cardiac procedures.
At Massachusetts General Hospital, the impact of the physician-scientists in the Department of Anesthesia, Critical Care and Pain Medicine (DACCPM) extends well beyond the bedside. They are the innovators pioneering new discoveries that lead to more effective treatments, interventions, medications, and, overall, approaches to patient care.
We spoke with three physician-scientists on our team whose work is advancing scientific progress.
Hilary Gallin, MD, MBA, attending and Mass General anesthesia resident and fellow alumna, is the inventor of a device called FastLine, which improves upon the traditional placement technique of central lines by enabling ergonomic, intuitive placement with one hand.
Katarina Ruscic, MD, PhD, attending and Mass General anesthesia resident and fellow alumna, studies the biology of the lymphatic system as a way to better understand how it works and how anesthesia may be altering function in patients under long-term sedation.
Susana Vacas, MD, PhD, attending and neuroanesthesiologist, is studying the underlying mechanisms and risk factors of perioperative neurocognitive disorders. In her research, she harnesses machine learning, artificial intelligence, and cutting-edge brain imaging analyses to ascertain what happens to the brain before and after surgery and anesthesia.
Q: Please describe your research.
Dr. Vacas: My research takes a multipronged approach to understanding the granular underlying mechanisms of perioperative neurocognitive disorders (PND). PNDs result when the brain fails to resist acute stressors. This vulnerability can be caused by several processes that are not mutually exclusive. There is still some debate regarding the pathophysiology of PNDs, given the complexity of contributing factors, subtypes, and heterogeneity of these conditions. My research supports the view that neuroinflammation is a possible pathogenic mechanism and plausible target for interventions.
Dr. Ruscic: I am working to increase our understanding of how lymphatic vessels contract to propel excess fluid from tissues back into the central circulation. Using state-of-the-art techniques in cellular biology and in-vivo imaging, I am working to develop novel pharmacological tools to increase lymphatic function. I am also starting a novel study on the effects of anesthetic agents on lymphatic pumping.
Dr. Gallin: I'm working to create a one-handed venous access device by consolidating all the parts of a traditional central line kit into a single handheld device. It will allow the provider to use one hand to perform all the steps of placing a central line and for the other hand to maintain ultrasound guidance and dynamically scan a patient. It's compatible with all central venous catheters so it can be used regardless of the type of central line being placed.
Q: What are the clinical implications of your research?
Dr. Vacas: Anesthesia, as a field, is a leader in improving patient outcomes, and we have continued to develop new frontiers in perioperative care. We have a long way to go, but with advances in intraoperative monitoring, comprehension of anesthetic mechanisms, and the implementation of preventive measures, we have furthered our understanding of perioperative brain health. We can help maintain brain health and provide better outcomes for surgical patients.
Dr. Ruscic: My work seeks to define the mechanisms behind lymphatic contractility and use that knowledge to design novel therapeutics. This could help a range of diverse patients, from those with lymphedema after cancer surgery to patients receiving anesthetics in the operating room and intensive care unit.
Dr. Gallin: There are several benefits. The device we are creating aims to eliminate poorly controlled movements by maximizing control and dexterity, decrease set-up time for the care team, decrease the risk of contamination or needlesticks, and allow for the central line to be placed more ergonomically with continuous image guidance. It will be much easier for the clinician and, subsequently, safer for the patient.
Q: What challenges do providers and patients currently experience in this area of health?
Dr. Vacas: The implementation of patient assessments and preventive measures require a high degree of training and a significant amount of time to perform, which are barriers to integration in clinical practice. Our specialty needs to embrace a more holistic vision of care that is focused on perioperative medicine, but also along the continuity of patient health and care, one with a focus on long-term cognitive health.
Dr. Ruscic: Even though the lymphatic system is crucial for fluid homeostasis in the body, we rarely consider it in clinical practice. This is likely because we do not have the tools to easily image the lymphatic network in our patients or to evaluate the efficiency of lymphatic pumping. Even if we could, there are no FDA-approved drugs to improve lymphatic function. This is an area with a lot of low hanging fruit for discovery.
Dr. Gallin: Right now, the traditional way to place central lines requires both hands, relies on poorly controlled movements, takes an excessive amount of time, and can result in injury to the patient. It’s a frustrating experience for the providers who place these lines many times every single day.
Q: How did you first become interested in this area of research?
Dr. Vacas: During my training, I witnessed the debilitating and life-altering damage of PNDs in my own patients. I was inspired to uncover the underlying mechanisms of PNDs and improve brain health for these patients.
Dr. Ruscic: As a Mass General resident, it struck me that many of our patients in the surgical intensive care unit experience excess fluid in their peripheral tissues. I started to read more about the lymphatic system and realized that our understanding of this organ system is far behind, and that there is a great deal of room for research and innovation with the potential to impact clinical practice and patient outcomes.
Dr. Gallin: My undergraduate training is in biomedical engineering, and I have always been interested in solving problems in medicine. This research project was born from a conversation with my co-resident (a urologist). We both experienced a lot of frustration about the process to place central lines, and so we did a deep dive into it. We interviewed other clinicians, analyzed equipment, and discussed ways to improve the process. Eventually, we realized that having one hand free for an ultrasound while using the other hand to place the device has the potential to decrease injuries and improve the provider experience.
Q: Why did you choose to come to Mass General?
Dr. Vacas: The institutional culture of excellence. I also felt that the leadership in the department has the vision, wherewithal, and creativity to do something significant for the field.
Dr. Ruscic: Mass General provides unique opportunities for physician scientists to succeed in both their clinical and research careers. I was supported with a position on the Harvard Anesthesia T32 training grant, which has given me three years of 75% protected research time. This type of opportunity is rare outside of Mass General in the anesthesia world and has allowed me to continue to the next step in scientific independence. I now hold an International Anesthesia Research Society Mentored Research Award.
Dr. Gallin: I had the opportunity to do research with Douglas Raines, MD, the summer after my first year of medical school. I was in awe of the department’s faculty and the research environment. I came back for my Anesthesia Residency and again for Obstetric Anesthesia Fellowship. As a trainee at Mass General, there's a lot of autonomy very early on. There is always support available when needed, but I appreciated the team’s willingness to let us learn, experience independence, and develop at our own pace. Now as an attending, I remain grateful for the opportunity to collaborate with such wonderful colleagues.
Q: What advice would you give to someone who aspires to pursue a similar career?
Dr. Vacas: Be inspired by the community you come from and live within. There are a lot of ups and downs in our field, but the overall health of our community is always the focus. On a more personal basis, let curiosity be your guide.
Dr. Ruscic: Failure in discovery science is to be expected. Keep showing up and trying something different every time you fail. I never had a guarantee that my research would work, but I trusted myself to find the way. After troubleshooting and re-evaluating countless times, I became successful at a much higher rate and developed the tools I needed to make progress. Also, apply for funding. No one will hand it to you, so seek it out.
Dr. Gallin: Being a doctor is a privilege and it gives you unique vantage point to pursue any problem that you find frustrating. It's an opportunity to make something better. Use your vantage point as a physician to be deliberate in providing safer, better care for patients and be proactive in pursuing innovation.
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