Leveraging Automated Optimization of Inspired Oxygen and Oxidized Biomarker Lipidomics for Targeted Oxygenation during Mechanical Ventilation: a Pragmatic Clinical Trial

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PROJECT SUMMARY: Candidate: The candidate, Sonal Pannu, M.D. is an early career investigator from the division of Pulmonary, Critical Care, and Sleep Medicine at the Ohio State University and has an excellent academic track record. She has demonstrated persistent interest in clinical and translational research for improving the safety of mechanical ventilation, focusing on prevention of hyperoxia and hypoxemia. In addition, she has developed bioinformatics related electronic algorithms for targeted oxygenation and is using oxidized lipidomics biomarkers to determine optimal oxygenation targets. Her short-term goal is to augment the clinical researchtraining with advanced training in pragmatic and novel clinical trial design, bioinformatics and associated statistics for development of lipidomics biomarkers. Her long term goal is to become a successful independent clinical and translational scientist leading a multidisciplinary research team focused on pragmatic clinical trials in the ICU for utilizing lipidomics biomarkers for ascertainment of optimal oxygenation to improve outcomes of critically ill patients. Career Development: Dr. Pannu’s career development will include plans enroll in formal training for conducting pragmatic multi-center clinical trials; in lipidomics; in bioinformatics and associated statistics through didactics and experiential learning. Environment: Dr. Pannu is currently in an environment that is extremely supportive for her development as a clinical and translational researcher. There is a large ICU patient population and support in the form of resources for clinical research, bioinformatics, clinical coordinators and laboratory technicians. Dr. Pannu’smentors, Dr. Crouser (Ohio State University), Dr. Diaz (Ohio State University) and Dr. Rice (Vanderbilt) have an outstanding history as mentors in addition her research advisory committee consists of well-funded and accomplished researchers. Research: Dr. Pannu’s goal in this project is to study an approach to targeted oxygenation goals through an automated oxygen titration strategy. Her specific aims are: Aim 1: Determine the efficacy of an electronic health record based oxygen-titration strategy to maintain arterial oxygen saturation validated, optimized targeted peripheral oxygen saturation range and Aim 2: Analyze oxidized lipid biomarkers as markers of hyperoxia associated lung injury in patients with the optimized targeted oxygenation strategy compared with usual care. To accomplish this Dr. Pannu will conduct a pragmatic clinical trial with cluster randomization, stepped wedge design to study targeted oxygenation with an automated protocol vs conventional approach by ventilator management guidelines. She will assess short term (ventilator and ICU based) and long term clinical outcomes (6 month follow up for cognitive function assessment). She will also measure and compare oxidized lipid biomarkers within the two groups to determine the oxidized biomarker profile for optimal oxygenation and correlate their expression to the degree ofoxygen exposure and ventilator-free days.