Research
Major Clinical and Translational Interests
This multidisciplinary ACGME approved fellowship provides subspecialty training in adult neurocritical care, and successful completion will allow candidates to be eligible for ACGME certification in neurocritical care. Primary faculty members have appointments in the departments of neurology, neurosurgery, anesthesia, internal medicine, emergency medicine and radiology. Fellow applicants with primary training in neurology, neurosurgery, internal medicine, emergency medicine and anesthesia are encouraged to apply.
The program is designed to cover the full range of neurocritically ill patients, including but not limited to, first-hand experience with:
- Clinical evaluation and management of ischemic and hemorrhagic stroke, subarachnoid hemorrhage and intraventricular hemorrhage.
- Clinical evaluation and management of status epilepticus, neuromuscular respiratory failure and medical complications of neurologic disease.
- Clinical evaluation and management of traumatic brain injury, cerebral edema and intracranial hypertension.
- Clinical evaluation and management of post-op neurosurgical patients.
- Clinical evaluation and management of acute respiratory failure, hemodynamic collapse, sepsis, and shock.
- Clinical research, including clinical trials.
- Use of advanced neuro-monitoring devices.
- Develop procedural proficiency in central and arterial line placement, endotracheal intubation, bronchoscopy and ventilator management.
Fellows will rotate through the Medical and Trauma ICUs in addition to the NeuroMedical ICU. The fellowship also provides the opportunity for pursuit of individual interests or projects.
Opportunities in clinical research and quality/process improvement are available and strongly encouraged.
Multi-Center Trials
BOOST-3 – Brain Oxygen Optimization in Severe TBI Phase-3. SIREN Network study.
Clinicaltrials.gov Identifier: NCT03754114
Sponsored by NIH/NINDS 1U01NS099046
CHARM – Phase 3 Study to Evaluate the Efficacy and Safety of Intravenous BIIB093 (Glibenclamide) for Severe Cerebral Edema Following Large Hemispheric Infarction.
ClinicalTrials.gov Identifier: NCT02864953
Sponsored by Biogen
MOST – Multi-arm Optimization of Stroke Thrombolysis. NIH StrokeNet study.
ClinicalTrials.gov Identifier: NCT03735979
Sponsor: University of Cincinnati and NIH/NINDS 1U01NS100699
Bio-Boost – Biomarkers in the Brain Oxygen Optimization in Severe Traumatic Brain Injury Trial.
ClnicalTrials.gov Identifier: NCT04565119
Sponsor by University of Pennsylvania
ICECAP– Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients.
ClinicalTrials.gov Identifier: NCT04217551
Sponsor by University of Michigan
Marinus Ganaxolone– RAndomized Therapy In Status Epilepticus (RAISE)
ClinicalTrials.gov Identifier: NCT04391569
Sponsor by Marinus Pharmaceuticals
ExTINGUISH– The ExTINGUISH Trial of Inebilizumab in NMDAR Encephalitis
ClinicalTrials.gov Identifier: NCT04372615
Sponsor by University of Utah
Peer-Reviewed Publications
Khan, I., Saulle, M., Oldham, M., Weber, M., Schifitto, G., Lee, Hochang B. "Cognitive, Psychiatric, and Quality of Life Outcomes in Adult Survivors of Extracorporeal Membrane Oxygenation Therapy: A Scoping Review of the Literature." Crit. Care Med. In press, accepted May 21, 2020.
Roberts D, Holloway R, George B. “Post-acute care discharge delays for neurology inpatients.” Neurology: Clinical Practice. 2018. With editorial.
Kafashan M, Ryu S, Hargis MJ, Laurido-Soto O, Roberts DE, Thontakudi A, Eisenman L, Kummer TT, Ching S. “EEG dynamical correlates of focal and diffuse causes of coma.” BMC Neurology. 2017 Nov.
Estrada LI, Robinson AA, Amaral AC, Giannaris EL, Heyworth NC, Mortazavi F, Ngwenya LB, Roberts DE, Cabral HJ, Killiany RJ, Rosene DL. “Evaluation of long-term cryostorage of brain tissue sections for quantitative histochemisty.” Journal of Histochemistry and Cytochemistry. 2017 Jan.
Khan I., Rehan, M., Parikh, G., Zammit, C., Badjatia, N., Herr, D., et al. Regional Cerebral Oximetry as an Indicator of Acute Brain Injury in Adults Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation-A Prospective Pilot Study. Front Neurol. 2018;9:993.
Melinosky, C., Yang, S., Hu, P., Li, H., Miller, C.H.T., Khan, I., et al. Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury. Front Neurol. 2018;9:761.
Khan I., Haymore, J., Barnaba, B., Armahizer, M., Melinosky, C., Bautista, M.A., et al. Esophageal cooling device versus other temperature modulation devices for therapeutic normothermia in subarachnoid and intracranial hemorrhage. Ther Hypothermia Temp Manag. 2017 Dec 13.
Al-Mufti, F., Amarulu, K., Manning, N., Khan I., Peeling, L., Gandhi, C., et al. Efficacy and safety of emergent carotid stenting and intra-arterial abciximab in acute ischemic stroke due to extracranial internal carotid artery occlusion. Br J Neurosurg. 2017 Oct;31(5):573-579.
Selected Posters and Abstracts
Khan, I: "Lung Ultrasonography in the NeuroICU." Workshop on Integrated Cardiopulmonary Ultrasonography in Neurocritical Care Neurocritical Care Society Annual Meeting, Vancouver, BC, Canada October 15, 2019
Khan, I: "Histopathology and Clinical Characteristics of Brain Injury in Adult Decedents after ECMO" 30th Annual Extracorporeal Life Support Organization Conference Hilton Austin, Austin, TX September 14, 2019
Khan, I: "Understanding the Brain on ECMO: Pathology, Monitoring, and Outcomes" West Virginia University Heart Institute Grand Rounds, Morgantown, WV April 2, 2019
Khan, I: "Multimodal Noninvasive Neuromonitoring for Brain Injury in Adult ECMO." Working Group on Clinical Research, Department of Neurology University of Rochester School of Medicine, Rochester, NY March 29, 2019
George BP, Falcone GJ. "One Step Closer to Precision Medicine Strategies Based on Genetic Information: ABCB1 Polymorphisms in the CHANCE trial." JAMA Neurology. 2019 May 1; 76(5):523-525. PMID: 30742212
George BP, Pieters TA, Zammit CG, Kelly AG, Sheth KN, Bhalla T. "Trends in Interhospital Transfers and Mechanical Thrombectomy for United States Acute Ischemic Stroke Inpatients." Journal of Stroke and Cerebrovascular Diseases. 2019 Apr;28(4):980-987. PMID: 30630752
Gregory A, Lotia M, Jeong S, Fox R, Zhen D, Sanford Lynn, Hamada J, Jahic A, Beetz C, Freed A, Kurian M, Cullup T, van der Weijden M, Nguyen V, Setthavongsack N, Garcia D, Krajbich Victoria, Pham T, Woltjer R, George BP, Minks K, Paciorkowski A, Hogarth P, Jankovic J, Hayflick S. "Autosomal dominant mitochondrial membrane protein-associated neurodegeneration." Mol Genet Genomic Med. 2019 Jul;7(7):e00736. PMID: 31087512
Munger KC, George BP, Samkoff LM, Robb JF. "Difficult Discharges to Skilled Nursing Facilities Attributed to Multiple Sclerosis Medication Costs: An Observational Study." The Neurohospitalist. 2020 Apr;10(2):82-87.
Panos NG, Cook AM, John S, Jones GM, and the Neurocritical Care Society (NCS) Pharmacy Study Group. "Reversal of factor Xa inhibitor-related intracranial hemorrhage (FiX-ICH): results from a multicenter, observational cohort receiving prothrombin complex concentrates." Circulation. 8 Apr 2020. [Epub ahead of print]
George BP, Pieters TA, Zammit CG, Kelly AG, Sheth KN, Bhalla T. "Trends in Interhospital Transfers and Mechanical Thrombectomy for US Acute Ischemic Stroke Inpatients." American Association of Neurological Surgeons Annual Meeting. New Orleans, LA. Apr 2018.
Hwang DY, George BP. "Timing of Tracheostomy and Gastrostomy for Ventilated Stroke Inpatients Requiring Both for Survival." Society of Critical Care Medicine, 47th Annual Congress. San Antonio, TX. Feb 2018.
Roberts DE, Holloway RG, George BP. "Post-Acute Care Discharge Delays for Neurology Inpatients: Opportunity to Improve Patient Flow." 4th Annual Lawrence Symposium, Department of Anesthesiology, University of Rochester, Rochester, NY. May 2018.
Marchetti L, Khan I, Zammit C. Levothyroxine Associated Ventilator Autocycling in a Brain- Dead Organ Donor Causing Concern for a Mis-diagnosis of Brain Death. Poster. Neurocritical Care Society Annual Meeting. Boca Raton, FL, 2018
Roberts DE, Dhar, R. Impact of Obesity on Risk of Pulmonary Embolism and Chemoprophylaxis Under-dosing. Neurocritical Care Society Meeting. October 2015.
Roberts DE, Dhar R. A Predictive Model For Assessment Of Pulmonary Embolism In Neuro-Intensive Care Unit Patients. Neurocritical Care Society Meeting. September 2014.
Roberts DE, Clifford DB. Stroke Patient Characteristics and Risk Factors at Ayder Referral Hospital, Mekelle, Ethiopia: Pilot Data and Study Proposal. Washington University School of Medicine Department of Neurology Annual Symposium. May 2013.
Khan, I., Haymore, J., Barnaba, B., Melinosky, C., Bautista, M.A., Blaber, B., Chang, W., Motta, M., Parikh, G., Badjatia, N. Esophageal Cooling Device Versus Other Temperature Modulation Devices for Therapeutic Normothermia in Subarachnoid and Intracranial Hemorrhage. Neurocritical Care Society Annual Meeting, Waikoloa, HI. October 2017.
Khan, I., Malone, L., Ho, C. Y., Herr, D., Parikh, G. Histopathologic Findings in Adult Recipients of Extracorporeal Membrane Oxygenation. Neurocritical Care Society Annual Meeting, Waikoloa, HI. October 2017.
Khan, I., Rehan, M., Parikh, G., Badjatia, N., Herr, D., Kon, Z., Mazzeffi, M. Elevated initial regional brain oxygenation values may predict poor outcome in patients placed on veno-arterial ECMO. Neurocritical Care Society Annual Meeting, Waikoloa, HI, and Extracorporeal Life Support Organization Annual Conference, Baltimore, MD. September 2017.
Anand, A., Khan, I., Majoka, H., Ahmed, Z., Melinosky, C., Hefton, S., Motta, M., Chang, W., Herr, D., Badjatia, N., McCarthy, P., Parikh, G. Impact of secondary brain injury on function outcome in ECMO-treated adults after potentially reversible cardiorespiratory failure. Neurocritical Care Society Annual Meeting, National Harbor, MD. Distinguished Poster. September 2016.
Khan, I., Ahmed, Z., Tabish, S., Majoka, H., Anand, A., Hefton, S., Melinosky, C., Aparicio, J., Lange, M., Chang, W., Motta, M., Badjatia, N., Parikh, G. Elevated Graeb score is associated with loss of independence after aneurysmal subarachnoid hemorrhage. Neurocritical Care Society Annual Meeting, National Harbor, MD. September 2016.
Melinosky, C., Yang, S., Hu, P., Li, H., Khan, I., Mackenzie, C., Chang, W., Parikh, G., Stein, D., Badjatia, N. Assessment of autonomic nervous system dysfunction to predict neuroworsening after isolated head injury. Neurocritical Care Society Annual Meeting, Harbor, MD. September 2016.
Melinosky, C., Yang, S., Hu, P., Li, Y., Khan, I., Chang, W., Parikh, G., Motta, M., Simard, J.M., Badjatia, N. Early prediction of cerebral herniation in patients presenting with large hemispheric infarction. Neurocritical Care Society Annual Meeting, National Harbor, MD. September 2016.
Al-Mufti, F., Khan, I., Coyle, P., Nuoman, R., Guido III, M. CNS Vasculitis: A tertiary care center’s experience. International Stroke Conference, Honolulu, HI. February 2013.
Textbook Chapters
Begley C, Roberts D. "Management of Intracranial Hypertension and Status Epilepticus" In: La Rosa ed. Adult Critical Care Medicine: A Clinical Guide. New York, NY: Springer; 2019.
Khan I., Bodjedla, S., Badjatia, N. "Nutritional Support in the Neurointensive Care Unit". Nutrition in Neurologic Disorders. Arsava, E.M. (Ed.). vol 1., 77-90; 2017.
Roberts D. "Management of Neurological Emergencies in the ICU" In: LaRosa J ed. Current Concepts in Adult Critical Care. Society of Critical Care Medicine; 2017.
In Press Zammit C, Khan I. Electrical and Lightning Injuries. In: Louis E, Mayer S, Rowland L eds. Merritt’s Neurology, 13th ed. Philadelphia, PA: Wolters Kluwer; 2019.