Clinical Research Portfolio | Niagara Health

The Critical Care Research Program was co-founded by Dr. Jennifer Tsang and Dr. Erick Duan in 2017. The program conducts multicenter (Canadian and multinational) clinical trials/observational studies in the areas of COVID-19, pneumonia, sepsis, diabetes, acute respiratory distress syndrome, mechanical ventilation, acute kidney injury and translational biology.

Current Team Members

Dr. Jennifer Tsang
Physician Co-Lead

Dr. Erick Duan
Physician Co-Lead

Dr. Han-Oh Chung
Physician Co-Lead

Dr. Natasha Ovtcharenko
Physician Co-Lead

William Dechert
Clinical Research Coordinator

Sheeba Ramachandran
Clinical Research Coordinator

Ongoing Studies

ALTER-AKI

ALTER-AKI: Albumin To Enhance Recovery after severe Acute Kidney Injury

To maintain blood pressure during dialysis treatments, ICU patients receive extra fluid. The objective of this study is to determine whether a protein-based fluid (albumin) or salt-based fluid (normal saline) provides better outcomes for patients.

CANPoint

CANPoint: Point Prevalence Study

This study collects information on ICU capacity, disease burden and interventions that patients receive in Canadian ICUs with the goal of advancing the development a learning health system for critical care in Canada.

DaNGER

DaNGER: Diabetic Ketoacidosis from New Use of an SGLT2

Sodium glucose co-transporter 2 (SGLT2) inhibitors are a class of medication that help lower blood sugar levels, however, they can cause a harmful side effect; diabetic ketoacidosis (DKA). This study identifies genetic variants that put individuals at higher risk of SLGT2 inhibitor-associated DKA.

FISSH

FISSH: Fluids in Septic Shock

Septic shock is a life-threatening condition when the body’s response to an infection damages vital organs and leads to a dangerous decrease in blood pressure. The objective of this study is to investigate the effect of using higher chloride vs lower chloride fluids in critically ill patients with septic shock.

LIBERATE

LIBERATE: Midodrine for the Early Liberation of Vasopressor Support in the ICU

Patients in the ICU often need medications called vasopressors to help maintain their blood pressure. However, using these strong IV medications for too long can have risks. This study will explore whether midodrine, a blood pressure medication taken orally, can help reduce the need for IV vasopressors as patients recover in the ICU.

PRACTICAL

PRACTICAL: Platform of Randomized Adaptive Clinical Trials in Critical Illness

This platform trial evaluates novel interventions for patients with acute hypoxemic respiratory failure (AHRF).

Invasive Mechanical Ventilation (IMV) Strategies: will compare the use of the current recommended ventilation method to two new approaches: one that focuses on controlling lung-inflating pressure and another that aims to keep breathing effort at an optimal level to prevent injury to the diaphragm.
Corticosteroid Early and Extended: will examine the effect of early corticosteroids in non-COVID AHRF and examine the effect of extended corticosteroids at 10 days in both COIV and non-COVID persisting AHRF.

PRACTICAL-IMV

The Invasive Mechanical Ventilation Strategies domain compares standard lung-protective ventilation to two novel approaches in acute hypoxemic respiratory failure (AHRF) patients to identify the most effective strategy.

PRACTICAL-CORT-E2

The CORT-E2 Trial is a phase III multicenter RCT investigating early corticosteroids versus no extension in persistent acute hypoxemic respiratory failure (AHRF) from COVID or non-COVID causes.

REMAP-CAP

REMAP-CAP: Randomized, Embedded, Multifactorial, Adaptive Platform Trial for Patients with Community Acquired Pneumonia

Community acquired pneumonia that is severe enough to require admission to an ICU will often receive many different treatments as many as 20 or 30. These treatments act together to treat both the infection and its effect on the body. This study aims to help doctors understand which treatment options are best.

Antibiotic Domain: will compare use of up to 5 antibiotic interventions.
Macrolide Duration Domain: will compare standard course (3-5 days) to extended course (for 14 days) of macrolide administration.
Mechanical Ventilation Strategy Domain: will compare protocolized mechanical ventilation strategy to clinician-preferred mechanical ventilation strategy.
Corticosteroid Domain: will compare the following interventions: no corticosteroid administration, fixed duration hydrocortisone for 7 days and shock-dependent hydrocortisone while the patient is in septic shock.