History of RCS research at ZSFG

From left to right: Peter Suter; Jeffrey Katz; H. Barrie Fairley

Pictured above, from left to right: Peter Suter, MD, caring for a patient while collecting data for the Optimal Peep Study, circa 1973; Jeffrey Katz, MD, at the 4F4 door at then-San Francisco General Hospital; and H. Barrie Fairley, MD, pointing to a Davenport diagram at a Department of Anesthesia and Perioperative Care grand rounds session.

RCS has a long history of participating in clinical research, beginning in the 1970s, under the leadership of then department director Eric Gjerde (pictured here conducting research with RCS colleague Roger Kramer). This included technical assistance for landmark clinical studies on the physiologic effects of mechanical ventilation (including the seminal study on Optimal PEEP) by H. Barrie Fairley, MD, Peter Suter, MD, Jeffrey Katz, MD, and others. In 1975, RCS began to design and publish its own research in collaboration with the UCSF/SFGH Departments of Anesthesia, Surgery, Chest Medicine, and the UCSF Cardiovascular Research Institute.

From 1975 through 2017, 15 members of ZSFG RCS have authored (or coauthored) 120 abstracts and 88 peer-reviewed papers in 16 journals including: The Lancet, New England Journal of Medicine, Anesthesiology, Thorax, American Journal of Respiratory and Critical Care Medicine, American Journal of Surgery, Chest, Critical Care Medicine, and Minerva Anestiologica. From 1996 through 2008, RCS members served as clinical research coordinators for the NIH ARDS Network and participated in 11 clinical trials, including the landmark ARMA Trial of low tidal volume ventilation that revolutionized the management of ARDS.

RCS researchers Rich Kallet, James Alonso and Mark Siobal celebrating the publication of the  ARDS dead-space paper in the New England J of  Medicine (Circa 2002)

Some of the research published by RCS has been ground breaking. This has included the seminal study on work of breathing imposed by ventilator triggering performance (that was the impetus for advances in trigger sensitivity technology that emerged in the 1990s),[4] the landmark studies on aerosolized pentamidine for the treatment of pneumocystis pneumonia during the early years of the AIDS pandemic,[5,7-9] elucidating the cause of post-obstructive pulmonary edema,[14] the landmark study on early elevation of physiologic dead-space fraction and its impact on mortality in ARDS,[26] and the discovery that tidal volume mismatch between patient and ventilator imposes work of breathing (which became particularly relevant with the advent of lung-protective ventilation).[15,25,34,40] Since 1996, RCS-directed research at ZSFG has garnered 15 national awards from both the American Association for Respiratory Care and the Society of Critical Care Medicine. Above, RCS researchers Rich Kallet, James Alonso and Mark Siobal celebrate the publication of the ARDS dead-space paper in the New England J of Medicine (Circa 2002).

From left: Greg Burns, Vivian Yip, H. Barrie Fairley, Jeffrey Katz, Justin Phillips, Lance Pangilinan

It is our belief that excellence in respiratory care requires an environment that fosters curiosity, creativity and critical thinking. Clinical research, along with quality assurance projects, provide the unique opportunity to introduce clinicians to the principles of scientific research and how knowledge is acquired. This is a crucial aspect of maintaining the highest degree of professionalism possible.

 

Events

Since 1993, ZSFG Respiratory Care Services has been presenting an annual all day, 5 CEU seminar on Selected Topics in Intensive Respiratory Care. 

The seminar always offers a very diverse range of topics, from the latest trends in Respiratory Care to hot topics of more general interest, such as Hospital Disaster Preparedness and Response in the Post-Katrina Era Civilian Hospital Response to Mass Casualty Events: The Israeli Experience Four Women From Whom Life-Sustaining Therapy Was Withdrawn, Medical Management of Biochemical Weapons Casualties. 

During the height of the SARS outbreak in 2002, we interrupted and extended the seminar so that we could show the live feed of the first CDC SARS webcast about the epidemic and CDC's recommendations.