Anesthesiology Critical 
Care Medicine Research

Montefiore Einstein Anesthesiology Critical Care Medicine has created a robust database to ensure optimal patient care within the surgical intensive care units (SICUs). This initiative is guided by continuously updated surgical and ICU data pulled directly from our hospital’s electronic health records, allowing us to assess patient outcomes and modify SICU policies to ensure improvement in care. Our work analyzing digital health data has improved care in the Moses SICU through shortening the duration of invasive ventilation, utilizing opioid-sparing analgesia, lowering the incidence of respiratory failure and reducing the proportion of deep sedation in intubated patients.

Current investigations focus on optimizing sedation protocols for mechanically ventilated patients, evaluating the impact of mobilization therapy on critical illness recovery and developing prediction and prevention strategies for respiratory failure. Most notably, we’ve created an innovative machine learning tool that predicts high-risk patients for case cancellation and postoperative respiratory failure. This sophisticated model incorporates physiological and procedural data and is being implemented system-wide through the Montefiore Einstein Center for Health Data Innovations.

Montefiore Einstein Anesthesiology Critical Care Medicine is a national leader in early mobilization in the SICU. In an ongoing observational study, our researchers are evaluating the depth of sedation in mechanically ventilated ICU patients and the impact of mobilization therapy on recovery in patients who are critically ill. Our Digital Health Research team found that among mechanically ventilated adults in the ICU, the proportion of time patients were deeply sedated was independently associated with adverse discharge. Patients who received lighter sedation had a lower risk of adverse discharge due to greater patient mobility and more active assessment and treatment of patients’ symptoms such as pain, anxiety and agitation. This research informs our multimodal, patient-centered symptom-control strategy to improve patient outcomes.

Our Department is at the forefront of investigating postoperative respiratory complications, a critical concern in perioperative medicine. We are exploring how mechanical power during general anesthesia influences postoperative respiratory failure and investigating the importance of optimizing respiratory mechanics during surgery to enhance patient outcomes and reduce healthcare burdens. These insights inform clinical practices and pave the way for personalized anesthetic approaches to improve postoperative recovery.

In parallel, our Digital Health Laboratory is analyzing the multifaceted effects of ketamine, a potent anesthetic and analgesic, on respiratory and neurological functions. We have investigated how ketamine infusion affects breathing patterns and brain activity in ICU patients, shedding light on its potential therapeutic applications. Furthermore, we examine the neuroanatomical and physiological impacts of hypoxia and esketamine, revealing their influence on breathing, the sympathetic nervous system and cortical function. By analyzing the role of ketamine in procedural sedation, including its association with oxygen desaturation and healthcare utilization, we contribute to a nuanced understanding of its safety and efficacy. Together, this research aims to optimize patient care and advance our knowledge of anesthetic pharmacology.