Trauma/Acute Care Research

The objective of our study is to evaluate and understand the dose relationship between metformin, inflammation, thrombosis, and the microbiome, while correlating changes in cellular respiration with changes in physiologic parameters in non diabetic, pre-frail adults. We plan to gather stool samples, blood samples, and baseline physiologic parameters on all patients. Patients will then be exposed to 90 days of metforminER (at either 500mg, 1000mg, or 1500mg) or placebo. The same samples will be gathered again at 30, 60, and 90 days. At 90 days, we may retest physiologic parameters.

Thrombocytopenia is incredibly common in the ICU but can have numerous causes.  Diagnostic testing for related conditions such as heparin-induced thrombocytopenia can be expensive and result in inappropriate alterations in care.  Using a collaborative approach with engineers at the University of Pittsburgh, we are conducting large scale modeling of databases of critically ill patients to define endotypes of thrombocytopenia and better understand the clinical variables related and how to best identify the source of thrombocytopenia in the critically ill patient.

Conventional coagulation monitoring suffers from numerous limitations in critically ill patients.  Although TEG is well studied in trauma, the role of TEG in monitoring coagulopathy in other states of critical illness, such as sepsis, is unclear.

A major current clinical problem in trauma and emergency general surgery is the monitoring and reversal of patients taking novel oral anticoagulants who present with bleeding or the need for intervention.  As part of an industry sponsored trial, we are investigating the role of TEG to detect Factor Xa inhibition and determine whether novel TEG based strategies can be used to detect/screen for NOAC use.