Candidate: Dr. Stuart Friess is an Assistant Professor of Anesthesiology and Critical Care Medicine at the University of Pennsylvania (UPENN) and a Pediatric Critical Care Medicine Attending Physician at the Children's Hospital of Philadelphia (CHOP). The candidate has an established record of academic and research excellence, and the investigations proposed in this application are a natural progression of his work utilizing a large animal model to study traumatic brain injury (TBI) in children. Dr. Friess's long term career goal is to become a clinician-scientist in the area of pediatric TBI with independent funding to pursue research, mentor pediatric critical care fellows in basic science research, and translate findings from basic science research to new and effective TBI therapies for the pediatric population. Under the mentorship of Dr. Margulies, Dr. Friess has developed a comprehensive career development plan of graduate coursework in neurobiology and statistical analysis, as well as workshops, seminars, and journal clubs to ensure his transition to an independent clinician-scientist. Environment: The career development and research plan build upon an existing network of research and mentorship already in place at UPENN and CHOP, including the Center for Brain Injury and Repair. Dr. Friess has recruited an advisory committee of experts in TBI, large animal models, stroke, and pediatric critical care to ensure successful implementation of his career development plan and proposed investigations during the proposed career development award. Research: One of the principal goals of intensive care management of patients with TBI is the stabilization of derangements in cerebrovascular hemodynamics to avoid subsequent and additional neurotrauma. Therapies and interventions available to the pediatric intensivist to treat TBI are limited, and evidence for their efficacy is mainly based on adult or anecdotal data. Clinical trials in pediatric TBI are difficult to conduct due to the heterogeneous patient population and need for large multi-center studies. The pediatric TBI patient may be in a broad range of environments (ground or air transport, community hospital, adult trauma center, or pediatric tertiary care center) during the initial stabilization period depending on the geographic location of the injury event. During this time, the patient may be at greatest risk for developing secondary insults. Our goal is to develop inexpensive, easy-to-administer therapeutic interventions that can stabilize cerebrovascular hemodynamics during this critical time period and improve pediatric outcomes. We hypothesize that early stabilization of cerebral hypoperfusion following TBI with higher than currently accepted cerebral perfusion pressures and modulation of endothelin-1 signal transduction will reduce brain injury and improve functional outcomes. We have developed a clinically relevant pediatric porcine model of non-impact inertial head injury with subdural and subarachnoid hemorrhage, infarction, ischemia, and diffuse axonal injury, consistent with typical severe pediatric TBI. Using this model of TBI, we propose identifying clinical intracranial monitoring parameters that correlate with severity of neuropathology and neurobehavioral functional outcomes. We will then examine the roles of cerebral perfusion pressure (CPP) and modulation of endothelin-1 signal transduction in stabilizing cerebral hypoperfusion and reducing brain injury after TBI. Our major objective is to determine the benefits of CPP and endothelin-1 to cerebral hypoperfusion after pediatric head injury, and to develop early therapeutic interventions that will improve functional outcomes following pediatric TBI. Summary: These investigations will be integrated with mentoring meetings and course work in statistics and neurobiology to provide the candidate a pathway towards independence as a clinician investigator in pediatric neurocritical care medicine. The proposed studies will provide important preclinical data for future clinical studies, and a similar approach can be used to identify other neuroprotective interventions and therapeutics in future new investigator NIH research proposals.

Public Health Relevance

Traumatic brain injury is the most common cause of death in childhood. Currently, treatment of pediatric traumatic brain injury is mainly supportive. The goal of this proposal is to develop new and effective therapies to treat acute traumatic brain injury in children utilizing an immature large animal model.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Clinical Investigator Award (CIA) (K08)
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Study Section
NST-2 Subcommittee (NST)
Program Officer
Hicks, Ramona R
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Children's Hospital of Philadelphia
United States
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Friess, Stuart H; Sutton, Robert M; French, Benjamin et al. (2014) Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation. Resuscitation 85:1298-303
Topjian, Alexis A; Stuart, Amber; Pabalan, Alyssa A et al. (2014) Risk factors associated with infections and need for permanent cerebrospinal fluid diversion in pediatric intensive care patients with externalized ventricular drains. Neurocrit Care 21:294-9
Friess, Stuart H; Hartman, Mary E (2014) An ounce of prevention but less than a pound of cure: seizure prophylaxis after intracranial hemorrhage. Pediatr Crit Care Med 15:781-2
Sutton, Robert M; Friess, Stuart H; Bhalala, Utpal et al. (2013) Hemodynamic directed CPR improves short-term survival from asphyxia-associated cardiac arrest. Resuscitation 84:696-701
Bruins, Benjamin; Kilbaugh, Todd J; Margulies, Susan S et al. (2013) The anesthetic effects on vasopressor modulation of cerebral blood flow in an immature swine model. Anesth Analg 116:838-44
Hasbani, Daphne M; Topjian, Alexis A; Friess, Stuart H et al. (2013) Nonconvulsive electrographic seizures are common in children with abusive head trauma*. Pediatr Crit Care Med 14:709-15
Sullivan, Sarah; Friess, Stuart H; Ralston, Jill et al. (2013) Improved behavior, motor, and cognition assessments in neonatal piglets. J Neurotrauma 30:1770-9
Friess, Stuart H; Sutton, Robert M; Bhalala, Utpal et al. (2013) Hemodynamic directed cardiopulmonary resuscitation improves short-term survival from ventricular fibrillation cardiac arrest. Crit Care Med 41:2698-704
Sullivan, Sarah; Friess, Stuart H; Ralston, Jill et al. (2013) Behavioral deficits and axonal injury persistence after rotational head injury are direction dependent. J Neurotrauma 30:538-45
Topjian, Alexis A; Gutierrez-Colina, Ana M; Sanchez, Sarah M et al. (2013) Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill children. Crit Care Med 41:215-23

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