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Spanning the spectrum of critical care: Dr. Dos Santos goes from bench to bedside

Toronto, October 8, 2013

By Evelyne Jhung

Dr. Claudia Dos Santos reviews a patient chart in the MSICU.
Dr. Claudia Dos Santos reviews a patient chart in the MSICU. (Photo by Evelyne Jhung)

The Recover research team at St. Michael’s includes:
  • Orla Smith, research manager for the Critical Care Department;
  • registered nurses Yoon Lee and Melissa Wang;
  • and respiratory therapist Julia Lee.

Fast fact: St. Michael’s is the second highest recruiting site for the main RECOVER study in Canada with 170 patients enrolled at last count; we were the highest recruiting site in 2012.

Margaret Palmer regained consciousness in January 2011 in St. Michael’s Medical Surgical Intensive Care Unit after suffering a near-death experience over the Christmas holidays.

She had been receiving chemotherapy for Wegener's granulomatosis, an inflammation of blood vessels, when she developed pneumonia and became seriously ill.

Palmer spent three months on life support in the MSICU recovering from acute respiratory distress syndrome, a life-threatening lung condition that leads to low oxygen levels in the blood, and sepsis, another life-threatening illness caused by bacteria in the blood.During this time, she was cared for by the MSICU team that included Dr. Claudia Dos Santos, a critical care intensivist and Li Ka Shing Knowledge Institute scientist.

Dr. Dos Santos’ research interests are inARDS and sepsis, the two illnesses from which Palmer recovered. Dr. Dos Santos is one of only a handful of Canadian women who both sees patients as an intensive care physician and is also a researcher with a basic science lab.

“All my research begins with the patients we take care of in the ICU,” said Dr. Dos Santos.

She is part of Recover – a nationally funded critical care research group spearheaded by Dr. Jan Friedrich, lead researcher at St. Michael's, and Drs. Margaret Herridge and Jill Cameron at the UHN. At St. Michael’s, Drs. Dos Santos and Jane Batt lead the basic science component of theRecover Program for survivors of critical illness, which is how Palmer came to participate in the research study.

The St. Michael’s Recover team has been obtaining leg muscle biopsies from survivors as part of its translational research program. The team is studying the biopsies with the goal of developing rehabilitation therapies.

As a molecular biologist on the Recover Program team, Dr. Dos Santos uses the biopsies to investigate the gene expression in muscles from survivors of prolonged mechanical ventilation.

“Some people get better, while others don’t. Why is that? It’s difficult to tell from physical exams who will recover, so we study the muscle biopsies,” said Dr. Dos Santos.

“When the research co-ordinators asked me if I would participate, I agreed even though I knew the biopsy was going to be painful, because I thought it would be worth it if I could help others avoid what I went through and it was my way of giving back,” said Palmer.

“Although we try to mimic what happens to patients in the ICU using animal models, nothing can replace understanding the disease in humans. Currently there are no specific treatments for sepsis or ARDS. In my lab, we study the response of cells toinjury and use our understanding to develop new therapy.Recently we have been investigating the use of mesenchymal stem cells, in the treatment of acute lung injury and sepsis,” said Dr. Dos Santos.

Palmer’s participation in the study was spread out over two years and included breathing, walking and balance tests.

“We assess our patients’ progress while studying the muscle weakness,” said Dr. Dos Santos. “In most cases, the lung function returns to normal after prolonged life support, but one of the main factorspreventing survivors from returning to a normal life is the debilitating weakness associated with muscle degradation and atrophy.”

Palmer, now 49, is walking on her own, able to drive again and has returned to work full-time. “When I first came to in the ICU, I couldn’t move or talk. I’d say I’m well on my way on the rehab journey.”

About St. Michael’s Hospital

St Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.