Division of Resuscitation and Critical Care

 

 

Critical care resuscitation of the undifferentiated critically ill patient is one of the most distinguishing and important skill sets of an emergency physician

 

 

 

 

 

Anthony Napoli, MD: Division DirectorAnthony Napoli, MD: Division Director

Critically ill patients are common in the emergency department, with admissions to the intensive care units accounting for approximately 13% of all admissions from the Rhode Island Hospital Emergency Department.  

Critical care resuscitation of the undifferentiated critically ill patient is one of the most distinguishing and important skill sets of an emergency physician. Increasing interest amongst graduating residents and the recent establishment of a critical care board certification pathway for emergency physicians highlight the growth of this subspecialty.

With its clinical, educational, and research resources, the Department of Emergency Medicine has the ability to provide leadership in critical care medicine.

Dr. Napoli is involved in the development of and ongoing success of neuroprotective hypothermia for cardiac arrest at Rhode Island Hospital and The Miriam Hospital.  He has past and ongoing grant research and publications related to non-invasive resuscitation research and the pathophysiology of severe sepsis and septic shock.  He has multiple ongoing studies in critical care resuscitation, including being on the steering committee for a national multicenter study.   

 His most recent investigation received the SAEM 2011 Junior Investigator Award for Research and was published as a highlighted clinical investigation in SHOCK.  He also serves as a reviewer, specifically for non-invasive resuscitation and critical care manuscripts and for multiple emergency medicine, critical care, and monitoring journals.    

Education

The division offers a two-week clinical selective (PGY2-4) and a four-week research/quality improvement elective (PGY3 or 4) through the Emergency Medicine Residency Program.

Research

Critical Care and Resuscitation

Non-Invasive Goal-Directed Therapy Resuscitation Protocol in Patients Presenting to the Emergency Department with High Risk of Progression from Sepsis to Severe Sepsis and Septic Shock.  Leading Member of Study Steering Committee and site primary investigator - Napoli

Prognostic Value of Inferior Vena Cava Collapsability by Bedside Sonography in Predicting Fluid Responsiveness in Mechanically Ventilated and Spontaneously Breathing Patients.  Primary Co-investigators – Seigel & Napoli

Prognostic Value of Respiratory Plethysmography Amplitude Variation in Predicting Fluid Responsiveness in Mechanically Ventilated and Spontaneously Breathing Patients.  Primary Co-investigators – Seigel & Napoli

 Inter-alpha Trypsin Inhibitor (ITI) levels in Emergency Department Patients with Severe Sepsis and Septic Shock – Primary investigator – Napoli

 Impedance Cardiography and Cytokine Characterization in Severe Sepsis and Septic Shock, Resident Initiating Project (Maughan), Primary investigator – Napoli

 Mathematical Modeling of Disease Progression in Patients at Risk for Sepsis.  Co-investigator – Seigel

 REVAMPED:  Reducing Ventilator Associated Pneumonia in Mechanically Ventilated Patients in the Emergency Department.  Resident Initiating Project (Van Ginkel), Primary investigator – Napoli

 DISPARITY:  Determining if Successful Provision of a Complete Sepsis Resuscitation Bundle Disparity exists Based on Gender.  Resident Initiating Project (Madsen), Primary investigator – Napoli

 VENTED: Identifying Practice Patterns of Mechanical Ventilation in the Emergency Department.  Primary investigator - Seigel

Acute Neurovascular Disease

An analysis of patient and institutional factors influencing time to administration of intravenous tissue plasminogen activator (tPA) for the treatment of acute stroke. Site co-investigator – Seigel

Platelet-Oriented Inhibition in New TIA (POINT) trial. Site co-investigator – Seigel

Acute Cardiovascular Disease

Emergency Department Recidivism and Outcomes of Previously Evaluated Chest Pain Unit Patients. Primary investigator – Napoli

 PENN Alliance for Therapeutic Hypothermia (PATH).  Site primary investigator – Napoli

Racial Disparities in Stress Test Utilization in a Chest Pain Unit.  Primary investigator - Napoli

Grants (current or in submission)

Characterization and Consequences of Lytic Cell Activation in Patients with Severe Sepsis.  Source:  The Rhode Island Foundation, $15,000 Award, 2011 – present. Principal Investigator – Napoli

Identifying Practice Patterns of Mechanical Ventilation in the Emergency Department. Department of Emergency Medicine Junior Faculty Development Grant, $40,000 Award, 2011- present.  Principal investigator – Seigel

The pivotal role of cytolytic lymphocytes in sepsis.  NIH Director's Transformative Research         Awards (R01), $ 1,981,634 budget, under review.  Co-investigator – Napoli

Identifying Practice Patterns of Mechanical Ventilation in the Emergency Department. Emergency Medicine Foundation (EMF) Career Development Award, $50,000 budget, under review. Principal investigator – Seigel