Clinical and Research Outline

           My clinical and research interests involve both pulmonary and critical care medicine. I am also involved in research activities as they relate to cardio-respiratory disease in persons with a range of congenital cardiac defects. Owing to the diversity of my academic involvement I have a variety of research interests and am involved in several ongoing projects. The majority of these projects are clinical in nature but some do involve laboratory work. At present I have no funding support for a fellow, but moneys are available for the materials requirement for each project.

Critical Care:

1. The proinflammatory response of the lung during conventional ventilation vs. a pressure limited strategy in patients with ARDS.
   Involves surveillance BAL for cytokines and growth factors, and high resolution CT following discharge from the ICU.
   Patients who are ventilated with low pressures/ volumes will have less lung injury and less inflammatory mediators in BAL.
2. Paralysis does not improve indices of oxygen delivery beyond adequate sedation in patients with ARDS.
   Challenges the "routine" use of paralysis in ARDS. Involves measuring oxygen delivery, consumption and estimates of tissue oxygenation before and following propofol administration and again after paralysis.
3. Blood transfusion leads to an inflammatory response in patients undergoing routine surgery.
   Evaluates the hypothesis that RBC's may stimulate or contribute to a proinflammatory response in the recipient. Cytokine levels in the blood and before and after transfusion in the recipient will be measured. Comparison between old and new RBC's will be made.

Respirology:

1. Obstructive sleep apnea is associated with increased platelet aggregability and leukocyte activation.
   Attempts to address the pathophysiology of cardiovascular and cerbrovascular morbidity in patients with OSA. Involves comparing the expression of platelet surface receptors and leukocyte receptors (L-Selectin, CD1 8/1 lb) following sleep studies in normals and patie6ts with OSA
2. The remainder of my activities center on patients with congenital heart disease. This is a goldmine and has not been studied well (or at all).
   a) Incidence of central sleep apnea in patients with congenital heart disease.
3. Role of exercise testing in following patients with complex congenital heart defects. Can it be used as a tool to determine which patients require correction or modification of existing repairs.
4. A final study is an attempt to document the pulmonary function abnormalities in patients with congenital heart disease. In addition we are attempting to determine why these patients have a high incidence of restrictive lung disease. We are specifically evaluating respiratory muscle strength.

Further Contact:

John T Granton, Programme Director, Critical Care Medicine, University of Toronto
Consultant Pulmonary and Critical Care Medicine
Director Pulmonary Hypertension Programme
University Health Network,
TGH - 10 EN - 220
585 University Ave., 11C-1170; Toronto, Ontario Canada  M5G 2N2
Phone: (416) 340-4485   Fax: (416) 340-3359 John.Granton@uhn.on.ca