Andrew Goodwin MD

Biography

Section Chief, Critical Care

Medical Director, Medical Surgical Intensive Care Unit

Dr. Goodwin is a physician scientist and leader with an interest in innovative clinical investigation focused on improving critical care outcomes.  His research has spanned the translational spectrum from examining the role of non-coding RNAs in the endothelial dysfunction of sepsis to implementation of clinical decision support (CDS) tools to novel uses of population EHR data to examine optimal care processes.  In this pursuit, he has utilized a multi-disciplinary approach including translational investigation, health services quantitative research and clinical trials. His specific foci of interest include:

Novel uses of Electronic Health Record Data and Clinical Decision Support Systems to Drive Implementation of Evidence Based Practices

Using funding from the CTSA programs at MUSC, Wake Forest University and UNC-Chapel Hill, I led a project to develop a computable phenotype for ventilator dependent respiratory failure and develop methodology for the extraction, merging and harmonization of EHR data from multiple institutions.  The phenotype has facilitated multicenter evaluation of ventilator best practices as well as novel approaches to respiratory failure classification.  Further, I have recently led multidisciplinary initiatives to use CDS to augment adherence to ICU best practices including fluid selection, invasive device de-escalation and liberation from mechanical ventilation.  

·         Spiegel MC, Simpson AN, Philip A, Bell CM, Nadig NR, Ford DW, Goodwin AJ. Development and implementation of a Clinical Decision Support-Based Initiative to Drive Intravenous Fluid Prescribing. International Journal of Medical Informatics. 2021;156:104619.

·         Brinton DL, Ford DW, Marten RH, Simpson KN, Goodwin AJ, Simpson AN. Missing Data Methods for ICU SOFA Scores in Electronic Health Records Studies: Results from a Monte Carlo Simulation.  Journal of Comparative Effectiveness Research. 2022;11(1):47-56.

·         Terry C, Brinton D, Simpson AN, Kirchoff K, Files DC, Carter G, Ford DW, Goodwin AJ. Elevated Driving Pressure and Elastance Does Not Increase In-Hospital Mortality Among Obese and Severely Obese Patients with Ventilator Dependent Respiratory Failure. Critical Care Explorations 2022;4(12):e0811.

·         Goodwin AJ, Brinton DL, Terry C, Carter G, Files DC, Ford DW, Simpson AN. Driving Pressure, Elastance and Outcomes in a Real-World Setting: A Bi-center Analysis of EHR Data. Critical Care Explorations. 2023;5(3):e0877.

Clinical Trials and Observational Studies in Critical Illness

In 2018, I was selected as a site PI in a competitive application process to expand the NHLBI-funded Prevention and Early Treatment of Acute Lung Injury (PETAL) trials network.  As part of this network, I have led MUSC’s participation in several pivotal multicenter studies.  These include: 1) Crystalloid Liberal or Vasopressors Early Resuscitation (CLOVERS) (study ongoing), Outcomes related to COVID-19 Treated with Hydroxochloroquine (ORCHID), COVID-19 Observational Study (CORAL), A Multicenter, Adaptive, Randomized, Blinded Controlled Trial of the Safety and Efficacy of Investigational Therapeutics for Hospitalized Patients With COVID-19 (ACTIV-3), A Multicenter, Adaptive, Randomized, Blinded Controlled Trial of the Safety and Efficacy of Investigational Therapeutics for Hospitalized Patients with Acute Respiratory Distress Syndrome Associated with COVID-19 (TESICO) and Acetaminophen in Sepsis: Targeted Therapy to Enhance Recovery (ASTER).  I have served as a member of the protocol committee for the CORAL and ASTER studies.  Most recently, I am serving as the site PI for the NIAID-funded Strategies and Treatments for Respiratory Infections and Viral Emergencies (STRIVE) clinical trials network. 

·         Sevransky et al. for the VICTAS Investigators. Effect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator- and Vasopressor-Free Days in Patients with Sepsis. JAMA 2021;325(8):742-750.

·         ACTIV-3-Therapeutics for Inpatients with COVID-19 (TICO) Study Group. Tixagevimab-cilgavimab for treatment of patients hospitalized with COVID-19: a randomized, double-blind, phase 3 trial. Lancet Resp Med 2022;10(10):972-984.

·         Prevention and Early Treatment of Acute Lung Injury (PETAL) Clinical Trials Network. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. NEJM. 2023;388(6):499-510.

·         ACTIV-3b/Therapeutics for Severely Ill Inpatients with COVID-19 (TESICO) Study Group. Intravenous Aviptadil and Remdesivir for Treatment of COVID-19-associated Hypoxemic Respiratory Failure. Lancet Resp Med. 2023;11(9):791-803.

The role of micro RNA in sepsis-related endothelial dysfunction

The development of endothelial dysfunction and its resultant vascular permeability is a critical hallmark of the transition from uncomplicated sepsis to septic shock with multi-organ failure.  However, the mechanisms which govern endothelial homeostasis are incompletely understood.  As part of a multi-disciplinary collaboration, we have identified that human endothelial progenitor cells (EPC) mitigate vascular leak, organ failure, and mortality when injected intravenously into septic mice.  Simultaneously, EPCs alter the circulating miRNA profile through release of miRNA-containing exosomes which can be taken up by recipient endothelium.  Our work has focused on: 1) exploring the mechanistic role of endothelial-relevant miRNA in sepsis-induced vascular leak; 2) characterizing the expression patterns of endothelial-relevant miRNA in human sepsis; and 3) exploring the therapeutic potential of miRNA in septic shock.

·               Fan H, Goodwin AJ, Chang E, Zingarelli B, Borg K, Guan S, Halushka PV, Cook JA. Endothelial progenitor cells and a stromal cell-derived factor-1α analogue synergistically improve survival in sepsis. Am J Respir Crit Care Med. 2014 Jun 15;189(12):1509-19. PMCID: PMC4226015.

·               Goodwin AJ, Guo C, Cook JA, Wolf B, Halushka PV, Fan H. Plasma levels of microRNA are altered with the development of shock in human sepsis: an observational study.  Critical Care 2015;19:440.

·               Zhou Y, Li P, Goodwin AJ, Cook JA, Halushka PV, Harley RA, Zingarelli B, Fan H. Exosomes from Endothelial Progenitor Cells Improve Outcomes of Murine Sepsis. Molecular Therapy. 2018;26(5):1375-1384.

·               Goodwin AJ, Li P, Halushka PV, Cook JA, Sumal AS, Fan H. Circulating MiRNA-887 is Differentially Expressed in  ARDS and Modulates Endothelial Function. Am J Physiol Lung Cell Mol Physiol. 2020;318:L1261-L1269.

The role of patient characteristics and hospital structure and processes on sepsis outcomes

Despite no new pharmacologic therapies for the treatment of sepsis, mortality rates have steadily declined over the last two decades, likely due to implementation of improved ICU structure and processes and the systematic implementation of best practices.  As an early career investigator, part of my research focus included large administrative database analyses in order to better understand which patient and hospital-level characteristics have the greatest impact on sepsis outcomes including mortality and post-survival hospital readmission. Specifically, I have been the lead investigator on multiple studies which have demonstrated that: 1) thirty-day readmissions after hospitalization with sepsis are as common as CMS-tracked conditions such as CHF and acute MI and are associated with patient socio-demographics, comorbidity burden and hospital characteristics; 2) patients who are hospitalized with sepsis at hospitals which care for high volumes of sepsis cases annually have better odds of surviving compared to patients cared for at low volume hospitals; and 3) residence in a medically underserved area is associated with higher odds of sepsis mortality.

·                  Goodwin AJ, Rice DA, Simpson KN, Ford DW.  Frequency, Cost and Risk Factors of Readmissions among Severe Sepsis Survivors. Crit Care Med 2015;43:738-746. PMID: 25746745

·                  Goodwin AJ, Simpson KN, Ford DW. Volume-Mortality Relationships During Hospitalization with Severe Sepsis Exist Only at Low Case Volumes. Annals of ATS 2015;12(8):1177-1184. PMID: 26086787.

·                  Ford DW, Goodwin AJ, Nadig N, Johnson E, Simpson A, Simpson KN. A Sepsis Mortality Prediction Score for Use with Administrative Data. Crit Care Med 2016; 44(2):319-27. PMID: 26496452.

·                  Goodwin AJ, Nadig NR, McEllligott JT, Simpson KN, Ford DW.  Where you live matters: the impact of place of residence on severe sepsis incidence and mortality. Chest 2016;150(4):829-836.

Optimizing patient and family-centered ICU care through mixed methods research

As a multi-disciplinary research group including intensivists, behavioral scientists, statisticians, and health economists, we use mixed methodology to identify barriers and enablers to best practices in the ICU.  These data are then used to facilitate dissemination and implementation strategies to optimize care.

·                  Nadig NR, Goodwin AJ, Simpson AN, Simpson KN, Richards J, Ford DW. Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure. Annals of the American Thoracic Society. 2017;14(5):730-736.

·                  Nadig NR, Sterba KR, Johnson E, Goodwin AJ, Ford DW. Inter-ICU Transfer of Patients with Ventilator Dependent Respiratory Failure: Qualitative Analysis of Multi-Stakeholder Perspectives. Patient Education and Counseling. 2019 102(9):1703-1710.

·                  Johnson E, Sterba KR, Goodwin AJ, Warr EH, Beeks R, Ford DW. Implementation of an Academic-to-Community Hospital ICU Quality Improvement Program: Qualitative Analysis of Multilevel Facilitators and Barriers.  Annals of the American Thoracic Society 2019 16(7):877-885.

·                  Nadig NR, Brinton D, Simpson KN, Goodwin AJ, Simpson AN, White K, Ford DW. The Impact of Timing on Clinical and Economic Outcomes During Inter-ICU Transfer of Acute Respiratory Failure Patients: Time and Tide Wait for No One. Critical Care Explorations 2022;4(3):pe0642.