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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.