Andrew Goodwin MD

Biography

Current titles:

Medical Director, Medical Intensive Care Unit

Section Chief, Critical Care

Dr. Goodwin is a physician scientist with an interest in clinical investigation in sepsis and ARDS therapeutics and outcomes.  His research training has included basic science investigation and a Masters of Science in Clinical Research.  His research has spanned the translational spectrum from examining the role of non-coding RNAs in the endothelial dysfunction of sepsis to novel uses of population EHR data to examine optimal care processes.  In this pursuit, has utilized a multi-disciplinary approach including translational investigation, health services quantitative research and clinical trials. His specific foci of interest include:

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 current work is 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.
• Halushka PV, Goodwin AJ, Halushka MK. Opportunities for miRNAs in the Crowded Field of Cardiovascular Biomarkers. Annual Review of Pathology: Mechanisms of Disease 2019;14:211

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 has 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 (In Press).
• 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 (In press).

Clinical trials in sepsis and ARDS management

Dr. Goodwin is a site PI for multicenter clinical trials is sepsis and ARDS including trials for the Prevention and Early Treatment of Acute Lung Injury (PETAL) network.