
Overview
Background
Shekar is a Senior Intensive Care Specialist and the Director of Research in the Adult Intensive Care Service at the Prince Charles Hospital. He holds academic appointments as a Professor at the University of Queensland, Adjunct Professor at Queensland University of Technology and Associate Professor at Bond University, Gold Coast. Shekar is the recipient of the Metro North Hospital and Health Service Clinician Research Fellowship and the Queeensland Health Research Fellowship. Shekar specialises in the design and conduct of both pre-clinical and clinical studies. His ongoing research programs, “The NO Tube Project” and “ The Budget ICU Project”, bring together clinicians, multidisciplinary allied health professionals, engineers, scientists, health economists, industry and policy experts to minimise the burden of invasive mechanical ventilation in intensive care units and to improve access to intensive care services around the world. His current body of research includes the pathophysiology of cardiorespiratory failure, sepsis and extracorporeal life support (ECLS). Shekar has significant experience in conducting mechanistic research in large animal models of lung injury, mechanical ventilation, sepsis and ECLS. His pioneering work in drug pharmacokinetics in adult patients on ECLS was recognised globally. He is the chief investigator of an ongoing international multi-centre clinical study that aims to develop drug dosing guidelines for ECLS patients. Shekar has secured over $16.5 million in grant funding, published over 250 peer-reviewed articles, 60 conference abstracts, 14 book chapters and has delivered over 100 national and international lectures. He regularly reviews articles for leading journals and competitive grant applications. He is routinely involved with bedside teaching and simulation exercises, as well as supervision of RHD students. Shekar has collaborated extensively both nationally and internationally. He is a member of the Scientific Committee of the International ECMO Network. He is the global research lead for Extracorporeal Life Support Organisation (ELSO) Education Taskforce and is a member of the Asia-Pacific ELSO Steering and Education Committee. He is also the Chair of the global ELSO COVID-19 working group. Shekar contributes to the Australia and New Zealand Intensive Care Society COVID-19 Guideline Committee and is the Co-Chair of the National COVID-19 Clinical Evidence Taskforce Hospital and Acute Care Panel. He has significant experience with Clinical Information Systems (CIS) and is the Chair of the CIS Special User Group in Queensland.
Availability
- Professor Kiran Shekar is:
- Available for supervision
- Media expert
Research interests
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Extracorporeal membrane oxygenation
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Respiratory failure and minimising the burden of invasive mechanical ventilation
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PK/PD on Extracorporeal membrane oxygenation support
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Cardiogenic Shock and Mechanical Circulatory Support
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Microcirculation on temporary Mechanical Circulatory Support
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Building a budget intensive care unit to improve intensive care access in resource poor countries
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Standardising ECMO education to bridge the variability in global ECMO outcomes
Works
Search Professor Kiran Shekar’s works on UQ eSpace
2013
Journal Article
Single-centre experience of donation after cardiac death
Kumar, Raj, Shekar, Kiran and Fraser, John F. (2013). Single-centre experience of donation after cardiac death. Medical Journal of Australia, 198 (2), 87-88. doi: 10.5694/mja12.11502
2013
Conference Publication
Feasibility of a novel echocardiographic imaging technique, intracatheter echocardiography, to guide venovenous extracorporeal membrane oxygenation cannulae placement in a validated ovine model
Platts, D., Hilton, A., Diab, S., MacDonald, C., Tunbridge, M., Chemonges, S., Dunster, K., Shekar, K., Burstow, D. and Fraser, J. (2013). Feasibility of a novel echocardiographic imaging technique, intracatheter echocardiography, to guide venovenous extracorporeal membrane oxygenation cannulae placement in a validated ovine model. CSANZ 2013: 61st Annual Scientific Meeting of the Cardiac Society of Australia and New Zealand; in conjunction with the 37th Annual Scientific Meeting of the International Society for Heart Research, Gold Coast, QLD, Australia, 8-11 August, 2013. Chatswood, NSW, Australia: Elsevier Australia. doi: 10.1016/j.hlc.2013.05.429
2013
Journal Article
Hyperoxic damage and the need for optimised oxygenation practices
Hayes, Rylan A., Shekar, Kiran and Fraser, John F. (2013). Hyperoxic damage and the need for optimised oxygenation practices. Critical Care, 17 (4) 441, 441. doi: 10.1186/cc12802
2013
Conference Publication
The impact of continuous flow from venovenous extracorporeal membrane oxygenation cannulae on tricuspid valve geometry and function
Platts, D., Diab, S., MacDonald, M., Chemonges, S., Dunster, K., Shekar, K., Burstow, D., Mullany, D. and Fraser, D. (2013). The impact of continuous flow from venovenous extracorporeal membrane oxygenation cannulae on tricuspid valve geometry and function. 2013 ANZSCTS Annual Scientific Meeting, Darwin, NT Australia, 22 - 25 August 2013. Chatswood, NSW Australia: Elsevier Australia. doi: 10.1016/j.hlc.2013.05.474
2012
Journal Article
Drotrecogin alfa (activated) falls amid continuing enthusiasm to normalise physiology in ICU patients
Shekar, Kiran and Fraser, John F. (2012). Drotrecogin alfa (activated) falls amid continuing enthusiasm to normalise physiology in ICU patients. Critical Care and Resuscitation, 14 (4), 324-324. doi: 10.1016/s1441-2772(23)01775-1
2012
Journal Article
Massive bilateral pulmonary emboli, paradoxical embolus and the knot of life
Platts, David, Shekar, Kiran, Senz, Ainslie and Thomson, Bruce (2012). Massive bilateral pulmonary emboli, paradoxical embolus and the knot of life. European Heart Journal, 33 (24), 3077-3077. doi: 10.1093/eurheart/ehs256
2012
Journal Article
ASAP ECMO: antibiotic, sedative and analgesic pharmacokinetics during extracorporeal membrane oxygenation: a multi-centre study to optimise drug therapy during ECMO
Shekar, Kiran, Roberts, Jason A., Welsh, Susan, Buscher, Hergen, Rudham, Sam, Burrows, Fay, Ghassabian, Sussan, Wallis, Steven C., Levkovich, Bianca, Pellegrino, Vin, McGuiness, Shay, Parke, Rachael, Gilder, Eileen, Barnett, Adrian G., Walsham, James, Mullany, Daniel V., Fung, Yoke L., Smith, Maree T. and Fraser, John F. (2012). ASAP ECMO: antibiotic, sedative and analgesic pharmacokinetics during extracorporeal membrane oxygenation: a multi-centre study to optimise drug therapy during ECMO. BMC Anesthesiology, 12 (1) 29, 29.1-29.9. doi: 10.1186/1471-2253-12-29
2012
Journal Article
Sedation during extracorporeal membrane oxygenation-why more is less
Shekar, K., Roberts, J. A., Ghassabian, S., Mullany, D. V., Ziegenfuss, M., Smith, M. T., Fung, Y. L. and Fraser, J. F. (2012). Sedation during extracorporeal membrane oxygenation-why more is less. Anaesthesia and Intensive Care, 40 (6), 1067-1069.
2012
Journal Article
Altered antibiotic pharmacokinetics during extracorporeal membrane oxygenation: cause for concern?
Shekar, Kiran, Roberts, Jason A., Ghassabian, Sussan, Mullany, Daniel V., Wallis, Steven C., Smith, Maree T. and Fraser, John F. (2012). Altered antibiotic pharmacokinetics during extracorporeal membrane oxygenation: cause for concern?. Journal of Antimicrobial Chemotherapy, 68 (3), 726-727. doi: 10.1093/jac/dks435
2012
Journal Article
Sequestration of drugs in the circuit may lead to therapeutic failure during extracorporeal membrane oxygenation
Shekar, Kiran, Roberts, Jason A., McDonald, Charles I., Fisquet, Stephanie, Barnett, Adrian G., Mullany, Daniel V., Ghassabian, Sussan, Wallis, Steven C., Fung, Yoke L., Smith, Maree T. and Fraser, John F. (2012). Sequestration of drugs in the circuit may lead to therapeutic failure during extracorporeal membrane oxygenation. Critical Care, 16 (5) R194, R194.1-R194.7. doi: 10.1186/cc11679
2012
Journal Article
High-throughput assay for simultaneous quantification of the plasma concentrations of morphine, fentanyl, midazolam and their major metabolites using automated SPE coupled to LC-MS/MS
Ghassabian, Sussan, Moosavi, Seyed Mojtaba, Valero, Yarmarly Guerra, Shekar, Kiran, Fraser, John F. and Smith, Maree T. (2012). High-throughput assay for simultaneous quantification of the plasma concentrations of morphine, fentanyl, midazolam and their major metabolites using automated SPE coupled to LC-MS/MS. Journal of Chromatography B, 903, 126-133. doi: 10.1016/j.jchromb.2012.07.005
2012
Journal Article
Post-operative deep sternal wound infections: making an early microbiological diagnosis
Chaudhuri, Alex, Shekar, Kiran and Coulter, Chris (2012). Post-operative deep sternal wound infections: making an early microbiological diagnosis. European Journal of Cardio-Thoracic Surgery, 41 (6), 1304-1308. doi: 10.1093/ejcts/ezr239
2012
Journal Article
Outcomes of the first 30 cases of an adult extracorporeal membrane oxygenation program: strategies to manage the "learning curve" and implications for intensive care unit risk adjustment models
Mullany, Daniel V., Bull, Taressa N., Hunt, William, Shekar, Kiran, Thomson, Bruce, Fraser, John F. and Ziegenfuss, Marc (2012). Outcomes of the first 30 cases of an adult extracorporeal membrane oxygenation program: strategies to manage the "learning curve" and implications for intensive care unit risk adjustment models. Critical Care and Resuscitation, 14 (2), 119-129.
2012
Journal Article
Outcomes of the first 30 cases of an adult extracorporeal membrane oxygenation program: strategies to manage the "learning curve" and implications for intensive care unit risk adjustment models
Mullany, Daniel V., Bull, Taressa N., Hunt, William, Shekar, Kiran, Thomson, Bruce, Fraser, John F. and Ziegenfuss, Marc (2012). Outcomes of the first 30 cases of an adult extracorporeal membrane oxygenation program: strategies to manage the "learning curve" and implications for intensive care unit risk adjustment models. Critical Care and Resuscitation, 14 (2), 119-29.
2012
Journal Article
Development of simulated and ovine models of extracorporeal life support to improve understanding of circuit-host interactions
Shekar, Kiran, Fung, Yoke L., Diab, Sara, Mullany, Daniel V., McDonald, Charles I., Dunster, Kimble R., Fisquet, Stephanie, Platts, David G., Stewart, David, Wallis, Steven C., Smith, Maree T., Roberts, Jason A. and Fraser, John F. (2012). Development of simulated and ovine models of extracorporeal life support to improve understanding of circuit-host interactions. Critical Care and Resuscitation, 14 (2), 105-111.
2012
Journal Article
Development of simulated and ovine models of extracorporeal life support to improve understanding of circuit-host interactions
Shekar, Kiran, Fung, Yoke L., Diab, Sara, Mullany, Daniel V., McDonald, Charles I, Dunster, Kimble R., Fisquet, Kimble R, Platts, David G., Stewart, David G, Wallis, Steven C., Smith, Maree T., Roberts, Jason A. and Fraser, John F. (2012). Development of simulated and ovine models of extracorporeal life support to improve understanding of circuit-host interactions. Critical Care and Resuscitation, 14 (2), 105-111.
2012
Journal Article
Donation after cardiac death in Queensland: review of the pilot project
Kumar, R., Shekar, K., Widdicombe, N. and Fraser, J. F. (2012). Donation after cardiac death in Queensland: review of the pilot project. Anaesthesia and Intensive Care, 40 (3), 517-522. doi: 10.1177/0310057x1204000319
2012
Journal Article
Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation
Shekar, Kiran, Fraser, John F., Smith, Maree T. and Roberts, Jason A. (2012). Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation. Journal of Critical Care, 27 (6), 741.e9-741.e18. doi: 10.1016/j.jcrc.2012.02.013
2012
Conference Publication
Is morphine superior to fentanyl for analgesia during extracorporeal membrane oxygenation in adult patients?
Shekar, K., Mcdonald, C., Fisquet, S., Barnett, A., Ghassabian, S., Fung, L., Roberts, J., Smith, M. and Fraser, J. (2012). Is morphine superior to fentanyl for analgesia during extracorporeal membrane oxygenation in adult patients?. Cardiac Society of Australia and New Zealand Annual Scientific Meeting and the International Society for Heart Research Australasian Section Annual Scientific Meeting, Brisbane, QLD Australia, 16-19 August 2012. Chatswood, NSW Australia: Elsevier. doi: 10.1016/j.hlc.2012.05.585
2012
Conference Publication
Extracorporeal lessons from sheep
Fung, Y.L., Diab, S., Dunster, K., Foley, S.R., McDonald, C.I., Passmore, M., Platts, D., Simonova, G., Shekar, K., Stewart, D. and Fraser, J.F. (2012). Extracorporeal lessons from sheep. 32nd International Congress of the International Society of Blood Transfusion in joint cooperation with the 10th Congress of AMMTAC, Cancun, Mexico, 7-12 July 2012. Oxford, United Kingdom: Wiley-Blackwell Publishing. doi: 10.1111/j.1423-0410.2012.01615_1.x
Funding
Current funding
Past funding
Supervision
Availability
- Professor Kiran Shekar is:
- Available for supervision
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Available projects
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The NO TUBE Project
Induced coma and breathing machines have become synonymous with intensive care units (ICU). Breathing machines are undoubtedly life-saving in many situations where a person can’t breathe for themselves independently. A tube is placed in wind pipe through the back of the mouth and the patient is put on a breathing machine to achieve this. This buys time for caring team to fix the underlying problems that may have necessitated the breathing tube. Despite it being one of the most potent life sustaining technology available, it is also a leading cause of distress for patients and families in ICU, with survivors reporting long term physical and psychological sequalae. Although technology has improved and we have learnt how to use these breathing machines better, the risks and high costs remain.
Non-invasive alternatives such as nasal high flow oxygen delivery systems or pressurised face masks are usually used as first line treatment. This research intends to extend the benefits of these less invasive breathing support systems by adding nitric oxide gas to the oxygen-air mix. Nitric oxide gas delivered through the nose increases oxygen levels in blood and may help a patient avoid a breathing tube and induced coma. Equally, this project will expolore the efficacy of extarcoporeal respirtatory support technologies such as extracorporeal membrane oxygenation and extracoprporeal carbon dioxide removal in minimsing the need for invasive mechancial ventilation. In addition, the faesiblity and efficacy of biphasic cuirass ventilation(also termed negative pressure breathing) in minimisng the burden of invaisve mechanical ventilation will also be tested. These approaches may redefine our current management of respiratory failure, reduce distress for patients and allow them to be autonomous, maintain dignity, talk, eat and exercise while they recover. This may also lead to substantial reduction in health care costs.
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Building a budget ICU
There is signfiacant global inequity when it comes to intensive care reseources and it is estimated that moe than half the world population may not have access to quality intensive care servcies. This project will bring in clinicians, engineeers, sceintists , health economists, industry partners, policy makers and philanthropists to help develop modular budget intensive care unit systems to help address this and make ICU avaialble to the massess. Just like budget airlines trasnformed civil aviation, this project aims to transform intensive care around the world.
Please contact me A/Prof Kiran Shekar further details
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Optimising microcirculation post cardiac surgery to improve cardiac surgical outcomes
Please contact A/Prof Kiran Shekar further details
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Use of AI guided pathways to minimise low-flow time in ECMO assisted CPR
Please contact A/Prof Kiran Shekar further details
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The ECMO PK project : Understanding PK/PD on ECMO to improve patient outcomes
Extracorporeal membrane oxygenation (ECMO) is a supportive therapy and its success depends on optimal drug therapy along with other supportive care. Emerging evidence suggests significant interactions between the drug and the device resulting in altered pharmacokinetics (PK) of vital drugs which may be further complicated by the PK changes that occur in the context of critical illness. Such PK alterations are complex and challenging to investigate in critically ill patients on ECMO and necessitate mechanistic research. The aim of this project is to investigate each of circuit, drug and critical illness factors that affect drug PK during ECMO.
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Cardiac protection during veno-arterial extracorporeal membrane oxygenation
Advances in medical therapies in the last three decades have failed to improve mortality from cardiogenic shock (CS). This is despite the rapid uptake of TCS technologies, most notably V-A ECMO and percutaneous ventricular assist devices. Encouraging outcomes have been reported in selected group of CS patients with the use of veno-arterial extracorporeal membrane oxygenation (V-A ECMO). However, the CS population supported with V-A ECMO is quite heterogenous. While approximately 60% of patients have sufficient cardiac recovery to wean from V-A ECMO, 40% of patients survive to hospital discharge and this attrition is largely due to persistent heart failure. Most acute CS patients are not candidates for durable MCS or heart transplant, and therefore it is of critical importance to minimise secondary cardiac injury and maximise cardiac recovery during V-A ECMO. However, the current setup and use of V-A ECMO results in increased LV workload, potentially leading to progressive LV distension, loss of aortic valve opening, intra-cardiac blood stasis and thrombosis, with subendocardial ischemic injury and compromised cardiac recovery. Equally, significant impairment of microcirculation seen in CS and V-A ECMO patients, combined with blood component damage and activation of the endothelium, as well as coagulation and inflammatory systems may all lead to further cardiac injury. Therefore, merely replacing the native pump (patient’s own heart) with a non-pulsatile, continuous flow pump (V-A ECMO), without optimising the microcirculation and unloading the LV, may result in suboptimal outcomes.
To overcome this, we may have to look beyond traditional haemodynamic monitoring and measurements to achieve this goal. In the future, holistic monitoring during V-A ECMO may include continuous monitoring of cardiac mechanics and output, pulmonary pressures, haemostasis, microcirculation and brain tissue oxygenation. Defining CS patient populations that stand to benefit most in clinical studies, thereby enriching those studies is also a key priority moving forward. Equally, measuring quality and process metrics for ECMO is critical to making improvements in an ECMO program. This project takes a holistic look at V-A ECMO to systematically investigate this eveolving area to improve patient outcomes.
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Lung protection during venovenous extracorporeal membrane oxygenation
Although minimizing risks of ventilator-induced lung injury on venovenous ECMO is paramount, the risks/benefits of strategies employed to minimize ventilator-induced lung injury also merit due consideration. This research involves systematic invetsigation of topics espcially the use of partial or total liquid ventilation to minimsie iatrogenic lung injury on V-V ECMO and to provide best lung healing conditions.
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Standardising ECMO education to bridge the variability in global ECMO outcomes
Please contact A/Prof Kiran Shekar further details
Supervision history
Current supervision
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Doctor Philosophy
Single Hand Used inTubaTing Laryngoscope Evaluation (SHUTTLE) Project
Associate Advisor
Other advisors: Professor Jeffrey Lipman
Completed supervision
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2021
Doctor Philosophy
Optimising antimicrobial dosing in critically ill patients on extracorporeal membrane oxygenation (ECMO)
Associate Advisor
Other advisors: Dr Hafiz Abdul-Aziz, Professor Jason Roberts
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2019
Doctor Philosophy
Bioanalytical method development and validation to investigate cytochrome P450 mediated drug metabolism in patients receiving extracorporeal life support.
Associate Advisor
Other advisors: Emeritus Professor Maree Smith
Media
Enquiries
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