
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
2022
Journal Article
Reply to Fillatre, et al. and Li, et al
Abdul-Aziz, Mohd H., Roberts, Jason A. and Shekar, Kiran (2022). Reply to Fillatre, et al. and Li, et al. American Journal of Respiratory and Critical Care Medicine, 207 (7), 952-953. doi: 10.1164/rccm.202211-2140LE
2022
Journal Article
Outcomes of prolonged ICU stay for patients undergoing cardiac surgery in Australia and New Zealand
Shah, Vikram, Ahuja, Abhilasha, Kumar, Aashish, Anstey, Chris, Thang, Christopher, Guo, Linda, Shekar, Kiran and Ramanan, Mahesh (2022). Outcomes of prolonged ICU stay for patients undergoing cardiac surgery in Australia and New Zealand. Journal of Cardiothoracic and Vascular Anesthesia, 36 (12), 4313-4319. doi: 10.1053/j.jvca.2022.08.026
2022
Journal Article
A novel barrier device and method for protection against airborne pathogens during endotracheal intubation
Alonso, Julio M., Lipman, Jeffrey and Shekar, Kiran (2022). A novel barrier device and method for protection against airborne pathogens during endotracheal intubation. European Journal of Anaesthesiology, 39 (11), 900-903. doi: 10.1097/EJA.0000000000001731
2022
Journal Article
Need for tracheostomy in major head and neck ablative surgery: a paradigm shift during the COVID-19 pandemic
Quach, H., McGuire, B., Wallace, C. and Shekar, K. (2022). Need for tracheostomy in major head and neck ablative surgery: a paradigm shift during the COVID-19 pandemic. Annals of the Royal College of Surgeons of England, 104 (9), 700-702. doi: 10.1308/rcsann.2021.0327
2022
Journal Article
Respiratory system mechanics, gas exchange, and outcomes in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome: a systematic review and meta-analysis
Reddy, Mallikarjuna Ponnapa, Subramaniam, Ashwin, Chua, Clara, Ling, Ryan Ruiyang, Anstey, Christopher, Ramanathan, Kollengode, Slutsky, Arthur S and Shekar, Kiran (2022). Respiratory system mechanics, gas exchange, and outcomes in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome: a systematic review and meta-analysis. The Lancet Respiratory Medicine, 10 (12), 1178-1188. doi: 10.1016/s2213-2600(22)00393-9
2022
Journal Article
Impact of frailty on clinical outcomes in patients with and without COVID-19 pneumonitis admitted to intensive care units in Australia and New Zealand: a retrospective registry data analysis
Subramaniam, Ashwin, Shekar, Kiran, Anstey, Christopher, Tiruvoipati, Ravindranath and Pilcher, David (2022). Impact of frailty on clinical outcomes in patients with and without COVID-19 pneumonitis admitted to intensive care units in Australia and New Zealand: a retrospective registry data analysis. Critical Care, 26 (1) 301, 1-12. doi: 10.1186/s13054-022-04177-9
2022
Journal Article
Microaxial left ventricular assist device in cardiogenic shock: a systematic review and meta-analysis
Tan, Shien Ru, Low, Christopher Jer Wei, Ng, Wei Lin, Ling, Ryan Ruiyang, Tan, Chuen Seng, Lim, Shir Lynn, Cherian, Robin, Lin, Weiqin, Shekar, Kiran, Mitra, Saikat, MacLaren, Graeme and Ramanathan, Kollengode (2022). Microaxial left ventricular assist device in cardiogenic shock: a systematic review and meta-analysis. Life, 12 (10) 1629, 1-16. doi: 10.3390/life12101629
2022
Journal Article
Invasive mechanical ventilation in patients with acute respiratory distress syndrome receiving extracorporeal support: a narrative review of strategies to mitigate lung injury
Zochios, V., Brodie, D., Shekar, K., Schultz, M. J. and Parhar, K. K.S. (2022). Invasive mechanical ventilation in patients with acute respiratory distress syndrome receiving extracorporeal support: a narrative review of strategies to mitigate lung injury. Anaesthesia, 77 (10), 1137-1151. doi: 10.1111/anae.15806
2022
Journal Article
The impact of reduction in intensity of mechanical ventilation upon venovenous ECMO initiation on radiographically assessed lung edema scores: a retrospective observational study
Worku, Elliott T., Yeung, Francis, Anstey, Chris and Shekar, Kiran (2022). The impact of reduction in intensity of mechanical ventilation upon venovenous ECMO initiation on radiographically assessed lung edema scores: a retrospective observational study. Frontiers in Medicine, 9 1005192, 1-10. doi: 10.3389/fmed.2022.1005192
2022
Book Chapter
Pharmacology
Kirk, Christa Jefferis, Abdul-Aziz, Mohd H., Roberts, Jason A., Valencia, Eleonore, Watt, Kevin, MacLaren, Graeme and Shekar, Kiran (2022). Pharmacology. Extracorporeal life support: The ELSO red book. (pp. 643-654) edited by Graeme Maclaren, Daniel Brodie, Roberto Lorusso, Giles Peek, Ravi Thiagarajan and Leen Vercaemst. Ann Arbor, MI, United States: Extracorporeal Life Support Organization.
2022
Journal Article
Machines that help machines to help patients: optimising antimicrobial dosing in patients receiving extracorporeal membrane oxygenation and renal replacement therapy using dosing software
Roberts, Jason A., Bellomo, Rinaldo, Cotta, Menino O., Koch, Birgit C. P., Lyster, Haifa, Ostermann, Marlies, Roger, Claire, Shekar, Kiran, Watt, Kevin and Abdul-Aziz, Mohd H. (2022). Machines that help machines to help patients: optimising antimicrobial dosing in patients receiving extracorporeal membrane oxygenation and renal replacement therapy using dosing software. Intensive Care Medicine, 48 (10), 1338-1351. doi: 10.1007/s00134-022-06847-2
2022
Journal Article
Direct oral anticoagulants in atrial fibrillation following cardiac surgery: a systematic review and meta-analysis with trial sequential analysis
Koh, Kylynn K., Ling, Ryan R., Tan, Shaun Y.S., Chen, Ying, Fan, Bingwen E., Shekar, Kiran, Sule, Jai A., Subbian, Senthil K. and Ramanathan, Kollengode (2022). Direct oral anticoagulants in atrial fibrillation following cardiac surgery: a systematic review and meta-analysis with trial sequential analysis. British Journal of Anaesthesia, 129 (2), 154-162. doi: 10.1016/j.bja.2022.05.010
2022
Journal Article
Development and validation of a tool to appraise guidelines on SARS-CoV-2 infection control strategies in healthcare workers
Subramaniam, Ashwin, Reddy, Mallikarjuna, Kadam, Umesh, Zubarev, Alexander, Lim, Zheng, Anstey, Chris, Bihari, Shailesh, Haji, Jumana, Luo, Jinghang, Mitra, Saikat, Ramanathan, Kollengode, Rajamani, Arvind, Rubulotta, Francesca, Svensk, Erik and Shekar, Kiran (2022). Development and validation of a tool to appraise guidelines on SARS-CoV-2 infection control strategies in healthcare workers. Australian Critical Care, 35 (4), 415-423. doi: 10.1016/j.aucc.2021.06.015
2022
Journal Article
SARS-CoV-2 transmission risk to healthcare workers performing tracheostomies: a systematic review
Subramaniam, Ashwin, Lim, Zheng Jie, Ponnapa Reddy, Mallikarjuna, Mitchell, Hayden and Shekar, Kiran (2022). SARS-CoV-2 transmission risk to healthcare workers performing tracheostomies: a systematic review. ANZ Journal of Surgery, 92 (7-8), 1614-1625. doi: 10.1111/ans.17814
2022
Journal Article
Reply Letter to the Editor Regarding the ELSO Interim Guidelines for Veno-Arterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients
Lorusso, Roberto, Bartlett, Robert H., Shekar, Kiran, MacLaren, Graeme, Schmidt, Matthieu, Pellegrino, Vincent, Meyns, Bart, Haft, Jonathan, Vercaemst, Leen, Pappalardo, Federico, Bermudez, Christian, Belohlavek, Jan, Hou, Xiaotong, Boeken, Udo, Castillo, Roberto, Donker, Dirk W., Abrams, Darryl, Ranucci, Marco, Hryniewicz, Kasia, Chavez, Ivan, Chen, Yih-Sharng, Salazar, Leonardo and Whitman, Glenn (2022). Reply Letter to the Editor Regarding the ELSO Interim Guidelines for Veno-Arterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients. ASAIO Journal, 68 (6), E111-E112. doi: 10.1097/MAT.0000000000001701
2022
Journal Article
Development of a standardized assessment of simulation-based extracorporeal membrane oxygenation educational courses
Said, Ahmed S., Cooley, Elaine, Moore, Elizabeth A., Shekar, Kiran, Maul, Timothy M., Kollengode, Ramanathan and Zakhary, Bishoy (2022). Development of a standardized assessment of simulation-based extracorporeal membrane oxygenation educational courses. ATS Scholar, 3 (2), 242-257. doi: 10.34197/ats-scholar.2021-0068OC
2022
Journal Article
Population pharmacokinetics of ciprofloxacin in critically ill patients receiving extracorporeal membrane oxygenation (an ASAP ECMO study)
Cheng, Vesa, Abdul-Aziz, Mohd H., Burrows, Fay, Buscher, Hergen, Corley, Amanda, Diehl, Arne, Levkovich, Bianca J., Pellegrino, Vincent, Reynolds, Claire, Rudham, Sam, Wallis, Steven C., Welch, Susan A., Roberts, Jason A., Shekar, Kiran, Fraser, John F. and ASAP ECMO Investigators (2022). Population pharmacokinetics of ciprofloxacin in critically ill patients receiving extracorporeal membrane oxygenation (an ASAP ECMO study). Anaesthesia Critical Care and Pain Medicine, 41 (3) 101080, 1-6. doi: 10.1016/j.accpm.2022.101080
2022
Journal Article
Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis
Ling, Ryan Ruiyang, Ramanathan, Kollengode, Sim, Jackie Jia Lin, Wong, Suei Nee, Chen, Ying, Amin, Faizan, Fernando, Shannon M., Rochwerg, Bram, Fan, Eddy, Barbaro, Ryan P., MacLaren, Graeme, Shekar, Kiran and Brodie, Daniel (2022). Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis. Critical Care, 26 (1) 147, 1-13. doi: 10.1186/s13054-022-04011-2
2022
Journal Article
Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis
Li Bassi, Gianluigi, Gibbons, Kristen, Suen, Jacky Y., Dalton, Heidi J., White, Nicole, Corley, Amanda, Shrapnel, Sally, Hinton, Samuel, Forsyth, Simon, Laffey, John G., Fan, Eddy, Fanning, Jonathon P., Panigada, Mauro, Bartlett, Robert, Brodie, Daniel, Burrell, Aidan, Chiumello, Davide, Elhazmi, Alyaa, Esperatti, Mariano, Grasselli, Giacomo, Hodgson, Carol, Ichiba, Shingo, Luna, Carlos, Marwali, Eva, Merson, Laura, Murthy, Srinivas, Nichol, Alistair, Ogino, Mark, Pelosi, Paolo ... The COVID-19 Critical Care Consortium (2022). Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis. Critical Care, 26 (1) 141, 141. doi: 10.1186/s13054-022-03983-5
2022
Journal Article
Extracorporeal membrane oxygenation during pregnancy and peripartal. An international retrospective multicenter study
Malfertheiner, S. Fill, Brodie, D., Burrell, A., Taccone, F. S., Broman, L. M., Shekar, K., Agerstrand, C. L., Serra, A. L., Fraser, J. and Malfertheiner, M. V. (2022). Extracorporeal membrane oxygenation during pregnancy and peripartal. An international retrospective multicenter study. Perfusion, 38 (5), 1-7. doi: 10.1177/02676591221090668
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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