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Resident Adekemi Egunsola Places for SBAS Claude Organ Award

April 2017

Emory PGY3 general surgery resident Adekemi Egunsola, MD, was the second place winner in the Dr. Claude H. Organ, Jr., Resident Research Award Competition of the Society of Black Academic Surgeons (SBAS) at its April 2017 meeting in Chicago. Her paper was entitled "A Four Year Review of Aerosolized Epoprostenol Versus Inhaled Nitric Oxide with Inhalation Injury," and her coauthors included Rachael Williams MD, MHS, a burn surgeon and critical care intensivist based at Grady Memorial Hospital; Rita Gayed, Pharm D, the Grady Burn Unit's clinical pharmacist; Juvonda Hodge, MD, assistant medical director of the Grady Burn Unit; and Walter Ingram, MD, director of the Burn Unit.

Dr. Egunsola and her team compared the use of inhaled nitric oxide (iNO) to aerosolized epoprostenol in managing refractory hypoxemia with inhalation injury. Refractory hypoxemia is characterized by dangerously low levels of oxygen in the blood that cannot be corrected by the delivery of extra oxygen. The combination of the condition with inhalation injury is a significant source of morbidity and mortality. iNO has been shown in small case series to improve ventilation/perfusion mismatch (when the exchange of air between the lungs and the environment does not match the passage of blood through the lungs) and reduce pulmonary hypertension, both hallmarks of extreme inhalation injury. Meanwhile, aerosolized epoprostenolis is known to promote pulmonary vasodilation (opening of narrowed blood vessels) and has anti-inflammatory and anti-platelet properties.

The retrospective study reviewed the charts of adult patients admitted to Grady's Burn Unit between January 1, 2012-June 1, 2016, with inhalation injury who were treated with iNO or aerosolized epoprostenol. The primary endpoint was change in PaO2:FiO2 ratio (the oxygen level in the blood compared to the oxygen concentration that is breathed), while secondary endpoints included mortality, duration of mechanical ventilation, ICU length of stay, and cost analysis.

Both treatments had similar levels of success in raising the ratios of PaO2:FiO2, but mortality and ICU length of stay were lower in the epoprostenol group, while duration of therapy was lower in the iNO group. After combining these figures with an overall cost savings of $16,000 per patient when epoprostenol was used, Dr. Egunsola and her collaborators concluded that epoprostenol was a clinically feasible, more cost effective therapy for inhalation injury than iNO.

Claude H. Organ, Jr., MD, (1926-2005) was a world renowned academic surgeon that had a major role in shaping and supporting the lives and careers of thousands of young surgeons. In 1989, Dr. Organ and several other black academic surgeons founded SBAS and held its first meeting at Duke University. Throughout his career, Dr. Organ oversaw the training of dozens of surgeons, including several African-American women. His lifelong dedication to mentoring young surgeons and encouraging diversity in the field of surgery is represented in the annual Claude Organ Resident Paper Competition.

Dr. Hodge and Wendy Greene, MD, director of the Acute and Critical Care Surgery Service of Emory University Hospital, are SBAS members and served on the program committee for the 2017 meeting.

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