Emir Festic, M.D., M.S., has been studying acute respiratory failure for more than 15 years. He has helped develop, lead and complete multicenter studies on the treatment and prevention of acute respiratory distress syndrome. The long-term goal of his research is to develop effective prevention strategies for acute respiratory failure.
As a principal investigator in a multicenter feasibility clinical trial, Dr. Festic confirmed that early-administered, inhaled corticosteroids and beta agonists improve oxygenation in patients who are hospitalized for pneumonia and are at risk of progressing to fully established acute respiratory failure, acute respiratory distress syndrome or both.
Dr. Festic has since been funded by the National Institutes of Health, along with Joseph Levitt, M.D., M.S., of Stanford University Medical Center. They are leading Arrest Respiratory Failure From Pneumonia (ARREST Pneumonia), a prospective multicenter trial on the use of inhaled budesonide and formoterol to prevent or ameliorate acute respiratory failure in patients hospitalized with severe pneumonia. The study is also enrolling patients with COVID-19, as preliminary data suggest that these patients are at particular risk of developing viral pneumonia and acute respiratory failure.
Additionally, Dr. Festic has conceptualized the double effect of obstructive sleep apnea. In several retrospective observational studies, including a population-based study, he showed that although obstructive sleep apnea increases the risk of cardiovascular complications such as stroke, pulmonary embolism and cardiac arrest, patients with obstructive sleep apnea appear to fare better after a complication than do patients without a history of obstructive sleep apnea. This may be due to ischemic preconditioning, a phenomenon patients with obstructive sleep apnea are exposed to through chronic intermittent hypoxemia.
- Early identification of patients who will progress into fully established acute respiratory failure. Dr. Festic is contributing to and conducting trials in which patients are enrolled early in the hospital course — without established lung injury — to identify those at risk of progressing into acute respiratory failure. Identifying these patients early facilitates enrolling them into future studies on acute respiratory failure prevention.
- Identification of potential ancillary treatments for patients with pneumonia, with a focus on inhaled agents. Dr. Festic and colleagues have performed observational studies on the roles of numerous medications in preventing acute respiratory failure.
Significance to patient care
Identification of safe, inexpensive and widely available agents — for example, inhaled corticosteroids — that can prevent or attenuate lung injury in patients at high risk of acute respiratory failure would be a substantial step toward prevention of this life-threatening condition. This is especially true during the COVID-19 pandemic, when those with acute respiratory failure have extremely high mortality rates.
- Steering committee member, Discovery, the Critical Care Research Network, Society of Critical Care Medicine, February 2018-present