Dr. Arthur S. Slutsky, MD, MASc, BASc

Vice President (Research), St. Michael’s Hospital; Professor, Departments of Medicine, Surgery and Biomedical Engineering, University of Toronto
Researcher of the month: 
May 2016

Biotrauma – when help harms

Canadians with severe respiratory illness, such as lung failure, often require life support to help them breathe.

It works like this; a tube is inserted down a patient’s throat and into their lungs, and then connected to a mechanical ventilator which delivers air to their injured lungs. It is usually a relatively straightforward process, and mechanical ventilation is indeed live-saving in many situations.

Like all medical therapies, however, it comes with complications which may be very subtle but extremely severe – ironically, mechanical ventilation can worsen the patient’s condition in the medium- to long-run, even though it may save them in the short term.

Combining his expertise in engineering and medicine, Dr. Arthur S. Slutsky’s research has saved countless lives by providing insight as to how mechanical ventilation leads to injury, thus leading to advances in the delivery of this life-saving therapy, and subsequent improvements in outcomes for patients on mechanical ventilation.

Dr. Slutsky, who is vice-president of Research at St. Michael’s Hospital in Toronto discovered a new and very subtle form of injury which he and his team coined “biotrauma” to describe the biological lung damage caused by mechanical ventilation – so-called ventilator-induced lung injury (VILI).

“We proved that mechanical ventilation can lead to the release of various molecules, known as mediators, that can get into the blood stream and potentially lead to failure of organs such as the kidney,” explains Dr. Slutsky. “This multi-system organ failure is what actually leads to the death of some patients on a ventilator.”

In the process, Dr. Slutsky created a new field of medical research – biotrauma – and conducted studies on ventilator-induced injury that ranged from basic research to clinical trials. His research continues to develop better ways of caring for patients with severe lung injury, and is now helping to increase the number of eligible donor lungs available for transplantation.

“Our studies have helped lead the way to the development of better approaches to ventilating patients with respiratory failure,” says Dr. Slutsky. “Our research has helped decrease mortality in Acute Respiratory Distress Syndrome, a disease which affects more than 1 million patients worldwide per year.”

Death from ARDS has decreased from about 40 per cent to 31 per cent, in no small part due to Dr. Slutsky’s work to improve mechanical ventilation. An acknowledged leader in this field, he chaired an international consensus committee that laid the foundation for how patients with respiratory failure are treated around the world.

“Recent studies have demonstrated that lung-protective strategies are important, not just for treating those with ARDS but for ventilating all patients, and so these approaches are starting to be used in many millions of patients per year worldwide,” explains Dr. Slutsky.

A powerhouse in health research

As a University of Toronto Engineering Science student, Dr. Slutsky was fascinated by the human body’s complex system of chemical, biomechanical and other networks. Following his Engineering training, he completed medical school, and subsequently developed expertise in critical care medicine.

After serving on faculty at Harvard Medical School, Dr. Slutsky returned to Canada in 1984, becoming a clinician scientist at Mount Sinai Hospital and the University of Toronto. Within four years, he was a full professor of medicine, with cross-appointments in biomedical engineering and surgery.

In 2000, Dr. Slutsky became St. Michael’s Hospital’s first research executive, transforming it into a world-class research center. He played a key role in creating the Keenan Research Centre for Biomedical Science, the Li Ka Shing Knowledge Institute, and the Centre for Research on Inner City Health, a global leader in developing evidence-based solutions to address the health needs of disadvantaged populations — such as those who are homeless or under-housed, those with mental illness and those living with HIV.

Dr. Slutsky is the most cited scientist in the world in the field of mechanical ventilation. He has published more than 500 peer-reviewed papers, reviews and editorials. He has received numerous research awards including the Recognition for Scientific Accomplishments Award of the American Thoracic Society (ATS), Canadian Institutes of Health Research’s Health Researcher of the Year in 2014, and induction into the Royal Society of Canada.

Dr. Slutsky has chaired or been a member of many Data Monitoring and Safety Boards (DSMB. He has been an advisor to the US Food and Drug Administration on Biomedical Research, and chaired the FDA’s Anaesthesiology and Respiratory Devices Panel for eight years.

“The success I’ve had in my career is a testament to my superb collaborators at St. Michael’s, the University of Toronto and internationally, and most importantly to my supportive family,” says Dr. Slutsky.