Carolyn Calfee

Last updated
Carolyn S. Calfee
Born1973
Houston
Alma mater University of Pennsylvania (MD)
Yale University
Known for Acute respiratory distress syndrome
Scientific career
Institutions University of California, San Francisco
Website UCSF profile

Carolyn S. Calfee (born 1973) is a Professor of Medicine and Anaesthesia at the University of California, San Francisco. She works in intensive care at the UCSF Medical Center where she specialises in acute respiratory distress syndrome. During the COVID-19 pandemic Calfee studied why SARS-CoV-2 patients experienced such different symptoms.

Contents

Early life and education

Calfee was born in Houston. She was an undergraduate student at Yale University, where she was in the Phi Beta Kappa honour society. [1] [2] She attended medical school at the University of Pennsylvania, and graduated in 1999. In 1999 Calfee moved to San Francisco, where was a graduate student in clinical research at the University of California, San Francisco (UCSF). She was Chief Resident during her training in UCSF, where she focussed on pulmonary and critical care medicine. [3] After her research training Calfee was appointed to the faculty at UCSF.[ citation needed ]

Research and career

Calfee uses biomarkers to investigate the development, ability to detect and impact of treatment on acute lung injury and acute respiratory distress syndrome (ARDS). [3] In critically ill patients, ARDS is a frequent cause of acute respiratory failure, and has mortality rates of up to 40%. [4] In particular, Calfee studies different phenotypes of ARDS in an effort to identify novel treatments. By understanding unrecognised subphenotypes of people who suffer from ARDS, Calfee looks to test more targeted interventions. [5] She identified that around one third of ARDS patients have a hyper-inflammatory phenotype, which may be more responsive to mechanical ventilation and pharmacotherapy. [4] This particular phenotype is associated with elevated levels of proinflammatory biomarkers in plasma as well as an increase in organ dysfunction. [6]

She has explored to role of different environmental exposures on the prevalence of ARDS. As part of this work, Calfee has studied the biological impact of vaping. [7] In 2016 she was part of a $20 million Food and Drug Administration program to study the impact of emerging tobacco products, including electronic cigarettes and heated tobacco products. [8] In particular, Calfee focussed on the impact of different aspects of electronic cigarettes on acute lung injury. [9] She represented the American Thoracic Society in the creation of a Centers for Disease Control and Prevention (CDC) clinical guideline on the health impacts of vaping, with a focus on how it impacts lung injury. [10] [11] Calfee is concerned about the use of e-cigarettes amongst adolescents, and emphasised that e-cigarettes should not be used by youths or young adults. [12] In 2019 she was elected to the American Society for Clinical Investigation. [4]

During the COVID-19 pandemic Calfee studied why SARS-CoV-2 patients experienced such different symptoms; ranging from mild to life-threatening. [7] [13] Her research identified that the infection attacks the alveolar epithelium, small air sacs that usually prevent fluid entering the lungs. [7] When the barrier between the air sacs and blood becomes leaky, fluid starts to pour into the lungs. [13] This damage can be so severe that it takes a long time to heal, which means that the time for ventilation is longer than expected. [7] In this specific type of RNA virus, a human's immune system response can be so intense that it damages the lungs. [7] Calfee analyses the fluid and blood samples to understand what factors cause the most extreme responses of coronavirus disease. At the time, Calfee served as an intensive care physician, and remarked that “the scale and severity of this epidemic is like nothing any of us have experienced,”. [7]

Selected publications

Related Research Articles

<span class="mw-page-title-main">Respiratory failure</span> Inadequate gas exchange by the respiratory system

Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise in arterial carbon dioxide levels is called hypercapnia. Respiratory failure is classified as either Type 1 or Type 2, based on whether there is a high carbon dioxide level, and can be acute or chronic. In clinical trials, the definition of respiratory failure usually includes increased respiratory rate, abnormal blood gases, and evidence of increased work of breathing. Respiratory failure causes an altered mental status due to ischemia in the brain.

<span class="mw-page-title-main">Mechanical ventilation</span> Method to mechanically assist or replace spontaneous breathing

Mechanical ventilation or assisted ventilation is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move air into and out of the lungs, with the main goal of helping the delivery of oxygen and removal of carbon dioxide. Mechanical ventilation is used for many reasons, including to protect the airway due to mechanical or neurologic cause, to ensure adequate oxygenation, or to remove excess carbon dioxide from the lungs. Various healthcare providers are involved with the use of mechanical ventilation and people who require ventilators are typically monitored in an intensive care unit.

<span class="mw-page-title-main">Pulmonary edema</span> Fluid accumulation in the tissue and air spaces of the lungs

Pulmonary edema, also known as pulmonary congestion, is excessive fluid accumulation in the tissue or air spaces of the lungs. This leads to impaired gas exchange, most often leading to dyspnea which can progress to hypoxemia and respiratory failure. Pulmonary edema has multiple causes and is traditionally classified as cardiogenic or noncardiogenic.

<span class="mw-page-title-main">Extracorporeal membrane oxygenation</span> Technique of providing both cardiac and respiratory support

Extracorporeal membrane oxygenation (ECMO), is a form of extracorporeal life support, providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of oxygen, gas exchange or blood supply (perfusion) to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which provides shorter-term support with arrested native circulation. The device used is a membrane oxygenator, also known as an artificial lung.

<span class="mw-page-title-main">Acute respiratory distress syndrome</span> Human disease

Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin coloration (cyanosis). For those who survive, a decreased quality of life is common.

Permissive hypercapnia is hypercapnia in respiratory insufficient patients in which oxygenation has become so difficult that the optimal mode of mechanical ventilation is not capable of exchanging enough carbon dioxide. Carbon dioxide is a gaseous product of the body's metabolism and is normally expelled through the lungs.

<span class="mw-page-title-main">Fat embolism syndrome</span> Medical condition

Fat embolism syndrome occurs when fat enters the blood stream and results in symptoms. Symptoms generally begin within a day. This may include a petechial rash, decreased level of consciousness, and shortness of breath. Other symptoms may include fever and decreased urine output. The risk of death is about 10%.

<span class="mw-page-title-main">Electronic cigarette</span> Device that vaporizes a liquid nicotine solution for inhalation

An electronic cigarette (e-cigarette) or vape is a device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank filled with liquid. Instead of smoke, the user inhales vapor. As such, using an e-cigarette is often called "vaping". The atomizer is a heating element that vaporizes a liquid solution called e-liquid, which quickly cools into an aerosol of tiny droplets, vapor and air. E-cigarettes are activated by taking a puff or pressing a button. Some look like traditional cigarettes, and most kinds are reusable. The vapor mainly comprises propylene glycol and/or glycerin, usually with nicotine and flavoring. Its exact composition varies, and depends on several things including user behavior.

Ventilator-associated lung injury (VALI) is an acute lung injury that develops during mechanical ventilation and is termed ventilator-induced lung injury (VILI) if it can be proven that the mechanical ventilation caused the acute lung injury. In contrast, ventilator-associated lung injury (VALI) exists if the cause cannot be proven. VALI is the appropriate term in most situations because it is virtually impossible to prove what actually caused the lung injury in the hospital.

<span class="mw-page-title-main">Diffuse alveolar damage</span> Medical condition

Diffuse alveolar damage (DAD) is a histologic term used to describe specific changes that occur to the structure of the lungs during injury or disease. Most often DAD is described in association with the early stages of acute respiratory distress syndrome (ARDS). It is important to note that DAD can be seen in situations other than ARDS (such as acute interstitial pneumonia) and that ARDS can occur without DAD.

<span class="mw-page-title-main">Alcoholic lung disease</span> Human disease

Alcoholic lung disease is disease of the lungs caused by excessive alcohol. The term 'alcoholic lung disease' is not a generally accepted medical diagnosis, and "the association between alcohol abuse and acute lung injury remains largely unrecognized, even by lung researchers".

<span class="mw-page-title-main">Chronic obstructive pulmonary disease</span> Lung disease involving long-term poor airflow

Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. GOLD 2024 defined COPD as a heterogeneous lung condition characterized by chronic respiratory symptoms due to abnormalities of the airways and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.

Prone ventilation, sometimes called prone positioning or proning, is a method of mechanical ventilation with the patient lying face-down (prone). It improves oxygenation in most patients with acute respiratory distress syndrome (ARDS) and reduces mortality. The earliest trial investigating the benefits of prone ventilation occurred in 1976. Since that time, many meta-analyses and one randomized control trial, the PROSEVA trial, have shown an increase in patients' survival with the more severe versions of ARDS. There are many proposed mechanisms, but they are not fully delineated. The proposed utility of prone ventilation is that this position will improve lung mechanics, improve oxygenation, and increase survival. Although improved oxygenation has been shown in multiple studies, this position change's survival benefit is not as clear. Similar to the slow adoption of low tidal volume ventilation utilized in ARDS, many believe that the investigation into the benefits of prone ventilation will likely be ongoing in the future.

The use of electronic cigarettes (vaping) carries health risks. The risk depends on the fluid and varies according to design and user behavior. In the United Kingdom, vaping is considered by some to be around 95% less harmful than tobacco after a controversial landmark review by Public Health England.

<span class="mw-page-title-main">2019–2020 vaping lung illness outbreak</span> Outbreak of vaping-associated pulmonary injury

An outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) started in 2019 among users of illegal, unregulated cannabis vaping products, almost exclusively in the United States. The first cases of this particular outbreak were identified in Illinois and Wisconsin in April 2019; as of 18 February 2020, a total of 2,807 hospitalized cases, including 68 deaths, have been confirmed. According to the U.S. Centers for Disease Control (CDC), "Vitamin E acetate is strongly linked to the EVALI outbreak...Evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC or non-THC products, in some of the reported EVALI cases".

Vaping-associated pulmonary injury (VAPI), also known as vaping-associated lung injury (VALI) or e-cigarette, or vaping, product use associated lung injury (E/VALI), is an umbrella term, used to describe lung diseases associated with the use of vaping products that can be severe and life-threatening. Symptoms can initially mimic common pulmonary diagnoses, such as pneumonia, but sufferers typically do not respond to antibiotic therapy. Differential diagnoses have overlapping features with VAPI, including COVID-19. According to a systematic review article, "Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019." According to an article in the Radiological Society of North America news published in March 2022, EVALI cases continue to be diagnosed. “EVALI has by no means disappeared,” Dr. Kligerman said. “We continue to see numerous cases, even during the pandemic, many of which are initially misdiagnosed as COVID-19.”

<span class="mw-page-title-main">Proning</span> Nursing technique

Proning or prone positioning is the placement of patients into a prone position so that they are lying on their front. This is used in the treatment of patients in intensive care with acute respiratory distress syndrome (ARDS). It has been especially tried and studied for patients on ventilators but, during the COVID-19 pandemic, it is being used for patients with oxygen masks and CPAP as an alternative to ventilation.

<span class="mw-page-title-main">Symptoms of COVID-19</span> Overview of the symptoms of COVID-19

The symptoms of COVID-19 are variable depending on the type of variant contracted, ranging from mild symptoms to a potentially fatal illness. Common symptoms include coughing, fever, loss of smell (anosmia) and taste (ageusia), with less common ones including headaches, nasal congestion and runny nose, muscle pain, sore throat, diarrhea, eye irritation, and toes swelling or turning purple, and in moderate to severe cases, breathing difficulties. People with the COVID-19 infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; and a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, or throat disorders, loss of taste combined with loss of smell is associated with COVID-19 and is reported in as many as 88% of symptomatic cases.

The treatment and management of COVID-19 combines both supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support as needed, and a growing list of approved medications. Highly effective vaccines have reduced mortality related to SARS-CoV-2; however, for those awaiting vaccination, as well as for the estimated millions of immunocompromised persons who are unlikely to respond robustly to vaccination, treatment remains important. Some people may experience persistent symptoms or disability after recovery from the infection, known as long COVID, but there is still limited information on the best management and rehabilitation for this condition.

Marie-Carmelle Elie is an American emergency physician who is Professor and Chair of Emergency Medicine at the University of Alabama at Birmingham. She was elected Fellow of the National Academy of Medicine in 2022.

References

  1. ↑ "Carolyn S. Calfee, MD | UCSF Helen Diller Family Comprehensive Cancer Center". cancer.ucsf.edu. Retrieved 2020-04-13.
  2. ↑ "Carolyn Calfee • iBiology". iBiology. Retrieved 2020-04-13.
  3. 1 2 "Carolyn S. Calfee". ucsfhealth.org. Retrieved 2020-04-13.
  4. 1 2 3 "The American Society for Clinical Investigation" . Retrieved 2020-04-13.
  5. ↑ Wilson, Jennifer G.; Calfee, Carolyn S. (2020-03-24). "ARDS Subphenotypes: Understanding a Heterogeneous Syndrome". Critical Care. 24 (1): 102. doi: 10.1186/s13054-020-2778-x . ISSN   1364-8535. PMC   7092435 . PMID   32204722.
  6. ↑ Sinha, Pratik; Calfee, Carolyn S. (2019-07-01). "Peeking under the Hood of Acute Respiratory Distress Syndrome Phenotypes: Deeper Insights into Biological Heterogeneity". American Journal of Respiratory and Critical Care Medicine. 200 (1): 4–6. doi:10.1164/rccm.201901-0195ED. ISSN   1073-449X. PMC   6603053 . PMID   30753791.
  7. 1 2 3 4 5 6 "Bay Area scientists forge alliance to stop coronavirus — it may prove key to cure". San Francisco Chronicle. 2020-04-03. Retrieved 2020-04-13.
  8. ↑ "UCSF Receives $20 Million to Study New Tobacco Products | UCSF Helen Diller Family Comprehensive Cancer Center". cancer.ucsf.edu. Retrieved 2020-04-13.
  9. ↑ "UCSF Receives $20 Million to Study New Tobacco Products". UCSF Receives $20 Million to Study New Tobacco Products | UC San Francisco. Retrieved 2020-04-13.
  10. ↑ "CDC Releases Clinical Guide on Vaping-Associated Lung Injury". www.thoracic.org. Retrieved 2020-04-13.
  11. ↑ "ATS Expert Resources: New CDC Clinical Guide on Vaping Lung Injury". www.newswise.com. Retrieved 2020-04-13.
  12. ↑ Health, CDC's Office on Smoking and (2020-02-25). "Smoking and Tobacco Use; Electronic Cigarettes". Centers for Disease Control and Prevention. Retrieved 2020-04-13.
  13. 1 2 "Why does COVID-19 kill some, not others? Answer may lie in human immune system". SFChronicle.com. 2020-04-04. Retrieved 2020-04-13.
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