Ashish K. Khanna, MD, FCCP, FASA, FCCM, is an intensivist and anesthesiologist at Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, USA. He is associate professor and vice-chair for research for the department of anesthesiology at the Wake Forest School of Medicine. He has been actively involved with the Society of Critical Care Medicine (SCCM) since 2012, serving on several committees and currently serving as the co-chair of the 2023 Critical Care Congress Program Committee and incoming chair of the SCCM Research Section. You will find him playing tennis and spending time with his kids in his free time. His clinical interests include research, big data from electronic health records, resuscitation, and shock. He shares his thoughts on challenges and opportunities working in critical care.
Why do you love being in critical care?
Critical care is not like any other specialty in the hospital—it is life in the fast lane almost every day. I love being on the front lines and taking care of my patients when they are at their sickest and most critically ill, which is often not easy. A complex interplay of organ systems and altered pathophysiology creates a fine line between doing too much and doing too little for your patient. The gratification and sense of achievement when I can be involved in a successful patient story of ICU survival is hard to describe. However, not everyone survives a critical illness. This specialty has taught me a lot about understanding appropriate care and intervention. Speaking as someone who recently lost his own mother to critical illness, I will also say that the needs of the family waiting outside an ICU are special. The favorite part of my ICU day is the time (not to be quantified in minutes) that I spend with a family member talking to them about their loved one’s progress in my unit. I try to keep my answers simple and succinct and break down care into daily milestones.
How did you get into critical care?
My initial training was in anesthesia and intensive care in India, a part of the world where ICU-based training is very heavy. We had a modern, state-of-the-art ICU, where we saved many lives and had many an inspirational story of teamwork and critical care expertise to narrate. Following this, I trained at Cleveland Clinic where my early mentors on my ICU rotations were truly the smartest and most hardworking intensivists I had met to date. It was a critical care family that worked hard and played hard and enjoyed every minute in the unit. I was blessed to have been trained at institutions early on in my life with outstanding critical care facilities and expertise around me. I went into anesthesia to pursue critical care, and I have never second-guessed that decision. I would do this all over again if given a chance.
What are the top advances in critical care since you started your career?
While we have grown in our knowledge and perceptions of fluids, vasopressors, patient rehabilitation, early mobility, new adjuncts in management of shock states, better and smarter ICU monitoring, tele-ICU care models, and now COVID-19, nothing quite compares to the growth of big data and artificial intelligence (AI) in the ICU. The availability to capture vital sign patterns and patient data to aggregate hundreds and thousands of patients worldwide into openly available datasets has set the stage for this work. We are finally moving on from traditional prospective randomized trials in near-perfect trial conditions to the use of real-world patient data to predict and prevent poor outcomes using the expertise of data scientists. AI is here to stay, and the future ICU will be all about predicting outcomes and early interventions to prevent patient decline.
What is your biggest professional achievement?
From 2015 to 2017 I was the lead investigator for the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) trial. This trial randomized patients with high-output vasodilatory shock to a novel vasopressor, angiotensin II, or placebo in more than 80 ICUs worldwide. In 2017, we published our results in the prestigious New England Journal of Medicine (NEJM). I will never forget “A. Khanna and colleagues” on the front page of NEJM. This work lead to FDA approval for this compound, which is now being used in several ICUs in the United States and Europe to manage shock and hypotension. While publishing my first full paper as a first author in NEJM two years out of fellowship training was important, the most important part was all the behind-the-scenes sacrifices and blood, sweat, and tears that went into this work. For those two years, my family did not see me, we grew from one child to the addition of twins, and my wife did it mostly by herself as I disappeared from the radar, immersing myself in work and handling a 24/7, 365-days-of-the-year research trial. In the end, we ended up stronger as a family, and I ended up learning so much from several greats who were investigators on the trial with me. I owe these people much and thank them every time I read about angiotensin II.
What advice do you have for those starting their critical care careers?
You are here, and it is not easy. You chose to be here, now give it your best and enjoy every day in the ICU. Work hard, give everything you have to take care of these sick patients while you are at work. Most importantly, when you finish your shift and walk away from the unit, destress and disconnect for a little bit. This will allow you to come back stronger and do a much better job for your patients the next day. Finally, when you talk to a patient’s loved one, put yourself in his/her shoes. No one comes to the ICU by choice, and everyone feels scared, intimidated, and clueless. Answer every question, however dumb it may seem to you. Remember, this could be you some day.
What do you see as the most challenging issue facing critical care?
In my opinion, the most challenging issue facing critical care today is the need to unify training and practice into one critical care field. Currently (at least in North America), we are focused on specialty-based critical care, with pulmonary, anesthesiology, surgery, and others training and practicing in their own areas of critical care. A change should be made to a critical care or intensive care medicine model with a single fellowship, irrespective of primary training and the ability to open all ICU patient types to all ICU-trained specialists.
What industry trends have you excited about the future?
Miniaturization of monitoring technology, smart wearable monitors to allow patients to get untethered from their ICU beds and move through the hospital, along with the use of closed-loop AI-based technology to correct hemodynamic harm before it occurs; these are all exciting. They will change the face of how we practice in this space. Our patients have a lot to teach and tell us with their vital signs. I am glad that our industry partners are focusing on technology that captures vital signs and uses smart algorithms to understand how patients deteriorate and what can be done to avoid organ system failure before it occurs.
What do you love about SCCM membership?
SCCM membership is my ticket to the world of critical care medicine outside of my area of local practice. It has allowed me to connect to the world, make friends and collaborators and more, which opened my eyes and allowed me to rethink what I do in the ICU every day. We often grow in silos within our local institutions and ICUs. We wrongly believe that our way of practice is the best. SCCM membership took me away from this notion. I am grateful for all that I have learned from the years of interactions and professional development opportunities this organization has offered me. None of my collaborative research would have been possible without the SCCM membership that connected me to the best research minds in critical care worldwide.
Connect with @Ashish Khanna on SCCM Connect or on Twitter at @KhannaAshishCCM