Brian Kavanagh graduated from University College Dublin (Ireland) in 1985, winning the Maginnis gold medal for Medicine that year at St Vincent’s University Hospital.  He completed a 2 year rotation in Medicine at St Vincent’s University Hospital and obtained his Medical Membership of the Royal College of Physicians in 1988. His strong interest in scientific research was evident from the earliest stages of his career, and he obtained a first class honours degree in Pharmacology from UCD in 1989.                                                                                                                                                                                               In 1989, Brian moved to Toronto, Canada, where he completed residency and fellowship training in Anesthesia at the University of Toronto, receiving his Fellowship of the Royal College of Physicians and Surgeons of Canada in 1992. During his residency training, Brian received multiple awards, including the Hynryck Rothbart award for best resident research presentation from the University of Toronto department of Anesthesia in 1990, the Resident Research Award from the Canadian Anesthesiologists Society in 1993, and the Residents Essay award from the American Society of Anesthesiologists in 1994. Brian coauthored a number of important papers during this time, including key early descriptions of pre-emptive analgesia and neuroplasticity. He also somehow managed to complete the then 4-year anesthesia residency program in 3 years. Brian then moved to Stanford University for clinical and research fellowship training under the mentorship of Professor Ron Pearl, an internationally renowned expert in vascular biology. During his time at Stanford, he published several important papers on the biology and mechanisms of action of nitric oxide in the injured lung. He also obtained Board Certification from the American Board of Anesthesiology in both anesthesia and Critical Care Medicine. Combining multiple roles, as he has often done so well, Brian also worked as an attending staff anesthesiologist and intensivist during this time at Stanford University Medical Center and the VA hospital and Paolo Alto, California.                                                                                 

He returned to Toronto in 1994, taking up a position as staff anesthesiologist and intensivist at the Toronto General Hospital, and establishing his first independent laboratory there. He obtained independent grant funding, and published his first papers on the effects of hypercapnia in acute lung injury there. In 1999, Brian was recruited to the Department of Critical Care Medicine at the Hospital for Sick Children where he currently works as a clinician-scientist in the Critical Care Department and the Research Institute there. Brian was appointed the inaugural holder of the Dr. Geoffrey Barker Chair in Critical Care Medicine at Sickkids in December 2003. In July 2005, Brian was appointed a full Professor Departments of Anesthesia, Medicine & Physiology July at the University of Toronto. In 2009, he was appointed a Senior Scientist in the Program in Physiology & Experimental Medicine at the Research Institute of the Hospital for Sick Children.

Brian was appointed the Chair of the University Department of Anesthesia in July 2006, and served 2 highly successful terms as chair, completing his second term in July 2017. The department of Anaesthesia at the University of Toronto comprises over 300 active faculty members. During his time as Chair, Brian introduced several highly innovative initiatives. He developed a clinician scientist research track within the anaesthesia residency program, which is now producing world class early career researchers in anaesthesia, intensive care and pain medicine. His creation of a merit awards grants system for faculty members recognizes excellence in research and teaching by existing and new Department members, and has been adopted as a model for other Departments within the Faculty. Brian has worked with hospital chiefs across the University of Toronto hospital system to leverage Department funds to create perpetual endowments that fund protected academic time for 7 chairs of Anaesthesia. These initiatives, and indeed others, have had a transformative and lasting effect on the U of T department of Anesthesia. The Department is now ranked second in academic productivity in North America only to Harvard University Department of Anaesthesia. Brian – naturally – wonders why it is not number 1!   

Brian is a highly productive researcher. His own laboratory investigates mechanisms of ventilator-induced lung injury and the actions of carbon dioxide in the lung.  As a practicing intensivist, his work has focused on understanding the biology of lung injury, with the ultimate aim to find testable therapies for patients with ARDS. He has made multiple important scientific contributions to this field. First, he hypothesized and then proved, using several experimental models, that hypercapnia could attenuate acute lung injury, and elucidated multiple key mechanisms of action. Several other Irish fellows, including Nuala Cregg, Damian Murphy, Michelle Duggan, Conan McCaul and myself, were fortunate enough to work in his lab during this time. This work has changed how we think about carbon dioxide management in the critically ill, and has influenced over 10 clinical trials. It has also identified specific injury mediators and pathways that are now being targeted directly as potential therapeutic strategies for ARDS.  Second, Brian’s group provided the first demonstration of gene activation caused by ventilator-induced lung injury. They then identified key genes that were upregulated and that exerted pathogenic effects in this setting, and that blocking these genes reduced injury and was a potential therapeutic target. Third, he demonstrated that negative pressure ventilation may lessen lung injury. When applied to the abdomen it may selectively recruit dorsal atelectasis. This is the first approach to selective recruitment since the proposal for prone positioning, 30 years ago. A prototype ventilator is currently moving forward towards clinical testing. Fourth, he showed that lung injury can translocate bacterial products from the alveolus to the bloodstream, particularly during high stretch mechanical ventilation, and he proved that soluble mediators generated in the lung can cause or worsen injury. This constituted a key contribution to understanding the mechanism by which injury to the lung can lead to injury to other organs – the ‘biotrauma’ hypothesis. Fifth, using advanced imaging approaches, Brian’s group has demonstrated that, with positive pressure ventilation, injury is predominantly in the aerated lung with sparing of the more collapsed dorsal regions, contrary to what was previously thought. He has also demonstrated that the infant lung may be less susceptible to injury than the adult lung. 

In all, Brian has co-authored nearly 200 peer-reviewed research papers, many in the highest impact journals such as NEJM, Lancet, BMJ, as well as in our top specialty journals. His laboratory is extremely successful in attracting peer-reviewed funding from grant agencies such as the Canadian Instituted for Health Research. Brian’s contribution to research extends well beyond the important discoveries from his own laboratory. He has mentored a generation of fellows, many of whom have gone on to academic and clinical leadership roles in countries from Canada to Ireland to Japan and others. He is a key opinion former in Critical Care Medicine and in Anaesthesia. He has delivered over 175 talks at major international conferences across more than 30 countries worldwide, and been visiting professor and many major academic departments. He is highly regarded as a speaker, for the honesty and scientific rigour of his contributions, delivering many keynote and plenary lectures. He is never afraid to ask the hard questions, and to challenge the prevailing consensus, when that consensus needs to be challenged.   

Brian has received substantial international recognition for his accomplishments and contributions as a clinician-scientist in Intensive Care Medicine. One of the first of these was his honorary conferring with the Fellowship of the College of Anaesthetists of Ireland in 2004. Many other honours have followed in the years since. Brian was elected a fellow of the Canadian Academy of Health Sciences in May 2012, an uncommon achievement in our field.  He is the chair of Critical Care Canada Forum, which hosts what is probably the best critical care conference annually. He is an Editor for Anesthesiology and an Associate Editor for Critical Care.  All these achievements might leave one thinking that Brian is ‘all work and no play’. This is far from the truth. Brian is a highly accomplished Uileann Pipe player, and often brings them with him when he travels so that he can participate in a session at a local Irish pub. He is a devoted father to 2 twenty-something year old daughters. He is an avid reader, and something of a gym fanatic, generally in the gym before 6am in the mornings. 

This honorary conferring rightly recognizes the substantial contribution Brian has made to Intensive care medicine internationally. It also recognizes his contribution to intensive care medicine in Ireland. This contribution is all the more remarkable given that he has never trained or worked in an Irish ICU. What Brian has done, and continues to do, is provide mentorship and guidance to a large number of Irish-based physicians within clinical and academic Intensive care medicine. He is extremely generous with his time, he provides insightful and sound advice, and his door has always been open to Irish trainees during their time in Toronto. For that, I and many of my colleagues are extremely grateful to you Brian.                        In closing,  I am greatly honored to deliver this citation for Brian Kavanagh on behalf of the Joint Faculty of Intensive Care Medicine of Ireland. I have been extremely fortunate to have known Brian as a teacher, a mentor, a colleague and a really good friend for the last 20 years. I can think of no more deserving and worthy a recipient of the honorary Fellowship of the Joint Faculty of Intensive Care Medicine of Ireland. Congratulations Brian!