JFICMI honours Mary White and Brian Kavanagh

Wednesday, 5 September, 2018

The JFICMI, in cooperation with the ICSI, held an Honorary Conferring ceremony at the Joint scientific meeting in June this year.  This was the third time that the Joint Faculty has held such a ceremony and the first time that there were two award recipients. Both awardees were Irish Intensivists who have excelled and contributed enormously to Intensive Care Medicine, one while based and working primarily in Australia and the other in Canada.  While making major global contributions, both have retained a strong home link and have contributed very substantially to Irish Intensive Care by fostering training and research linkage, particularly by supporting advanced trainees from Ireland. In recognition of the greatly influential nature of their work, the Joint Faculty of Intensive Care Medicine of Ireland has awarded them its premium honour.  The citations below by Dr Liz Connolly and Prof John Laffey speak eloquently for themselves.
Mary White citation.     Liz Connolly  7June2018

Firstly I would like to thank the JFICMI and the College of Anaesthetists for the invitation to deliver the citation for Professor Mary White tonight. I know that many in this room will have studied, trained and worked with Mary White both here in Ireland and in Australia,. For those who have not had this opportunity I would like to briefly summarise Mary’s academic and professional journey to date.

Mary hails from beautiful Carlow. Carlow is obviously a wonderful place, and is a very unfairly and grossly underappreciated part of Ireland. Daughter of Mick and Kitty, both of whom were well known and tremendously well liked in Carlow, Mary completed her secondary school years at St Leo’s College for young ladies and subsequently commenced medicine at University College, Dublin. Mary swiftly completed her degree at UCD. However despite her intensive studies she found time to meet one Michael Goggin  whom she later married and with whom she subsequently had 5 fantastic kids.. Having chosen Anaesthesia as her preferred specialty, Mary completed the Eastern Regional  Anaesthesia Training Scheme, during which she discovered and developed an interest in Critical Care Medicine. And, like many critical care specialists in Ireland she elected to travel to Australia for further experience and training. 

On her return from Australia she took a consultant position in anaesthesia and critical care at St James’s Hospital here in Dublin, where she worked for several years in the growing specialty of Critical Care Medicine. She was one of the pioneers in this field in Ireland, along with Dermot Phelan, Ed Carton, Brian Marsh, Tom Ryan, Ciaran Crowley, Jeanne Moriarty and Kate Flynn. It was an exciting time in many ways, with the recognition that Critical Care Medicine was a specialty in its own right, and that it would be possible to work primarily or exclusively in CCM, opening a myriad of, clinical, research and educational opportunities.  Mary was actively involved from the outset, becoming a founding ICSI council member, examining in the original Irish Diploma in Intensive Care Medicine and mentoring enthusiastic trainees. However, unfortunately for SJH the lure of sun, sea and sand proved too strong and in 1997 Mary ultimately relocated with her growing family to Adelaide, South Australia to take up a post as Senior Consultant in critical care medicine at the Royal Adelaide Hospital, where she continues to work to this day.
Having returned to Adelaide, Mary continued to lead in undergraduate and post-graduate critical care education.  In addition to numerous publications and presentations, she was appointed Associate Professor in the Discipline of Acute Care Medicine at the University of Adelaide in 2010 and remains heavily involved in the ongoing development of acute and critical care undergraduate and post-graduate educational programmes. The Australian and New Zealand Intensive Care Society. ANZICS is a leading advocate on all intensive care related matters in Australia and New Zealand and is a world leader in intensive care research through its Clinical Trials Group and patient databases.  The Society is involved with, and influential in, all aspects of intensive care medical practice through ongoing profes​sional education, the provision of leadership in medical settings, clinical research and analysis of critical care resources. As South Australian Regional Chairperson, then National Honorary Secretary, then National Vice-President and ultimately National President Mary has devoted many years of work and expertise to ANZICS and remains an invaluable committee member. Current other executive appointments include, but not limited to  Chairperson of the Australian Council on Healthcare Standards Intensive Care Working Party, Co-Chair, ANZICS/CICM Advisory group on training and competencies for recognising and responding to clinical deterioration, Member of Medical School Advisory Committee, Australian Medical Council. In addition to her Australia-wide educational work, Mary continues to lecture on The Annual Short Course in Intensive Care Medicine. Previously known as Tub’s course this is an institution in Australian Critical Care. Originally run by Tub Worthley, and based in Adelaide until mid 2000’s  it was, and remains “the” pre-fellowship course for all hopeful exam candidates. In a similar vein Mary organises Tub’s Travelling Scholarship. This is a South Australian initiative which gives Critical Care trainees the opportunity to present their research to a wide audience, with a prize fund specifically to travel and work in Critical Care in another jurisdiction.

This is a very brief synopsis and only a small sample of Mary’s contribution to Critical Care Medicine, here in Ireland and in Australia-New Zealand. Throughout her career she has championed and prioritised critical care education and training. From her time as a young anaesthesia trainee when she convened the first annual scientific meetings for anaesthetists in training, through the early days of Irish Critical Care Medicine to current times where she continues to lead undergraduate and post-graduate training in Acute Care Medicine at state and national levels in Australia.  I have been fortunate to work with Mary as a trainee in Ireland and as a consultant colleague in Australia, and have benefitted at first hand from her mentorship, advice and unswerving support in difficult situations. I know many other trainees have likewise benefitted in this manner, including numerous international trainees, and especially those travelling from Ireland. I have also had the privilege of having Mary and Michael as friends for many years and have seen her Irish Australian fantastic kids grow to fantastic adults. I have no doubt that Mary’s work in Critical Care, particularly in the field of Critical Care education, and her strong links with the Irish critical care community, will continue to benefit us both here in Ireland and in Australia. 

President and Dean, I propose Professor Mary White as a worthy recipient of an Honorary Fellowship of the Joint Faculty of Intensive Care Medicine of Ireland in recognition of her outstanding contribution to Critical Care Medicine in Ireland and Australia.


Brian Kavanagh citation.     John Laffey  7June2018

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!