Clinical Focus

  • Pediatric CriticalCare Medicine
  • Solid Organ Transplantation
  • Sedation
  • Pediatric Critical Care Medicine

Academic Appointments

Professional Education

  • Fellowship: Stanford University Pain Management Fellowship (2012) CA
  • Internship: University of Brooklyn at Long Island College Hospital (2007) NY
  • Medical Education: University of Medicine and Pharmacy Carol Davila (2003) Romania
  • Board Certification: American Board of Pediatrics, Pediatric Critical Care Medicine (2012)
  • Board Certification, American Board of Pediatrics, Pediatric Critical Care Medicine (2012)
  • Board Certification: American Board of Pediatrics, Pediatrics (2009)
  • Residency: University of Illinois at Chicago College of Medicine (2009) IL

Current Research and Scholarly Interests

I do have multiple interests in the ICU: from quality improvement to research, from transplant to palliative care. However, most of my projects are related to transplant medicine and quality improvement. My initial resident QI project changed the way kidney transplant recipients are managed in the immediate postoperative period at University of Illinois at Chicago. My fellowship research looked at pharmacokinetics after liver transplant and my preliminary results are very promising. As part of my scholarly activities for the last 6 months I am conducting a research study, looking at ways to better monitor and manage the pediatric kidney transplant in the ICU by assessing the hemodynamics in the first 48 hours post transplant.
As part of my QI involvement, I am currently mentoring some of the PCCM fellows in longitudinal quality improvement projects such as: sedation in recipients of liver transplantation, ICU outcomes for children receiving bone marrow transplantation.

All Publications

  • Time to Continuous Renal Replacement Therapy Initiation and 90-Day Major Adverse Kidney Events in Children and Young Adults. JAMA network open Gist, K. M., Menon, S., Anton-Martin, P., Bigelow, A. M., Cortina, G., Deep, A., De la Mata-Navazo, S., Gelbart, B., Gorga, S., Guzzo, I., Mah, K. E., Ollberding, N. J., Shin, H. S., Thadani, S., Uber, A., Zang, H., Zappitelli, M., Selewski, D. T. 2024; 7 (1): e2349871


    In clinical trials, the early or accelerated continuous renal replacement therapy (CRRT) initiation strategy among adults with acute kidney injury or volume overload has not demonstrated a survival benefit. Whether the timing of initiation of CRRT is associated with outcomes among children and young adults is unknown.To determine whether timing of CRRT initiation, with and without consideration of volume overload (VO; <10% vs ≥10%), is associated with major adverse kidney events at 90 days (MAKE-90).This multinational retrospective cohort study was conducted using data from the Worldwide Exploration of Renal Replacement Outcome Collaborative in Kidney Disease (WE-ROCK) registry from 2015 to 2021. Participants included children and young adults (birth to 25 years) receiving CRRT for acute kidney injury or VO at 32 centers across 7 countries. Statistical analysis was performed from February to July 2023.The primary exposure was time to CRRT initiation from intensive care unit admission.The primary outcome was MAKE-90 (death, dialysis dependence, or persistent kidney dysfunction [>25% decline in estimated glomerular filtration rate from baseline]).Data from 996 patients were entered into the registry. After exclusions (n = 27), 969 patients (440 [45.4%] female; 16 (1.9%) American Indian or Alaska Native, 40 (4.7%) Asian or Pacific Islander, 127 (14.9%) Black, 652 (76.4%) White, 18 (2.1%) more than 1 race; median [IQR] patient age, 8.8 [1.7-15.0] years) with data for the primary outcome (MAKE-90) were included. Median (IQR) time to CRRT initiation was 2 (1-6) days. MAKE-90 occurred in 630 patients (65.0%), of which 368 (58.4%) died. Among the 601 patients who survived, 262 (43.6%) had persistent kidney dysfunction. Of patients with persistent dysfunction, 91 (34.7%) were dependent on dialysis. Time to CRRT initiation was approximately 1 day longer among those with MAKE-90 (median [IQR], 3 [1-8] days vs 2 [1-4] days; P = .002). In the generalized propensity score-weighted regression, there were approximately 3% higher odds of MAKE-90 for each 1-day delay in CRRT initiation (odds ratio, 1.03 [95% CI, 1.02-1.04]).In this cohort study of children and young adults receiving CRRT, longer time to CRRT initiation was associated with greater risk of MAKE-90 outcomes, in particular, mortality. These findings suggest that prospective multicenter studies are needed to further delineate the appropriate time to initiate CRRT and the interaction between CRRT initiation timing and VO to continue to improve survival and reduce morbidity in this population.

    View details for DOI 10.1001/jamanetworkopen.2023.49871

    View details for PubMedID 38165673

    View details for PubMedCentralID PMC10762580

  • International Pediatric Transplant Association (IPTA) position statement supporting prioritizing pediatric recipients for deceased donor organ allocation. Pediatric transplantation Freeman, M. A., Botha, J., Brewer, E., Damian, M., Ettenger, R., Gambetta, K., Lefkowitz, D. S., Ross, L. F., Superina, R., Blydt-Hansen, T. 2022: e14358


    A position statement of the International Pediatric Transplant Association endorsing prioritizing pediatric recipients for deceased donor organ allocation, examining the key ethical arguments that serve as the foundation for that position, and making specific policy recommendations to support prioritizing pediatric recipients for deceased donor organ allocation globally.

    View details for DOI 10.1111/petr.14358

    View details for PubMedID 36468303

  • 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Smith, H. A., Besunder, J. B., Betters, K. A., Johnson, P. N., Srinivasan, V., Stormorken, A., Farrington, E., Golianu, B., Godshall, A. J., Acinelli, L., Almgren, C., Bailey, C. H., Boyd, J. M., Cisco, M. J., Damian, M., deAlmeida, M. L., Fehr, J., Fenton, K. E., Gilliland, F., Grant, M. J., Howell, J., Ruggles, C. A., Simone, S., Su, F., Sullivan, J. E., Tegtmeyer, K., Traube, C., Williams, S., Berkenbosch, J. W. 1800; 23 (2): e74-e110


    RATIONALE: A guideline that both evaluates current practice and provides recommendations to address sedation, pain, and delirium management with regard for neuromuscular blockade and withdrawal is not currently available.OBJECTIVE: To develop comprehensive clinical practice guidelines for critically ill infants and children, with specific attention to seven domains of care including pain, sedation/agitation, iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment, and early mobility.DESIGN: The Society of Critical Care Medicine Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility Guideline Taskforce was comprised of 29 national experts who collaborated from 2009 to 2021 via teleconference and/or e-mail at least monthly for planning, literature review, and guideline development, revision, and approval. The full taskforce gathered annually in-person during the Society of Critical Care Medicine Congress for progress reports and further strategizing with the final face-to-face meeting occurring in February 2020. Throughout this process, the Society of Critical Care Medicine standard operating procedures Manual for Guidelines development was adhered to.METHODS: Taskforce content experts separated into subgroups addressing pain/analgesia, sedation, tolerance/iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment (family presence and sleep hygiene), and early mobility. Subgroups created descriptive and actionable Population, Intervention, Comparison, and Outcome questions. An experienced medical information specialist developed search strategies to identify relevant literature between January 1990 and January 2020. Subgroups reviewed literature, determined quality of evidence, and formulated recommendations classified as "strong" with "we recommend" or "conditional" with "we suggest." Good practice statements were used when indirect evidence supported benefit with no or minimal risk. Evidence gaps were noted. Initial recommendations were reviewed by each subgroup and revised as deemed necessary prior to being disseminated for voting by the full taskforce. Individuals who had an overt or potential conflict of interest abstained from relevant votes. Expert opinion alone was not used in substitution for a lack of evidence.RESULTS: The Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility taskforce issued 44 recommendations (14 strong and 30 conditional) and five good practice statements.CONCLUSIONS: The current guidelines represent a comprehensive list of practical clinical recommendations for the assessment, prevention, and management of key aspects for the comprehensive critical care of infants and children. Main areas of focus included 1) need for the routine monitoring of pain, agitation, withdrawal, and delirium using validated tools, 2) enhanced use of protocolized sedation and analgesia, and 3) recognition of the importance of nonpharmacologic interventions for enhancing patient comfort and comprehensive care provision.

    View details for DOI 10.1097/PCC.0000000000002873

    View details for PubMedID 35119438

  • Pharmacokinetics of Dexmedetomidine in Infants and Children After Orthotopic Liver Transplantation ANESTHESIA AND ANALGESIA Damian, M. A., Hammer, G. B., Elkomy, M. H., Frymoyer, A., Drover, D. R., Su, F. 2020; 130 (1): 209–16
  • Triheptanoin: A Rescue Therapy for Cardiogenic Shock in Carnitine-acylcarnitine Translocase Deficiency. JIMD reports Mahapatra, S., Ananth, A., Baugh, N., Damian, M., Enns, G. M. 2018; 39: 19–23


    Carnitine-acylcarnitine translocase (CACT) deficiency is a rare long-chain fatty acid oxidation disorder (LC-FAOD) with high mortality due to cardiomyopathy or lethal arrhythmia. Triheptanoin (UX007), an investigational drug composed of synthetic medium odd-chain triglycerides, is a novel therapy in development for LC-FAOD patients. However, cases of its safe and efficacious use to reverse severe heart failure in CACT deficiency are limited. Here, we present a detailed report of an infant with CACT deficiency admitted in metabolic crisis that progressed into severe cardiogenic shock who was successfully treated by triheptanoin. The child was managed, thereafter, on triheptanoin until her death at 3 years of age from a cardiopulmonary arrest in the setting of acute respiratory illness superimposed on chronic hypercarbic respiratory failure.

    View details for PubMedID 28689308

  • Near-Fatal Gastrointestinal Hemorrhage in a Child with Medulloblastoma on High Dose Dexamethasone. Cureus Yecies, D. n., Tawfik, D. n., Damman, J. n., Thorson, C. n., Hong, D. S., Grant, G. A., Bensen, R. n., Damian, M. n. 2017; 9 (7): e1442


    A four-year-old female was admitted to a university-based children's hospital with a newly-diagnosed posterior fossa tumor. She was started on famotidine and high-dose dexamethasone and underwent gross total resection of a medulloblastoma. She was continued on dexamethasone and famotidine. She exhibited postoperative posterior fossa syndrome and was started on enteral feeds via the nasoduodenal tube. She had small gastrointestinal bleeds on postoperative days eight, 11, and 18, and was found to have a well-circumscribed posterior duodenal ulcer. On postoperative day 19, she suffered a massive life-threatening gastrointestinal bleed requiring aggressive resuscitation with blood products. She required an emergent laparotomy due to ongoing blood loss and she was found to have posterior duodenal wall erosion into her gastroduodenal artery. She recovered and subsequently began delayed chemotherapy. This case demonstrates a rare and life-threatening complication of high-dose dexamethasone therapy in the setting of posterior fossa pathology despite stress ulcer prophylaxis. We present a historical perspective with the review of the association between duodenal and intracranial pathology and the usage of high-dose dexamethasone in such cases.

    View details for PubMedID 28924528