Dr Rakshit Panwar

Dr Rakshit Panwar

Conjoint Lecturer

School of Medicine and Public Health

Career Summary

Biography

Dr Rakshit Panwar is a practicing intensive care specialist at the John Hunter Hospital, NSW, and holds a conjoint lecturer position at the School of Medicine and Public Health, University of Newcastle, NSW (Australia). Dr Panwar trained at Mumbai University (India) in clinical medicine, and after obtaining postgraduate qualification in general internal medicine (MD), he moved to Australia where he trained with the College of Intensive Care Medicine (CICM) for five years and obtained his professional fellowship in intensive care (FCICM) in 2011. He has been working as a consultant intensivist at the John Hunter Hospital ICU since 2012. Dr Panwar is currently also pursuing his PhD (Medicine) at the University of Newcastle on the question of finding optimal blood pressure targets during management of shock among critically ill patients. He was recently successful in obtaining a four year NSW PhD scholarship to complete his PhD. He is an early career researcher and in the last five years has published several papers in national or international peer reviewed indexed medical journals. He is actively involved in clinical research and is the lead/chief investigator on two ongoing multicentre studies. He recently conducted a multicentre randomized controlled trial, as a lead investigator, comparing two different oxygen targets among mechanically ventilated patients in ICU; it was the first published RCT on this question in critical care literature. He has proactively sought collaborations from his colleagues and senior researchers for conducting clinical trials. He has obtained over $1.3 million in competitive, peer reviewed grant support over last five years. He is a peer reviewer for American Journal of Respiratory and Critical Care Medicine, Intensive Care Medicine, Journal of Critical Care, Annals of American Thoracic Society, Cochrane Database of Systematic Reviews, and Critical Care and Resuscitation. Currently, he is also supervising fellowship projects for two Intensive Care trainees. 

Qualifications

  • Bachelor of Medicine, Bachelor of Surgery, University of Mumbai - India

Keywords

  • Critical Care Medicine
  • Intensive Care
  • Oxygen inhalation therapy
  • Perfusion pressure
  • physiological targets

Languages

  • Hindi (Mother)
  • English (Fluent)

Fields of Research

Code Description Percentage
110310 Intensive Care 100

Professional Experience

Professional appointment

Dates Title Organisation / Department
11/04/2013 -  Staff Specialist in Intensive Care Hunter New England Health
John Hunter Hospital
Australia
30/01/2012 - 14/04/2013 Postgraduate fellow John Hunter Hospital, Newcastle
Anaesthesia and Intensive Care
Australia
1/02/2011 - 29/01/2012 Senior Registrar The Alfred Hospital
Intensive Care
Australia
2/02/2009 - 30/01/2011 Senior registrar Monash Medical Centre
Intensive Care and Anaesthesia
Australia
4/02/2008 - 26/01/2009 Senior Registrar The Alfred Hospital
Intensive Care
Australia
13/06/2006 - 16/01/2008 Registrar Princess Alexandra Hospital
Intensive Care
Australia

Invitations

Speaker

Year Title / Rationale
2016 CLOSE study

Teaching

Code Course Role Duration
TRAU6002 Master of Traumatology
Faculty of Health and Medicine, University of Newcastle
Prepared a recorded talk on Relationship between SIRS-Sepsis-Shock and organ dysfunction.
Lecturer 9/01/2015 - 9/09/2017
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Journal article (12 outputs)

Year Citation Altmetrics Link
2017 Panwar R, Sullohern B, Shiel E, Alexis Brown C, Quail A, 'Validity of a protocol to estimate patients¿ pre-morbid basal blood pressure

© 2017 Informa UK Ltd, trading as Taylor & Francis Group Purpose: The pre-illness basal mean arterial BP (MAP) is an important reference point to gauge the degree of relati... [more]

© 2017 Informa UK Ltd, trading as Taylor & Francis Group Purpose: The pre-illness basal mean arterial BP (MAP) is an important reference point to gauge the degree of relative hypotension among unwell patients. We aimed to assess mean bias, correlation, and agreement between basal MAP measured during nighttime ambulatory BP monitoring (ABPM) and basal MAP estimated using a standardized protocol. Materials and methods: For a cohort of 137 consecutive patients, aged =40 years, who recently underwent ABPM, a blinded investigator estimated basal MAP from up to five most recent clinic BP measurements. Both basal MAP values, measured and estimated, were compared pairwise for each participant. Results: We traced a median of 4 [interquartile range 3¿5] previous BP measurements per patient over a median period of 132 [interquartile range 55¿277] days up until the ABPM test. The estimated basal MAP (mean 88¿±¿8¿mmHg) was linearly related (Pearson¿s r¿=¿0.41, p¿=¿0.0001) to the measured basal MAP (mean 88¿±¿12¿mmHg). Bland-Altman plot revealed a mean bias of 0.3¿mmHg with agreement limits of ±22¿mmHg. Conclusions: The mean bias between estimated and measured values for basal MAP was insignificant and modest. When a recent nighttime ABPM is unavailable, a protocol based on recent clinic BP readings can be used to estimate patient¿s basal MAP. Study registration: Australian New Zealand Clinical Trials Registry ACTRN12613001382763.

DOI 10.1080/08037051.2017.1358055
2017 Khanna A, English SW, Wang XS, Ham K, Tumlin J, Szerlip H, et al., 'Angiotensin II for the treatment of vasodilatory shock', New England Journal of Medicine, 377 419-430 (2017) [C1]

Copyright © 2017 Massachusetts Medical Society. BACKGROUND Vasodilatory shock that does not respond to high-dose vasopressors is associated with high mortality. We investigated t... [more]

Copyright © 2017 Massachusetts Medical Society. BACKGROUND Vasodilatory shock that does not respond to high-dose vasopressors is associated with high mortality. We investigated the effectiveness of angiotensin II for the treatment of patients with this condition. METHODS We randomly assigned patients with vasodilatory shock who were receiving more than 0.2 µg of norepinephrine per kilogram of body weight per minute or the equivalent dose of another vasopressor to receive infusions of either angiotensin II or placebo. The primary end point was a response with respect to mean arterial pressure at hour 3 after the start of infusion, with response defined as an increase from baseline of at least 10 mm Hg or an increase to at least 75 mm Hg, without an increase in the dose of background vasopressors. RESULTS A total of 344 patients were assigned to one of the two regimens; 321 received a study intervention (163 received angiotensin II, and 158 received placebo) and were included in the analysis. The primary end point was reached by more patients in the angiotensin II group (114 of 163 patients, 69.9%) than in the placebo group (37 of 158 patients, 23.4%) (odds ratio, 7.95; 95% confidence interval [CI], 4.76 to 13.3; P < 0.001). At 48 hours, the mean improvement in the cardiovascular Sequential Organ Failure Assessment (SOFA) score (scores range from 0 to 4, with higher scores indicating more severe dysfunction) was greater in the angiotensin II group than in the placebo group (-1.75 vs. -1.28, P = 0.01). Serious adverse events were reported in 60.7% of the patients in the angiotensin II group and in 67.1% in the placebo group. Death by day 28 occurred in 75 of 163 patients (46%) in the angiotensin II group and in 85 of 158 patients (54%) in the placebo group (hazard ratio, 0.78; 95% CI, 0.57 to 1.07; P = 0.12). CONCLUSIONS Angiotensin II effectively increased blood pressure in patients with vasodilatory shock that did not respond to high doses of conventional vasopressors.

DOI 10.1056/NEJMoa1704154
Citations Scopus - 6Web of Science - 2
2016 Panwar R, 'The unknowns about oxygen therapy in critically ill patients', JOURNAL OF THORACIC DISEASE, 8 E1543-E1546 (2016)
DOI 10.21037/jtd.2016.11.85
Citations Scopus - 1Web of Science - 1
2016 Panwar R, Hardie M, Bellomo R, Barrot L, Eastwood GM, Young PJ, et al., 'Conservative versus liberal oxygenation targets for mechanically ventilated patients: A pilot multicenter randomized controlled trial', American Journal of Respiratory and Critical Care Medicine, 193 43-51 (2016) [C1]

Rationale: There are no randomized controlled trials comparing different oxygenation targets for intensive care unit (ICU) patients. Objectives: To determine whether a conservativ... [more]

Rationale: There are no randomized controlled trials comparing different oxygenation targets for intensive care unit (ICU) patients. Objectives: To determine whether a conservative oxygenation strategy is a feasible alternative to a liberal oxygenation strategy among ICU patients requiring invasive mechanical ventilation (IMV). Methods: At four multidisciplinary ICUs, 103 adult patients deemed likely to require IMV for greater than or equal to 24 hours were randomly allocated to either a conservative oxygenation strategy with target oxygen saturation as measured by pulse oximetry (SpO2) of 88-92% (n = 52) or a liberal oxygenation strategy with target SpO2 of greater than or equal to 96% (n = 51). MeasurementsandMainResults:Themean area under the curve and 95% confidence interval (CI) for SpO2 (93.4% [92.9-93.9%] vs. 97% [96.5-97.5%] ), SaO2 (93.5% [93.1-94%] vs. 96.8% [96.3-97.3%] ), PaO2 (70 [68-73] mm Hg vs. 92 [89-96] mm Hg), and FIO2 (0.26 [0.25-0.28] vs. 0.36 [0.34-0.39) in the conservative versus liberal oxygenation arm were significantly different (P < 0.0001 for all). There were no significant between-group differences in any measures of new organ dysfunction, or ICU or 90-day mortality. The percentage time spent with SpO2 less than 88% in conservative versus liberal arm was 1% versus 0.3% (P = 0.03), and percentage time spent with SpO2 greater than 98% in conservative versus liberal arm was 4% versus 22% (P < 0.001). The adjusted hazard ratio for 90-day mortality in the conservative arm was 0.77 (95% CI, 0.40-1.50; P = 0.44) overall and 0.49 (95% CI, 0.20-1.17; P = 0.10) in the prespecified subgroup of patients with a baseline PaO2/FIO2 less than 300. Conclusions: Our study supports the feasibility of a conservative oxygenation strategy in patients receiving IMV. Larger randomized controlled trials of this intervention appear justified.

DOI 10.1164/rccm.201505-1019OC
Citations Scopus - 36Web of Science - 34
2015 Martinez FE, Panwar R, Kelty E, Smalley N, Williams C, 'Idiopathic interstitial pneumonia in the ICU: an observational cohort.', Anaesthesia and intensive care, 43 707-711 (2015) [C1]
2014 Panwar R, Young P, Capellier G, 'Conservative Oxygen Therapy in Mechanically Ventilated Patients', CRITICAL CARE MEDICINE, 42 E630-E631 (2014) [C3]
DOI 10.1097/CCM.0000000000000439
Citations Scopus - 5Web of Science - 5
2013 Panwar R, Capellier G, Schmutz N, Davies A, Cooper DJ, Bailey M, et al., 'Current oxygenation practice in ventilated patients-an observational cohort study', ANAESTHESIA AND INTENSIVE CARE, 41 505-514 (2013)
Citations Scopus - 15Web of Science - 14
2013 Panwar R, Lanyon N, Davies AR, Bailey M, Pilcher D, Bellomo R, 'Mean perfusion pressure deficit during the initial management of shock-an observational cohort study', JOURNAL OF CRITICAL CARE, 28 816-824 (2013)
DOI 10.1016/j.jcrc.2013.05.009
Citations Scopus - 14Web of Science - 14
2012 Panwar R, Schmutz N, Baguley D, Pilcher D, Davies A, Bailey M, et al., 'CURRENT OXYGENATION PRACTICE IN MECHANICALLY VENTILATED PATIENTS IN AN AUSTRALIAN TEACHING HOSPITAL', INTENSIVE CARE MEDICINE, 38 S266-S266 (2012)
2011 Capellier G, Panwar R, 'Is it time for permissive hypoxaemia in the intensive care unit?', Critical Care and Resuscitation, 13 139-141 (2011)
Citations Scopus - 8
2009 Panwar R, Venkatesh B, Kruger P, Bird R, Gill D, Nunnink L, Dimeski G, 'Plasma protein C levels in immunocompromised septic patients are significantly lower than immunocompetent septic patients: A prospective cohort study', Journal of Hematology and Oncology, 2 (2009)

Introduction. Activated Protein C [APC] improves outcome in immunocompetent patients with severe sepsis particularly in those who are perceived to have high mortality risk. Before... [more]

Introduction. Activated Protein C [APC] improves outcome in immunocompetent patients with severe sepsis particularly in those who are perceived to have high mortality risk. Before embarking on a trial of APC administration in immunocompromised septic patients, a preliminary study on plasma levels of protein C in this cohort is essential. Objective. To assess serum Protein C concentrations in immunocompromised patients as compared to immunocompetent patients during sepsis, severe sepsis, septic shock and recovery. Methods. Prospective cohort study in a tertiary hospital. Patients satisfying inclusion criteria were enrolled after informed consent. Clinical variables were noted with sample collection when patients met criteria for sepsis, severe sepsis, septic shock and recovery. Protein C levels were measured using monoclonal antibody based fluorescence immunoassay. Results. Thirty one patients partici pated in this study (22 immunocompromised, 9 immunocompetent). Protein C levels were found to be significantly lower in the immunocompromised group compared to the immunocompetent group, particularly observed in severe sepsis [2.27 (95% CI: 1.63-2.9) vs 4.19 (95% CI: 2.87-5.52) mcg/ml] (p = 0.01) and sepsis [2.59 (95% CI: 1.98-3.21) vs 3.64 (95% CI: 2.83-4.45) mcg/ml] (p = 0.03). SOFA scores were similar in both the groups across sepsis, severe sepsis and septic shock categories. Protein C levels improved significantly in recovery (p = 0.001) irrespective of immune status. Conclusion. Protein C levels were significantly lower in immunocompromised patients when compared to immunocompetent patients in severe sepsis and sepsis categories. Our study suggests a plausible role for APC in severely septic immunocompromised patients which need further elucidation. © 2009 Panwar et al; licensee BioMed Central Ltd.

DOI 10.1186/1756-8722-2-43
Citations Scopus - 3
2005 Rakshit P, Nagar V, Deshpande A, 'Incidence, clinical outcome, and risk stratification of ventilator-associated pneumonia-a prospective cohort study', Indian Journal of Critical Care Medicine, 9 211-211 (2005)
DOI 10.4103/0972-5229.19761
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Conference (1 outputs)

Year Citation Altmetrics Link
2015 Barrot L, Panwar R, Hardie M, Bellomo R, Eastwood G, Young P, et al., 'Conservative versus liberal oxygenation targets for mechanically ventilated patients: Pilot multicentre randomised trial.', Intensive Care Medicine Experimental (2015) [E3]
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Grants and Funding

Summary

Number of grants 7
Total funding $1,378,571

Click on a grant title below to expand the full details for that specific grant.


20172 grants / $103,809

Can individualized BP targets reduce the incidence of new onset acute kidney injury among critically ill patients with shock?$80,000

Funding body: NSW ministry of health

Funding body NSW ministry of health
Project Team

Rakshit Panwar, Anthony Quail, John Attia

Scheme NSW Health PhD Scholarship Program
Role Lead
Funding Start 2017
Funding Finish 2022
GNo
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON N

Relative hypotension and acute kidney injury in critically ill patients- a multicenter prospective cohort study$23,809

Funding body: John Hunter Charitable Trust Grant

Funding body John Hunter Charitable Trust Grant
Project Team

Rakshit Panwar, Peter Harrigan, Miranda Hardie, Frank Van Haren, Rinaldo Bellomo

Scheme John Hunter Charitable Trust Grant
Role Lead
Funding Start 2017
Funding Finish 2018
GNo
Type Of Funding Internal
Category INTE
UON N

20162 grants / $1,221,200

An ICU RCT of conservative vs. standard oxygen therapy$1,200,000

Funding body: Health Research Council of New Zealand

Funding body Health Research Council of New Zealand
Project Team

Paul Young, Ross Freebairn, Michael Bailey, Diane Mackle, Adam Deane, Glenn Eastwood, Edward Litton, Rakshit Panwar, Richard Beasley, Rinaldo Bellomo, Colin McArthur, Shay McGuinness

Scheme HRC 2016 funding round
Role Investigator
Funding Start 2016
Funding Finish 2020
GNo
Type Of Funding International - Competitive
Category 3IFA
UON N

A multicenter before-and-after feasibility study comparing an approach to individualised blood pressure targets to standard care among critically ill patients with shock$21,200

Funding body: John Hunter Charitable Trust

Funding body John Hunter Charitable Trust
Project Team

Rakshit Panwar, Frank Van Haren

Scheme Charitable trust grant
Role Lead
Funding Start 2016
Funding Finish 2019
GNo
Type Of Funding Internal
Category INTE
UON N

20141 grants / $27,512

Standard care versus individualised blood pressure targets for critically ill patients with shock- a pilot multi centre randomised controlled trial$27,512

Funding body: John Hunter Charitable Trust Grant

Funding body John Hunter Charitable Trust Grant
Project Team

Rakshit Panwar, Jorge Brieva, Katrina Ellem, Glenn Eastwood, Rinaldo Bellomo

Scheme John Hunter Charitable Trust Grant
Role Lead
Funding Start 2014
Funding Finish 2021
GNo
Type Of Funding Internal
Category INTE
UON N

20121 grants / $15,000

Conservative vs. liberal oxygenation in mechanically ventilated patients$15,000

Funding body: Intensive Care Foundation

Funding body Intensive Care Foundation
Project Team

Rakshit Panwar, Glenn Eastwood, Rinaldo Bellomo, Gilles Capellier

Scheme Research Grant
Role Lead
Funding Start 2012
Funding Finish 2015
GNo
Type Of Funding Aust Competitive - Non Commonwealth
Category 1NS
UON N

20081 grants / $11,050

Plasma Protein C levels in immunocompromised septic patients$11,050

Funding body: Australian and New Zealand College of Anaesthesia

Funding body Australian and New Zealand College of Anaesthesia
Project Team

Rakshit Panwar, Bala Venkatesh

Scheme ANZCA Novice Investigator Research Grant
Role Lead
Funding Start 2008
Funding Finish 2009
GNo
Type Of Funding Aust Competitive - Non Commonwealth
Category 1NS
UON N
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Dr Rakshit Panwar

Position

Conjoint Lecturer
School of Medicine and Public Health
Faculty of Health and Medicine

Contact Details

Email rakshit.panwar@newcastle.edu.au
Link Google+
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