Center for Brain Injury and Repair
University of Pennsylvania

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JosE L. Pascual, M.D., Ph.D., FRCS(C), FRCP(C)

Jose L. Pascual, MD, PhD, FRCS

Jose L. Pascual MD, PhD, FRCS(C), FRCP(C) is a surgeon trained at McGill University with specialized fellowship training in trauma and critical care at the University of Pennsylvania in Philadelphia. His clinical and research interests are in shock and head injury. His research work is shared in clinical and basic science to learn how a variety of insults including head injury and shock affect the microcirculation and how different management strategies influence their effects. This basic science work is translated into several clinical projects both retrospective and prospective evaluating the effects of different osmotherapeutic agents in traumatic brain injured patients as well as the immunemodulating effects of different resuscitation fluids in different forms of shock. Dr. Pascual is also the lead physician in a series of pedagogical efforts to train medical trainees as well as advanced practitioners in the ICU using simulation based curricula.

Selected Publications

  1. Pascual JL, Khwaja KA, et al.  Hypertonic saline resuscitation attenuates neutrophil lung sequestration and transmigration by diminishing leukocyte-endothelial interactions in a two-hit model of hemorrhagic shock and infection J Trauma 54(1):121-132,2003.
  2. Pascual JL, Khwaja KA et al., Hypertonic Saline and the Microcirculation J Trauma,54(5S):S133-40,2003
  3. Pascual JL, Maloney-Wilensky E, et al. Resuscitation of hypotensive head-injured patients: is hypertonic saline the answer?  Am Surgeon 74(3):253-9, March 2008
  4. Pascual JL, Gracias VH, LeRoux PD. Injury to the Brain in Trauma: Contemporary Principles and Therapy, Lippincott Williams & Wilkins. Philadelphia, PA:  Ed. Flint, Meredith, Schwab et al (December 2008)
  5. Oddo M, Levine JM, Frangos S, Carrera E, Maloney-Wilenski E, Pascual JL, et al. Effect of Osmotherapy with Mannitol and Hypertonic Saline on Brain Tissue Oxygenation in Patients with Severe Traumatic Brain Injury and Refractory Intracranial Hypertension. J Neurol Neurosurg Psychiatry 80(8):916-20,2009
  6. Sarani B, Temple-Lykens B, Kim P, Sonnad S, Bergey B, Pascual JL et al. Factors Associated with Mortality and Brain Injury Following Fall from the Standing Position. J Trauma 67(5):954-958, 2009
  7. Pascual JL., Georgoff, P, et al. Reduced Brain Tissue Oxygen in Traumatic Brain injury: Are most commonly used interventions successful? J Trauma 70(3):535-46, 2011
  8. Gong, W, Sanati, P, Marks, J, Sarani, B, Sims, C, Pascual, J Hypertonic saline resuscitation of hemorrhagic shock does not decrease in vivo neutrophil interactions with endothelium in the blood brain microcirculation. Journal of Trauma, 2011 August;71(2): 330-338
  9. JL Pascual, VH Gracias. Fluid and Volume Status. In: LeRoux, PD, Levine, JM, Kofke, WA, eds. Monitoring in Neurocritical Care. 1st ed. Philadelphia: Elsevier; (in press, 2012).
  10. Edgardo Salcedo, Jose L. Pascual Fluid Management in Traumatic Brain Injury in Encyclopedia of Intensive Care Medicine, Heidelberg, Germany: Eds Vincent, Hall (in press 2012)
  11. Pascual, J, Holena, D, Vella, M, Sicoutris, C, Chandrakaladharan, B, Fox, A, Sarani, B, Sims, C, Williams, N, Schwab, W, Short Simulation Training Improves Objective Skills in Established Advanced Practitioners Managing Emergencies on the Ward and Surgical Intensive Care Unit Journal of Trauma, 2011 August;71(2): 330-338
  12. Ferri LE, Pascual J, Seely AJ, Chaudhury P, Christou NV.  Soluble L-selectin attenuates tumor necrosis factor-alpha-mediated leukocyte adherence and vascular permeability: a protective role for elevated soluble L-selectin in sepsis. Critical Care Medicine 30(8):1842-1847, Aug. 2002.
  13. Andrew JE Seely, José L Pascual, Nicolas V Christou, Science Review: Cell membrane expression (connectivity) regulates neutrophil delivery, function and clearance Critical Care 7: 291-307 (2003).
  14. Ferri LE, Pascual J, Seely AJ, Giannias B, Christou NV.  Intra-abdominal sepsis attenuates local inflammation-mediated increases in microvascular permeability at remote sites in mice in vivo.  Surgery 135(2):187-195, Feb. 2004.

Selected Abstracts

  1. Pascual JL, Maloney E, Reilly PM, Keutmann MK, Stein S, Leroux PD, Gracias VH.  The effect of an institutional pathway on TBI resuscitation with 7.5% hypertonic saline.  Oral presentation at the 36th Annual Western Trauma Association Scientific Meeting, Big Sky, MT, March 2006. 
  2. Pascual J, Ferri L, Khwaja K, Giannias B, Evans D, Michel R, Christou N. Hypertonic saline in hemorrhagic shock blunts tissue injury independent of its ability to block neutrophil-endothelial adhesion. Oral presentation at the Joint Meeting of the Trauma Association of Canada & Pan-American Trauma Society, Banff, Alberta, March 2006. 
  3. Pascual JL, Ding W, Sarani B, Peterson J, Horan A, Abdurraheim N, Aized M, Sims C, Gracias VH, Schwab CW. Hypertonic Saline in the ICU Worsens Neutrophil Respiratory burst Despite Reducing Adhesion Receptor Expression. Poster presented at the 38th Annual Congress of the Society of Critical Care Medicine, Miami Beach CA, February 2010
  4. Ding W, Sims C, Horan A, Sarani B, Schwab CW, Pascual JL. HTS in the ICU reduces inflammation and increases shedding of receptors responsible for microcirculatory inflammation. Oral presentation 8th World Congress on Trauma, Shock, Inflammation and Sepsis, Munich, Germany, March 2010
  5. Pascual J, Rosen P, Horan A, Sarani B, Sims C, Schwab CW. Hypertonic Fluids in SICU Shock Patients Reduce Fluid and Oxygen Requirements Shock. Poster presented at the 33rd Conference on Shock, Portland, ON. April 2010
  6. Rosenbloom J, Guan Y, Sawey E., Becker L, Sarani B, Pascual J, Sims C. Posterior Pituitary Exhaustion in Hemorrhagic Shock and Resuscitation Poster presented at the 33rd Conference on Shock, Portland, ON. April 2010
  7. Pascual JL, McNicholas A, Bridges A, Sims C, Sarani B, Fernandez F, Schwab CW, The effects of instituting a hospital guideline to reverse the coagulopathy of Plavix (clopidogrel) in traumatic brain injury patients. Poster presented at the 69th AAST Scientific Meeting, Boston MA, Sept. 2010
  8. Pascual JL, Georgoff P, Horan A, Sims C, Sarani B, Stiefel MF, LeRoux PD, Schwab CW. Reduced brain tissue oxygen in traumatic brain injury: are most commonly used interventions successful? Oral presentation at the 69th AAST Scientific Meeting, Boston MA, September 2010
  9. Gong W, Sanati P, Marks JA, Sarani B, Sims C, Pascual JL.  Hypertonic saline resuscitation of hemorrhagic shock increases in vivo neutrophil interactions with endothelium in the blood brain microcirculation. Oral presentation at the 23rd EAST Scientific Meeting, Naples, FL, January 2010
  10. Pascual, J, Fang, P, Sarani, B, Sims, C, Schwab, W. The steadily increasing incidence and lethality of penetrating brain injury: A single GCS point drop increases mortality. Poster presented at the 70th American Association for the Surgery of Trauma Scientific Meeting, Chicago, IL, September 2011.
  11. Marks J, Li S, Gong, W, Sanati P, Eisenstadt R, Sims C, Sarani, B, Pascual JL. In vivo inflammation of the blood brain barrier microcirculation after TBI: HTS is not superior to mannitol. Oral presentation at 25th EAST Annual Scientific Assembly, Lake Buena Vista, FL, Jan 2012
  12. Li S, Marks J, Sanati P, Eisenstadt R, Gong, W, Browne K, Smith, D, Becker L, Pascual JL. In vivo evolution of microvascular inflammation after traumatic brain injury: An Intravital Microscopy Study. Oral presentation at the 41st Congress of the Society of Critical Care Medicine, Houston TX, February 2012

Video Clip of Pial Microcirculation Observed at 200x Magnification

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