2025 Kosaka Top Clinical Research Abstract Winner Interview: Peter Santer, MD, DPhil

Mechanical Power in the Operating Room: Is Driving Pressure the Answer After All?

As a medical student, Peter Santer, MD, DPhil, was immediately fascinated by how anesthesiologists managed a patient’s physiology and adapted to acute changes. That curiosity eventually grew into an interest with airway management and mechanical ventilation. After completing his PhD in pulmonary physiology, he decided the natural transition was to pursue a career in the anesthesiology specialty, specifically with a research focus on mechanical ventilation and respiratory physiology. Now a CA-3 resident at Beth Israel Deaconess Medical Center, and Harvard Medical School, Dr. Santer has been able to pursue research that tries to dissect how the relative contribution of individual ventilator parameters to mechanical power varies between different patient groups and how this might improve outcomes by reducing mechanical power in the operating room. The hope is that this investigation will lead to prospective studies that change the current practice of mechanical ventilation. The importance and quality of his research, Mechanical Power in the Operating Room: Is Driving Pressure the Answer After All?, was recently recognized with the Kosaka Clinical Research Abstract Award at the “Kosaka Best Abstracts Session” on Sunday, March 23 at the 2025 Annual Meeting, presented by IARS and SOCCA. In the following interview, Dr. Santer shares his research journey so far, how he hopes this investigation will evolve in the future and how this award will influence his career and future work.

1. For this research, I am…

Clinical Investigator

2. What drew you to the anesthesiology specialty?

The main draw of the specialty for me was the combination of acute care medicine and applied physiology. As a medical student, I was fascinated by how anesthesiologists managed a patient’s physiology and adapted to acute changes. I also developed a fascination with airway management and mechanical ventilation early on, which ultimately led me to the decision to pursue my career in this field.

3. What drew you to this area of research?

As mentioned in my previous answer, I’ve always had an interest in mechanical ventilation and respiratory physiology. It was therefore a natural fit to continue this line of research after completing my PhD in pulmonary physiology. Furthermore, I was lucky to be able to do that at an institution with a long track record of excellence in this field.

4. What are the goals you most want to accomplish in your work with this research project?

I hope that our research will lead to prospective studies that will lead to changes in our current practice of mechanical ventilation. The ultimate goal of course is to improve outcomes that matter for patients.

5. What is the potential impact of your research on the field of anesthesia and patient care?

Mechanical ventilation in the OR is often treated with less attention than it deserves. Many anesthesiologists believe that the relatively short period of time patients are on a ventilator doesn’t really affect any outcomes. That isn’t the case however and more and more research has suggested that lung-protective ventilation does improve outcomes, not just in the ICU, but also in the OR. Several studies have shown that targeting specific variables such as tidal volume or driving pressure can improve outcomes, but others have also found equivocal results when only a single parameter was targeted. That’s where mechanical power comes into play as it unifies all those ventilator parameters into a single metric. Our research tries to dissect how the relative contribution of individual ventilator parameters to mechanical power varies between different patient groups and how we can improve outcomes by reducing mechanical power in the OR.

6. What are the benefits of presenting your research at the IARS Annual Meeting?

The IARS Annual Meeting is always an annual highlight for the anesthesia research community. I think everyone attending will agree that it is an incredibly stimulating platform to present and discuss research. The biggest benefit is definitely the exposure of one’s work to a group of national and international experts as well as the networking abilities that come with it.

7. How do you feel about receiving the Kosaka Best Abstract Award?

I feel incredibly honored and grateful. I am thankful for the support from my entire research team who made this work possible. This award definitely goes to every single member of the team. I am also incredibly thankful that the IARS recognized the importance and quality of our work.

8. How will this award affect your research and professional trajectory?

More than anything this award is validation of the importance of this work. Research is never linear and comes with many setbacks. Awards like the Kosaka Best Abstract Award remind us to keep pushing the boundaries and continue answering the questions that ultimately benefit patient care.

9. Is there anyone else you wish to acknowledge as part of this research team?

Everyone on our research team deserves a big shoutout as none of this work would have been possible without the support of the team of the Perioperative Outcomes Lab within the Center of Anesthesia Research Excellence (CARE) at BIDMC. Max Schäfer, director of CARE and a long-term mentor and friend, was instrumental in shaping this research project and I’m thankful for his guidance and support. A big thanks also goes to the residency program leadership team led by Program Director Sara Neves and our department Chair Danny Talmor for providing me an environment to pursue my research interests.

10. Outside of your research, what might someone be surprised to learn about you?

I am an avid runner and am currently training for a marathon later this spring. Last year, I started road biking, and I’m hoping to add swimming to the mix this year. I love food and have been to some of the world’s best restaurants. I also have a pilot’s license and love spending time with my two cats.