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Giants in Chest Medicine |

Giants in Chest MedicineGiants in Chest Medicine: Lawrence Wood: Lawrence D. H. Wood, MD, PhD FREE TO VIEW

Jesse B. Hall, MD, FCCP
Author and Funding Information

From The University of Chicago.

CORRESPONDENCE TO: Jesse B. Hall, MD, FCCP, University of Chicago, 5413 South Blackstone, Chicago, IL 60615-5406; e-mail: jhall@medicine.bsd.uchicago.edu


Editor’s Note:This series recognizes and highlights the accomplishments of individuals who have contributed greatly to chest medicine. To listen to the interview with Dr Wood, go to journal.publications.chestnet.org.

FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST the following conflicts of interest: Dr Hall received publishing royalties for medical textbooks and holds pharmaceutical or other medical industry stock only for retirement mutual funds.

ADDITIONAL INFORMATION: Listen to podcast interview of Dr Wood online at: http://traffic.libsyn.com/chestpodcasts/140014.mp3

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(1):13-15. doi:10.1378/chest.14-0014
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Speaking for the remarkable number of mentees of Lawrence D. H. Wood, MD, PhD, who are productive and creative contributors to the field of critical care medicine, of which Dr Wood is a primary founder, I feel both delighted and humbled to offer some thoughts about this extraordinary man. Many others could and should add their own reflections on knowledge and inspiration received from him, and I acknowledge this as but a single step in that process. I believe that all of us regard Dr Wood as a leader in applying rigorous science to test hypotheses or answer questions arising at the bedside of critically ill patients.

The details of Dr Wood’s career include an MD received in 1966 from the University of Manitoba followed by a rotating internship at St. Boniface Hospital in Winnipeg, Manitoba, Canada. After internship he was assigned to the Canadian Forces Institute of Environmental Medicine in Toronto, Ontario, working with Charles Bryan, MD, on the relationship of maximum expiratory flow to the density of gas being breathed. While his rapid evolution as a physician-scientist can be measured by his sophisticated early discoveries with Dr Bryan, his steadfastness and dedication to clinical investigation was illustrated by his completing Navy diving certification along the way, a requirement to permit him to conduct studies of pulmonary physiology using a hyperbaric chamber.

Dr Wood left Toronto to pursue a PhD in physiology at McGill University in Montreal, Quebec, with another great teacher, Peter T. Macklem, MD, continuing his study and mastery of pulmonary mechanics, gas exchange, circulatory function, and heart-lung interactions. Dovetailing completion and defense of his PhD with additional clinical training, he returned to Winnipeg to complete his internal medicine residency and critical care fellowship, working with and guided by Reuben M. Cherniack, MD, who offered him his first faculty position. During this time, Dr Wood’s abiding recognition of both a scientific and spiritual voice speaking from within led him to spend several years living in a Marianist religious community while he continued to hone his skills as a physician and investigator.

Dr Wood’s work during this time period became explosive and wide-reaching relative to the emerging field of critical care medicine. He asked and answered questions central to the management of the critically ill, including the determinants of low-pressure pulmonary edema in acute lung injury, the effects of positive end-expiratory pressure and tidal volume on gas exchange and potential adverse effects promoting lung injury, the effects of and means to reduce pulmonary vascular pressure to improve gas exchange in low-pressure pulmonary edema, the interactions of the lung and circulation during mechanical ventilation of the injured lung, and the effects of alternative modes of ventilation such as constant flow and high-frequency ventilation. In subsequent years, additional areas of investigation would include the limits of aerobic metabolism in sepsis, use of low-density gas in airflow-obstructed patients, effects of hypoxia and respiratory acidosis on myocardial contractility, and methods to reduce oxygen consumption in the critically ill.

I remember well Dr Wood’s recruitment to begin a critical care program at the University of Chicago in 1982. I was a chief resident and attendee at his Grand Rounds presentation on acute hypoxemic respiratory failure during which he presented his elegant studies, concluding with three principles that he believed could be taken from his laboratory studies to the bedside of the patient with ARDS:

  • 1. Seek the lowest tidal volume consistent with adequate ventilation.

  • 2. Seek the lowest positive end-expiratory pressure consistent with an adequate saturation of hemoglobin on a nontoxic Fio2.

  • 3. Seek the lowest pulmonary capillary wedge pressure consistent with an adequate cardiac output.

By the end of his lecture I was convinced that I wished to work with him, a choice which soon came to pass. Little did I know that it would take >20 years for an army of clinical investigators, myself included, to confirm in large clinical trials the principles he laid out so simply and clearly that day.

Dr Wood’s excellence extended deeply into clinical care and teaching as well, and he ranked the enjoyment and rewards of these pursuits as equal if not greater than those of his scholarship. His syllabus of critical care evolved quickly to become a major textbook in the field—Principles of Critical Care—a project I joined him on and have enjoyed through multiple editions. He went on to receive multiple awards for his teaching prowess, and it has never failed to amaze me how many colleagues—including many outside the field of pulmonary and critical care medicine—note how deeply affected they were at the beginning of their careers by contact with Dr Wood in the classroom or on the wards, learning either the intricacies of physiology or how to help a family and patient through the difficulties and fears of end-of-life care, done by Dr Wood with compassion, reflective listening, and gentle guidance. The science and humanity of medicine have rarely inhabited a person as they have in him.

The sum of these accomplishments can be the making of a great mentor and that is Dr Wood’s continued contribution to our field, still present after his retirement from academic medicine. Many of his trainees, now quite senior in their own right, continue to enjoy this relationship with him. It is in this spirit that I invite the reader and listener to receive and enjoy this interview with a giant of pulmonary and critical care medicine.

Suggested Readings

Wood LD, Bryan AC. Effect of increased ambient pressure on flow-volume curve of the lung. J Appl Physiol. 1969;27(1):4-8. [PubMed]
 
Wood LD, Bryan AC, Bau SK, Weng TR, Levison H. Effect of increased gas density on pulmonary gas exchange in man. J Appl Physiol. 1976;41(2):206-210. [PubMed]
 
Wood LD, Bryan AC. Exercise ventilatory mechanics at increased ambient pressure. J Appl Physiol. 1978;44(2):231-237. [PubMed]
 
Ali J, Chernicki W, Wood LD. Effect of furosemide in canine low-pressure pulmonary edema. J Clin Invest. 1979;64(5):1494-1504. [CrossRef] [PubMed]
 
Mink S, Ziesmann M, Wood LD. Mechanisms of increased maximum expiratory flow during HeO2 breathing in dogs. J Appl Physiol. 1979;47(3):490-502. [PubMed]
 
Prewitt RM, Wood LD. Effect of positive end-expiratory pressure on ventricular function in dogs. Am J Physiol. 1979;236(4):H534-H544. [PubMed]
 
Mink SN, Wood LD. How does HeO2 increase maximum expiratory flow in human lungs? J Clin Invest. 1980;66(4):720-729. [CrossRef] [PubMed]
 
Mink SN, Light RB, Cooligan T, Wood LD. Effect of PEEP on gas exchange and pulmonary perfusion in canine lobar pneumonia. J Appl Physiol. 1981;50(3):517-523. [PubMed]
 
Prewitt RM, McCarthy J, Wood LD. Treatment of acute low pressure pulmonary edema in dogs: relative effects of hydrostatic and oncotic pressure, nitroprusside and positive end-expiratory pressure. J Clin Invest. 1981;67(2):409-418. [CrossRef] [PubMed]
 
Prewitt RM, Oppenheimer L, Sutherland JB, Wood LD. Effect of positive end-expiratory pressure on left ventricular mechanics in patients with hypoxemic respiratory failure. Anesthesiology. 1981;55(4):409-415. [CrossRef] [PubMed]
 
Wood LD, Prewitt RM. Cardiovascular management in acute hypoxemic respiratory failure. Am J Cardiol. 1981;47(4):963-972. [CrossRef] [PubMed]
 
Breen PH, Schumacker PT, Hedenstierna G, Ali J, Wagner PD, Wood LD. How does increased cardiac output increase shunt in pulmonary edema? J Appl Physiol. 1982;53(5):1273-1280. [PubMed]
 
Breen PH, Ali J, Wood LD. High-frequency ventilation in lung edema: effects on gas exchange and perfusion. J Appl Physiol. 1984;56(1):187-195. [PubMed]
 
Malo J, Ali J, Wood LD. How does positive end-expiratory pressure reduce intrapulmonary shunt in canine pulmonary edema? J Appl Physiol. 1984;57(4):1002-1010. [PubMed]
 
Hall JB, Wood LD. Liberation of the patient from mechanical ventilation. JAMA. 1987;257(12):1621-1628. [CrossRef] [PubMed]
 
Nelson DP, Beyer C, Samsel RW, Wood LD, Schumacker PT. Pathological supply dependence of O2 uptake during bacteremia in dogs. J Appl Physiol (1985). 1987;63(4):1487-1492. [PubMed]
 
Long R, Breen PH, Mayers I, Wood LD. Treatment of canine aspiration pneumonitis: fluid volume reduction vs. fluid volume expansion. J Appl Physiol (1985). 1988;65(4):1736-1744. [PubMed]
 
Walley KR, Becker CJ, Hogan RA, Teplinsky K, Wood LD. Progressive hypoxemia limits left ventricular oxygen consumption and contractility. Circ Res. 1988;63(5):849-859. [CrossRef] [PubMed]
 
Corbridge TC, Wood LD, Crawford GP, Chudoba MJ, Yanos J, Sznajder JI. Adverse effects of large tidal volume and low PEEP in canine acid aspiration. Am Rev Respir Dis. 1990;142(2):311-315. [CrossRef] [PubMed]
 
Humphrey H, Hall J, Sznajder I, Silverstein M, Wood L. Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest. 1990;97(5):1176-1180. [CrossRef] [PubMed]
 
Walley KR, Lewis TH, Wood LD. Acute respiratory acidosis decreases left ventricular contractility but increases cardiac output in dogs. Circ Res. 1990;67(3):628-635. [CrossRef] [PubMed]
 
Manthous CA, Hall JB, Caputo MA, et al. Heliox improves pulsus paradoxus and peak expiratory flow in nonintubated patients with severe asthma. Am J Respir Crit Care Med. 1995;151:310-314. [CrossRef] [PubMed]
 
Manthous CA, Hall JB, Olson D, et al. Effect of cooling on oxygen consumption in febrile critically ill patients. Am J Respir Crit Care Med. 1995;151(1):10-14. [CrossRef] [PubMed]
 
Hall JB, Schmidt GA, Wood LDH., eds. Principles of Critical Care.3rd ed. New York, NY: McGraw/Hill; 2005.
 
Wood LDH. Science, Belief, Intuition: Reflections of a Physician. Bloomington, IN: Balboa Press; 2012.
 

Tables

Suggested Readings

Wood LD, Bryan AC. Effect of increased ambient pressure on flow-volume curve of the lung. J Appl Physiol. 1969;27(1):4-8. [PubMed]
 
Wood LD, Bryan AC, Bau SK, Weng TR, Levison H. Effect of increased gas density on pulmonary gas exchange in man. J Appl Physiol. 1976;41(2):206-210. [PubMed]
 
Wood LD, Bryan AC. Exercise ventilatory mechanics at increased ambient pressure. J Appl Physiol. 1978;44(2):231-237. [PubMed]
 
Ali J, Chernicki W, Wood LD. Effect of furosemide in canine low-pressure pulmonary edema. J Clin Invest. 1979;64(5):1494-1504. [CrossRef] [PubMed]
 
Mink S, Ziesmann M, Wood LD. Mechanisms of increased maximum expiratory flow during HeO2 breathing in dogs. J Appl Physiol. 1979;47(3):490-502. [PubMed]
 
Prewitt RM, Wood LD. Effect of positive end-expiratory pressure on ventricular function in dogs. Am J Physiol. 1979;236(4):H534-H544. [PubMed]
 
Mink SN, Wood LD. How does HeO2 increase maximum expiratory flow in human lungs? J Clin Invest. 1980;66(4):720-729. [CrossRef] [PubMed]
 
Mink SN, Light RB, Cooligan T, Wood LD. Effect of PEEP on gas exchange and pulmonary perfusion in canine lobar pneumonia. J Appl Physiol. 1981;50(3):517-523. [PubMed]
 
Prewitt RM, McCarthy J, Wood LD. Treatment of acute low pressure pulmonary edema in dogs: relative effects of hydrostatic and oncotic pressure, nitroprusside and positive end-expiratory pressure. J Clin Invest. 1981;67(2):409-418. [CrossRef] [PubMed]
 
Prewitt RM, Oppenheimer L, Sutherland JB, Wood LD. Effect of positive end-expiratory pressure on left ventricular mechanics in patients with hypoxemic respiratory failure. Anesthesiology. 1981;55(4):409-415. [CrossRef] [PubMed]
 
Wood LD, Prewitt RM. Cardiovascular management in acute hypoxemic respiratory failure. Am J Cardiol. 1981;47(4):963-972. [CrossRef] [PubMed]
 
Breen PH, Schumacker PT, Hedenstierna G, Ali J, Wagner PD, Wood LD. How does increased cardiac output increase shunt in pulmonary edema? J Appl Physiol. 1982;53(5):1273-1280. [PubMed]
 
Breen PH, Ali J, Wood LD. High-frequency ventilation in lung edema: effects on gas exchange and perfusion. J Appl Physiol. 1984;56(1):187-195. [PubMed]
 
Malo J, Ali J, Wood LD. How does positive end-expiratory pressure reduce intrapulmonary shunt in canine pulmonary edema? J Appl Physiol. 1984;57(4):1002-1010. [PubMed]
 
Hall JB, Wood LD. Liberation of the patient from mechanical ventilation. JAMA. 1987;257(12):1621-1628. [CrossRef] [PubMed]
 
Nelson DP, Beyer C, Samsel RW, Wood LD, Schumacker PT. Pathological supply dependence of O2 uptake during bacteremia in dogs. J Appl Physiol (1985). 1987;63(4):1487-1492. [PubMed]
 
Long R, Breen PH, Mayers I, Wood LD. Treatment of canine aspiration pneumonitis: fluid volume reduction vs. fluid volume expansion. J Appl Physiol (1985). 1988;65(4):1736-1744. [PubMed]
 
Walley KR, Becker CJ, Hogan RA, Teplinsky K, Wood LD. Progressive hypoxemia limits left ventricular oxygen consumption and contractility. Circ Res. 1988;63(5):849-859. [CrossRef] [PubMed]
 
Corbridge TC, Wood LD, Crawford GP, Chudoba MJ, Yanos J, Sznajder JI. Adverse effects of large tidal volume and low PEEP in canine acid aspiration. Am Rev Respir Dis. 1990;142(2):311-315. [CrossRef] [PubMed]
 
Humphrey H, Hall J, Sznajder I, Silverstein M, Wood L. Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest. 1990;97(5):1176-1180. [CrossRef] [PubMed]
 
Walley KR, Lewis TH, Wood LD. Acute respiratory acidosis decreases left ventricular contractility but increases cardiac output in dogs. Circ Res. 1990;67(3):628-635. [CrossRef] [PubMed]
 
Manthous CA, Hall JB, Caputo MA, et al. Heliox improves pulsus paradoxus and peak expiratory flow in nonintubated patients with severe asthma. Am J Respir Crit Care Med. 1995;151:310-314. [CrossRef] [PubMed]
 
Manthous CA, Hall JB, Olson D, et al. Effect of cooling on oxygen consumption in febrile critically ill patients. Am J Respir Crit Care Med. 1995;151(1):10-14. [CrossRef] [PubMed]
 
Hall JB, Schmidt GA, Wood LDH., eds. Principles of Critical Care.3rd ed. New York, NY: McGraw/Hill; 2005.
 
Wood LDH. Science, Belief, Intuition: Reflections of a Physician. Bloomington, IN: Balboa Press; 2012.
 
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