About

Grace Hsu, M.D., is an Associate Professor of Clinical Anesthesiology and Critical Care at the Perelman School of Medicine at the University of Pennsylvania. She is also an Attending Physician at the Children's Hospital of Philadelphia, specializing in anesthesiology and critical care. Her educational background includes a Bachelor of Arts in Biology with Honors and minors in Chemistry and Music from Case Western Reserve University, obtained in 2005, and a Medical Degree from the University of Florida College of Medicine, earned in 2009. Her professional focus encompasses pediatric anesthesia, with research contributions in areas such as thromboelastography changes in children, geographic and socioeconomic factors affecting pediatric care, and approaches to difficult pediatric airways. Dr. Hsu has authored multiple publications and presentations related to pediatric anesthesiology and critical care, emphasizing her expertise in managing complex pediatric cases and advancing clinical practices in her field.

Research topics

• Surgery
• Medicine
• Cell biology
• Botany
• Biology
• Biochemistry
• Anesthesia
• Chemistry

Selected publications

• Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time

  EClinicalMedicine · 2024-02-14 · 18 citations

  articleOpen access

  Background: The Paediatric Difficult Intubation Collaborative identified multiple attempts and persistence with direct laryngoscopy as risk factors for complications in children with difficult tracheal intubations and subsequently engaged in initiatives to reduce repeated attempts and persistence with direct laryngoscopy in children. We hypothesised these efforts would lead to fewer attempts, fewer direct laryngoscopy attempts and decrease complications. Methods: Paediatric patients less than 18 years of age with difficult direct laryngoscopy were enrolled in the Paediatric Difficult Intubation Registry. We define patients with difficult direct laryngoscopy as those in whom (1) an attending or consultant obtained a Cormack Lehane Grade 3 or 4 view on direct laryngoscopy, (2) limited mouth opening makes direct laryngoscopy impossible, (3) direct laryngoscopy failed in the preceding 6 months, and (4) direct laryngoscopy was deferred due to perceived risk of harm or poor chance of success. We used a 5:1 propensity score match to compare an early cohort from the initial Paediatric Difficult Intubation Registry analysis (August 6, 2012-January 31, 2015, 785 patients, 13 centres) and a current cohort from the Registry (March 4, 2017-March 31, 2023, 3925 patients, 43 centres). The primary outcome was first attempt success rate between cohorts. Success was defined as confirmed endotracheal intubation and assessed by the treating clinician. Secondary outcomes were eventual success rate, number of attempts at intubation, number of attempts with direct laryngoscopy, the incidence of persistence with direct laryngoscopy, use of supplemental oxygen, all complications, and severe complications. Findings: First-attempt success rate was higher in the current cohort (42% vs 32%, OR 1.5 95% CI 1.3-1.8, p < 0.001). In the current cohort, there were fewer attempts (2.2 current vs 2.7 early, regression coefficient -0.5 95% CI -0.6 to -0.4, p < 0.001), fewer attempts with direct laryngoscopy (0.6 current vs 1.0 early, regression coefficient -0.4 95% CI -0.4 to 0.3, p < 0.001), and reduced persistence with direct laryngoscopy beyond two attempts (7.3% current vs 14.1% early, OR 0.5 95% CI 0.4-0.6, p < 0.001). Overall complication rates were similar between cohorts (19% current vs 20% early). Severe complications decreased to 1.8% in the current cohort from 3.2% in the early cohort (OR 0.55 95% CI 0.35-0.87, p = 0.011). Cardiac arrests decreased to 0.8% in the current cohort from 1.8% in the early cohort. We identified persistence with direct laryngoscopy as a potentially modifiable factor associated with severe complications. Interpretation: In the current cohort, children with difficult tracheal intubations underwent fewer intubation attempts, fewer attempts with direct laryngoscopy, and had a nearly 50% reduction in severe complications. As persistence with direct laryngoscopy continues to be associated with severe complications, efforts to limit direct laryngoscopy and promote rapid transition to advanced techniques may enhance patient safety. Funding: None.

  PublisherOA PDFDOI

• Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry

  British Journal of Anaesthesia · 2023 · 21 citations

  • Medicine
  • Anesthesia
  • Surgery

  BACKGROUND: Difficult facemask ventilation is perilous in children whose tracheas are difficult to intubate. We hypothesised that certain physical characteristics and anaesthetic factors are associated with difficult mask ventilation in paediatric patients who also had difficult tracheal intubation. METHODS: We queried a multicentre registry for children who experienced "difficult" or "impossible" facemask ventilation. Patient and case factors known before mask ventilation attempt were included for consideration in this regularised multivariable regression analysis. Incidence of complications, and frequency and efficacy of rescue placement of a supraglottic airway device were also tabulated. Changes in quality of mask ventilation after injection of a neuromuscular blocking agent were assessed. RESULTS: The incidence of difficult mask ventilation was 9% (483 of 5453 patients). Infants and patients having increased weight, being less than 5th percentile in weight for age, or having Treacher-Collins syndrome, glossoptosis, or limited mouth opening were more likely to have difficult mask ventilation. Anaesthetic induction using facemask and opioids was associated with decreased risk of difficult mask ventilation. The incidence of complications was significantly higher in patients with "difficult" mask ventilation than in patients without. Rescue placement of a supraglottic airway improved ventilation in 71% (96 of 135) of cases. Administration of neuromuscular blocking agents was more frequently associated with improvement or no change in quality of ventilation than with worsening. CONCLUSIONS: Certain abnormalities on physical examination should increase suspicion of possible difficult facemask ventilation. Rescue use of a supraglottic airway device in children with difficult or impossible mask ventilation should be strongly considered.

  PublisherOA PDFDOI

• Plastic Surgery

  Elsevier eBooks · 2022-01-01

  book-chapter1st authorCorresponding
  PublisherDOI

• List of Contributors

  Elsevier eBooks · 2022-01-01

  book-chapter
  PublisherDOI

• Plant cytokinesis and the construction of new cell wall

  FEBS Letters · 2022 · 31 citations

  • Cell biology
  • Chemistry
  • Botany

  Cytokinesis in plants is fundamentally different from that in animals and fungi. In plant cells, a cell plate forms through the fusion of cytokinetic vesicles and then develops into the new cell wall, partitioning the cytoplasm of the dividing cell. The formation of the cell plate entails multiple stages that involve highly orchestrated vesicle accumulation, fusion and membrane maturation, which occur concurrently with the timely deposition of polysaccharides such as callose, cellulose and cross-linking glycans. This review summarizes the major stages in cytokinesis, endomembrane components involved in cell plate assembly and its transition to a new cell wall. An animation that can be widely used for educational purposes further summarizes the process.

  PublisherOA PDFDOI

• SPATIAL ANALYSIS OF AMBIENT AIR QUALITY EXPOSURE AMONG PEDIATRIC PATIENTS IN A CHILDREN'S HOSPITAL

  Zenodo (CERN European Organization for Nuclear Research) · 2022-04-01

  paratextOpen accessSenior author

  Exposure to poor air quality has been associated with the development of asthma, increases in the severity of asthma exacerbations, and increases in the utilization of health care resources in children. Traffic-related air pollution and nitrogen dioxide represents significant risk factors for pediatric asthma development. Pollutants that are considered the greatest impact on human health are particulate matter (PM). PM can be measured as PM 2.5 and PM 10 , where 2.5 or 10 represents the diameter size of particles in microns. The smaller the PM the more likely particles penetrate to the lower respiratory system, exacerbating bronchitis and other lung disease. Both long-term and short-term exposure to levels of air pollution can impact respiratory health in children. Although studies have recently examined the ambient air quality exposure on children in primary care settings, to our knowledge there is no research on the epidemiology of air quality exposure among pediatric patients undergoing anesthesia and surgery care. Understanding the long- and short-term exposure variation in air quality over space and time will enable future studies on the subsequent impact on perioperative outcomes such as respiratory adverse events.

  PublisherDOI

• Predicting Progression of Oral Lesions to Malignancy Using Machine Learning

  The Laryngoscope · 2022-07-09 · 11 citations

  article

  OBJECTIVE: To use large-scale electronic health record (EHR) data to develop machine learning models predicting malignant transformation of oral lesions. METHODS: A multi-institutional health system database was used to identify a retrospective cohort of patients with biopsied oral lesions. The primary outcome was malignant transformation. Chart review and automated system database queries were used to identify a range of demographic, clinical, and pathologic variables. Machine learning was used to develop predictive models for progression to malignancy. RESULTS: There were 2192 patients with a biopsied oral lesion, of whom 1232 had biopsy proven oral dysplasia. There was malignant transformation in 34% of patients in the oral lesions dataset, and in 54% of patients in the dysplasia subset. Multiple machine learning-based models were trained on the data in two experiments, (a) including all patients with biopsied oral lesions and (b) including only patients with biopsy-proven dysplasia. In the first experiment, the best machine learning models predicted malignant transformation among the biopsied oral lesions with an area under the curve (AUC) of 86%. In the second experiment, the random forest model predicted malignant transformation among lesions with dysplasia with an AUC of 0.75. The most influential features were dysplasia grade and the presence of multiple lesions, with smaller influences from other features including anemia, histopathologic description of atypia, and other prior cancer history. CONCLUSION: With diverse features from EHR data, machine learning approaches are feasible and allow for generation of models that predict which oral lesions are likely to progress to malignancy. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:1156-1162, 2023.

  PublisherDOI

• Pediatric airway management

  Current Opinion in Anaesthesiology · 2021-04-08 · 39 citations

  review1st authorCorresponding

  PURPOSE OF REVIEW: Children are at risk of severe hypoxemia in the perioperative period owing to their unique anatomy and physiology. Safe and effective airway management strategies are therefore key to the practice of pediatric anesthesia. The goal of this review is to highlight recent publications (2019-2021) aimed to advance pediatric airway safety and to highlight a proposed simple, pediatric-specific, universal framework to guide clinical practice. RECENT FINDINGS: Recent investigations demonstrate that infants with normal and difficult airways experience high incidences of multiple laryngoscopy attempts and resulting hypoxemia. Video laryngoscopy may improve tracheal intubation first attempt success rate in infants with normal airways. In infants with difficult airways, standard blade video laryngoscopy is associated with higher first attempt success rates over non-standard blade video laryngoscopy. Recent studies in children with Pierre Robin sequence and mucopolysaccharidoses help guide airway equipment and technique selection. Department airway leads and hospital difficult airway services are necessary to disseminate knowledge, lead quality improvement initiatives, and promote evidence-based practice guidelines. SUMMARY: Pediatric airway management morbidity is a common problem in pediatric anesthesia. Improvements in individual practitioner preparation and management strategies as well as systems-based policies are required. A simple, pediatric-specific, universal airway management framework can be adopted for safe pediatric anesthesia practice.

  PublisherDOI

• The Pediatric Difficult Airway

  Anesthesiology Clinics · 2020-07-16 · 16 citations

  review1st authorCorresponding
  PublisherDOI

• Correction to: Exploratory data analysis for pre and post 24/7/365 attending radiologist coverage support in an emergency department: fundamentals of data science

  Emergency Radiology · 2020-01-14

  erratum
  PublisherDOI

Frequent coauthors

• John E. Fiadjoe

  Boston Children's Hospital

  29 shared

• Allan F. Simpao

  University of Pennsylvania

  22 shared

• Mohamed A. Rehman

  Johns Hopkins University

  21 shared

• Britta S. von Ungern‐Sternberg

  The Kids Research Institute Australia

  19 shared

• Alan Schwartz

  Research Network (United States)

  16 shared

• Paul A. Stricker

  Children's Hospital of Philadelphia

  16 shared

• Luke S. Janik

  University of Pennsylvania

  16 shared

• Gregory G. Heuer

  16 shared

Labs

• Grace Hsu LabPI

Education

• Pediatric Anesthesiology Fellowship, Anesthesiology and Critical Care Medicine

  The Children's Hospital of Philadelphia

  2014

• Anesthesiology Residency, Anesthesia, Critical Care and Pain Medicine

  Beth Israel Deaconess Medical Center

  2013

• Internship, Internal Medicine

  Boston Medical Center

  2010

• MD

  University of Florida College of Medicine

  2009

• BA

  Case Western Reserve University

  2005