Critical care research group, Toronto

In pursuit of better critical care

We are ICU clinician-investigators who run pragmatic trials, learn from large clinical databases and bring what works back to the bedside.

Work with us Explore our research

Pragmatic, Unified Research in critical care Systems: Understanding, Implementation and Trials

Many decisions at the ICU bedside still rest on limited evidence.

Which vasopressor to start, through which line, and when to stop it. Whether a steroid helps, and for whom. We answer questions like these with trials embedded in routine care, careful analyses of large ICU databases, and implementation work that brings the results back to patients.

PURSUIT brings together intensivists, anesthesiologists, methodologists and trainees at St. Michael's Hospital, Sunnybrook Health Sciences Centre and Lakeridge Health, with collaborators across Canada and around the world.

Our work appears in
  • JAMA Internal Medicine
  • American Journal of Respiratory and Critical Care Medicine
  • Intensive Care Medicine
  • Annals of the American Thoracic Society
Investigators in
  • REMAP-CAP
  • PRACTICAL

Research

What we work on

Four programs that feed each other: trials answer the questions our data raise, and implementation work keeps both close to the bedside.

  • Trials

    Pragmatic and platform trials

    We help lead international adaptive platform trials, including REMAP-CAP and PRACTICAL, where we lead work on corticosteroids such as fludrocortisone in severe pneumonia, sepsis and acute respiratory failure.

    • Fludrocortisone across platform trials
    • The FLUDRO-1 pilot in acute hypoxemic respiratory failure
    • Priorities for future corticosteroid trials in pneumonia

  • Data

    Target trial emulation in ICU databases

    When a trial is not yet feasible, we emulate one. Most of our students lead projects in large public ICU databases such as MIMIC and eICU, using causal inference methods to compare treatments the way a trial would.

    • Choosing, delivering and weaning vasopressors
    • Extubation during vasopressor support
    • Acid suppression in septic shock

  • Practice

    Implementation and health systems

    We work with clinicians and hospitals to put evidence into practice. Our team led Unity Health Toronto's move to starting vasopressors through peripheral IVs, and we study safer central line use, ICU sedation and the capacity and costs of critical care.

    • Peripheral vasopressor administration
    • Complications of central venous catheters
    • Sedation and analgesia during and after the ICU

  • AI

    AI and clinical decision support

    We are building INSIGHT, an AI decision-support tool for the ICU, at St. Michael's Hospital. It is designed to warn teams early and to admit uncertainty, starting with the moments around intubation and weaning from the ventilator.

    • Low blood pressure after intubation
    • Readiness for extubation
    • Prolonged ventilator weaning

People

Co-leads

PURSUIT is led jointly by four clinician-investigators. Select a photo to read more.

Trainees

Profiles of the students, residents and fellows who work with us are on their way.

Join them
Portrait of Naheed Jivraj

Anesthesia and critical care, Sunnybrook Health Sciences Centre

Naheed Jivraj

MBBS, MSc, FRCPC

Naheed is an Assistant Professor in the Department of Anesthesiology and Pain Medicine at the University of Toronto and a clinician-investigator at Sunnybrook Health Sciences Centre, where he practises anesthesia and critical care. His research focuses on sedation and analgesia during and after critical illness, critical care capacity and health economics. He trained in medicine at King's College London, in anesthesiology and critical care medicine at the University of Toronto, and in health policy at the London School of Economics.
Portrait of Michael Sklar

Critical care and anesthesia, St. Michael's Hospital

Michael Sklar

MD, FRCPC

Mike is an Assistant Professor in the Department of Anesthesiology and Pain Medicine at the University of Toronto and an intensivist and anesthesiologist at St. Michael's Hospital, Unity Health Toronto. He works in the medical-surgical and trauma-neurosurgical ICUs and with the critical care outreach team. His research focuses on respiratory failure, mechanical ventilation and extracorporeal life support, and he co-leads INSIGHT, our AI decision-support tool for the ICU.
Portrait of Bijan Teja

Critical care and cardiac anesthesia, St. Michael's Hospital

Bijan Teja

MD, PhD, MBA, FRCPC

Bijan is an Assistant Professor at the University of Toronto and a staff physician in critical care medicine and cardiac anesthesia at St. Michael's Hospital, Unity Health Toronto. His research aims to improve drug therapy for critically ill patients, especially vasopressors and corticosteroids, and he leads corticosteroid work in the REMAP-CAP and PRACTICAL platform trials. He trained at Dartmouth (MD, MBA), Beth Israel Deaconess Medical Center and Harvard Medical School (anesthesiology), and the University of Toronto (critical care medicine and a PhD in clinical epidemiology).
Portrait of Nasim Zamir

Critical care and informatics, Lakeridge Health

Nasim Zamir

MD, FRCPC

Nasim is an intensivist at Lakeridge Health and an Assistant Professor at Queen's University, and he serves as informatics lead for Lakeridge's critical care department. His work brings health information systems and AI into clinical workflows, and he leads data science for several of our studies. He trained in medicine at McMaster University, in internal medicine at the University of Saskatchewan and in critical care medicine at the University of Toronto.

Work with us

Train with PURSUIT

We take on a small number of students and trainees from across North America. Each joins a project with a clear question and a supervisor who meets with them regularly, and leads their own analyses and papers.

  • Medical and undergraduate students

    Part-time and summer projects, most often analyses of large ICU databases such as MIMIC and eICU. We look for some research experience and comfort with R, Python or statistics.

  • Graduate students

    MSc and PhD projects in clinical epidemiology, causal inference, trial methods and machine learning. Apply early so we can talk about supervision and program fit.

  • Residents, fellows and postdocs

    Research blocks, fellowship projects and postdoctoral work in trials, target trial emulation, implementation science and AI, with the goal of first-author work.

How to apply

Apply through our online form with your CV. We review applications four times a year, in January, April, July and October, and usually take on one or two new trainees each round. Priority goes to applicants who already have research experience.

Apply now

Please apply through the form. We do not review applications sent by email.

News

Latest from PURSUIT

  1. GroupOct 2026

    PURSUIT launches

    Investigators from St. Michael's Hospital, Sunnybrook and Lakeridge Health come together as one critical care research group.

  2. Publication2026

    Priorities for corticosteroid trials in pneumonia

    A survey of REMAP-CAP investigators sets out the open questions that future corticosteroid trials in community-acquired pneumonia should answer.

    Intensive Care Medicine

  3. Publication2026

    How clinicians use corticosteroids in septic shock

    Our international survey of corticosteroid practice in septic shock is accepted for publication.

    CHEST Critical Care

  4. PublicationMay 2024

    Fludrocortisone plus hydrocortisone in septic shock

    A network meta-analysis of randomized trials suggests that adding fludrocortisone to hydrocortisone may lower mortality compared with hydrocortisone alone.

    American Journal of Respiratory and Critical Care Medicine

  5. PublicationMar 2024

    How often central venous catheters cause complications

    A systematic review and meta-analysis of complication rates for central venous catheters in adults.

    JAMA Internal Medicine

  6. PublicationMar 2023

    Two steroids or one in septic shock

    A target trial emulation in 88,275 patients compares fludrocortisone plus hydrocortisone with hydrocortisone alone.

    JAMA Internal Medicine

  7. PublicationOct 2022

    First-line vasopressors and how they are given

    An epidemiologic study of which vasopressor patients with septic shock receive first, and through which route.

    Annals of the American Thoracic Society