Intensive Care Research Current Projects
The team are managing a number of world-wide research studies that are looking to improve ICU patient outcomes.
The 65 Trial
Principal Investigators: Beverley Faulkner, Dr Matt Thomas
Investigator: Dr Katherine Fok
This national multi-centre study is run by the Intensive Care National Audit and Research Centre (ICNARC) and funded by the National Institute of Health Research (NIHR). It asks if reducing the dose of medication to support blood pressure (“vasopressors”) in shock in patients over 65 will produce a better outcome to standard practice.
The best blood pressure target to guide treatment in critical care is not known. It is, however, well-known that both very low blood pressure (severe hypotension) and, side effects from medications that increase blood pressure (vasopressors), can increase the risk of death. Current guidelines recommend that clinicians aim for a mean arterial pressure (MAP) of 65 mmHg or more. These guidelines are based on low quality evidence and no guidance is given on an upper limit. Previous research shows MAP values in critical care frequently rise significantly higher than 65 mmHg, exposing patients to potentially unnecessary doses of vasopressors and associated side-effects. There is emerging evidence suggesting that using a lower MAP target (permissive hypotension) to guide treatment may increase survival in older critically ill patients. A large clinical trial is therefore needed to evaluate this idea. The aim of this study is to evaluate the clinical and cost-effectiveness of permissive hypotension (MAP target of 60 - 65 mmHg during vasopressor therapy) in critically ill patients aged 65 years or over with hypotension.
Planned end date: October 2019
PI: Matt Thomas
Investigators: Chris Newell, Tim Hooper
This trial is a multi-centre prospective diagnostic test accuracy study assessing the performance of three rapid tests for fungal infection. The accuracy of these tests will be compared and the optimal test (or combination) identified. The emphasis is on their ability to rule out infection. Although fungal infection, most often with Candida, is rare (0.6% of patients in UK ICUs) the mortality is high hence the importance of getting the diagnosis right.
The study is run by the Northern Ireland Clinical Trials Unit and is funded by the National Institute of Health Research.
More information may be found at www.ukctg.nihr.ac.uk/trials?query=%257B%2522query%2522%253A%2522ASTOP%2520candida%2522%257D.
Planned end date: March 2021.
PI: Matt Thomas
Investigators: Charis Banks
This trial is a UK wide multi-centre randomised trial to determine whether antibiotic treatment protocols based on daily monitoring of C-Reactive Protein (CRP) or procalcitonin (PCT) safely allow a reduction in duration of therapy. The overall duration of antibiotic treatment for infection is often not certain because clinical signs and microbiology tests are not useful to monitor a patient’s response. Proteins in blood – CRP and PCT – are often raised in sepsis and fall with antibiotic treatment. They provide an opportunity to personalise the duration of antibiotics and to provide population benefit.
The study is run by the Warwick Clinical Trials Unit and is funded by the National Institute for Health Research.
More information may be found at: www.ukctg.nihr.ac.uk/trials?query=%257B%2522query%2522%253A%2522ADAPT-Sepsis%2522%257D.
Planned end date: April 2021.