Intensive Care Research Current Projects

The team are managing a number of world-wide research studies that are looking to improve ICU patient outcomes.

A-STOP

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.

Planned end date: March 2021.

ADAPT-Sepsis

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.
 

Planned end date: April 2021.

A2B

Principal Investigator: Matt Thomas
Investigators: Kate Crewdson, Chris Newell
This is a randomised trial of three different sedative drugs used to help patients who need support from a ventilator. The aim is to find out whether minimising the use of the standard drug (propofol) means people spend less time on the ventilator, if this is safe and if this represents value for money.
The study is funded by the Health Technology Assessment Programme of the NIHR and is sponsored by the Academic and Clinical Central Office for Research (ACCORD) in Edinburgh.

More information about A2B trial can be found here.

eFONA: Cognitive barriers in emergency front of neck airway study

As anaesthetists, one of our primary roles is maintaining the patient’s airway during anaesthesia. tubes. Very rarely (1/50,000 anaesthetics) an anaesthetist is unable to either insert one of these tubes or provide oxygen to the patient in any other way which may result in brain damage due to harmfully low oxygen levels (hypoxia) or death. The solution to these situations, involves accessing the airway through an incision in the front of the neck (emergency Front of Neck Airway).

All anaesthetists are taught the practical steps involved, and the procedure itself is relatively easy to perform. Delay in making this decision is often the most common problem, yet very little research has been done examining the actual decision making required to perform this life saving procedure.

Aims
• To understand the thought process undergone by professionals needing to perform this task
• To identify reasons for any delay in making this decision

An experienced psychologist will carry out confidential semi-structured interviews with individuals whom have performed or attempted this emergency procedure within the past 2 years. It is hoped that the reasons why anaesthetists are reluctant to make this lifesaving decision could be elucidated. In doing so, these factors could be addressed in education and training of the workforce with the ultimate intention of making airway management and therefore anaesthesia safer for all patients.

 

Host Site: North Bristol NHS Trust

Chief Investigator: Dr Lawrence Kidd

End Date: 01/05/2022

Hypothalamo-pituitary-adrenal (HPA) axis function and control mechanisms in traumatic brain injury

Principal Investigator: Aravind Ramesh
Investigator: Matt Thomas
This is an observational study of cortisol (a “stress hormone”) levels in the first 24 hours after trauma using a technique called microdialysis. This involves a small tube like a drip being placed under the skin. The aim is to see how cortisol levels vary with the type of injury and the time of the day. It may allow new ways of reducing the harm of traumatic brain injury to be developed.
The study is funded by the David Telling Charitable Trust and the British Society of Neuroendocrinology. It is sponsored by the University of Bristol.

Ketogenic diet in traumatic brain injury

Chief Investigator: Kate Crewdson
Investigators: Matt Thomas, Kaylee Allan
A ketogenic (or low carbohydrate, high fat) diet is known to help in some brain diseases and may protect the brain after trauma. This study aims to determine the levels of ketones in the blood that a standard ketogenic feed can produce in patients after serious traumatic brain injury.
The study is funded by the Bristol Health Research Charity and the ICU Charitable Fund. It is sponsored by North Bristol NHS Trust.

EBB-TBI

Chief Investigator: Matt Thomas
Investigators: Kate Crewdson, Aravind Ramesh
There is some evidence that beta-blocker drugs can improve the chances of surviving after severe traumatic brain injury but there are worries about the side effect of low blood pressure. This study will use a very short acting beta-blocker and aims to find a dose that will mean patients receive the drug without an effect on blood pressure.
The study is funded by the Research for Patient Benefit Programme of the NIHR and sponsored by North Bristol NHS Trust.

CIRCA: Critical Illness Related Cardiac Arrest

Chief Investigator: Matt Thomas
Investigators: Chris Newell, Emma Gendall
Although there is a national database of cardiac arrests that happen in hospital wards in most cases it does not include the ICU. This study records all cardiac arrests happening in ICU over the course of a year. The aim is to determine how commonly cardiac arrests happen in ICU and what the impact is on patients and families.
The study is funded by the Resuscitation Council (UK) and sponsored by the Intensive Care National Audit and Research Centre.