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ICU Bereavement Service and Follow-Up

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Sadly, despite our best efforts, not all our patients on Intensive Care will survive. We realise this is an extremely distressing time for relatives and friends and we want to assure you that we will do all we can to help if your loved one passes away.

In this situation, we can offer a memory box in which any items of personal significance, such as cards and locks of hair can be kept. We can also help with other keepsakes such as a handprint if this is something that you would like.

We will make sure you are given information for what happens next, with a bereavement leaflet containing contact details for the hospital bereavement service.

In addition, we aim to call you within a few days to offer our support. At this time, we will ask if you would like any further input from the wider medical and nursing team responsible for the care of your loved one. If you need to call us before this, please do not hesitate to contact us via the ICU Reception on 0117 414 1400.

Towards the end of the year, we hold an annual ICU memorial service to celebrate the lives of those that have died on our ICU. This is held in a venue close to the hospital, usually in December. All friends and family are very welcome to attend.

Mr Dimitri Pournaras - Upper Gastrointestinal, Bariatric & Metabolic Surgery

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GMC Number: 6109278

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Specialty: Upper Gastrointestinal, Bariatric and Metabolic Surgery

Secretary: Kate Hewings

Telephone: 0117 414 0837

Clinical interests: Surgical treatment of obesity and diabetes as part of multi-modal care. Laparoscopic (keyhole) gastrointestinal surgery, management of gallstone disease and gastro-oesophageal reflux. 

Research interests: Outcomes of bariatric/metabolic surgery beyond weight loss with a focus on obesity associated morbidity and cardiovascular risk.  Identification of how these operations work or how bariatric/metabolic surgery changes the way the gut talks to the brain. 

Dimitri Pournaras graduated from the Aristotle University of Thessaloniki, Greece and undertook all his postgraduate training in the UK. He was awarded Research Fellowship by the Royal College of Surgeons of England to conduct research on obesity, diabetes and metabolic surgery.  He completed his PhD in the Department of Investigative Medicine, Hammersmith Hospital, Imperial College London and then trained in all aspects of laparoscopic oesophagogastric surgery in Cambridge and Norwich. Following a Bariatric and Metabolic Surgery Fellowship approved by the Royal College of Surgeons, he was appointed as a Consultant in Bristol where he works as part of a multidisciplinary team.  He is on the editorial board of journals Obesity Surgery and Clinical Obesity and has authored more than 50 peer reviewed publications, including articles in the Lancet, the Annals of Surgery, the British Journal of Surgery and the British Medical Journal. He delivers more than 10 invited international lectures every year. 

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Pournaras

Intensive Care Current Research

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A vital branch of our Acute Care Department, the Intensive Care Clinical Research Team deliver national and international multi-centre studies in Intensive Care Medicine and related specialities, working to advance the care that we give to our patients.

The team also work closely with colleagues across the Trust and beyond to develop new and innovative research ideas that test new treatments especially in the fields of major trauma and neurosciences.

Please speak to the person treating you to find out if there is a research study that may be able to help you.

Current Studies:

GuARDS

GuARDS is a research study running in Intensive Care Units (ICU) across the UK.

Patients with Acute Respiratory Distress Syndrome (ARDS) and the treatment being tested is a safe drug called dexamethasone alongside the standard ICU care.

PI: Dr Matt Thomas

Planned end date: 31st July 2027

Local ref: 5505

SepTiC

SepTiC is the name of a research trial which is looking at treatments for sepsis. The trial aims to find out what are the best treatments for sepsis.

We are testing three different things in this study:

  1. Diagnostic Trial 

Patients who have sepsis due to a serious infection need treatment as soon as possible. The treatment usually starts with drugs such as antibiotics to help fight the infection. Sometimes these drugs are used for longer than needed, which can cause side effects that can be harmful to patients. This might also make infections more difficult to treat in the future as it risks bugs (bacteria and other microorganisms) becoming used to and not being killed by antibiotics. Also, not all patients who are at first thought to have sepsis (and receive antibiotics) have an infection, so they may not have required antibiotic treatment at all. So, it is really important that we find out which patient needs antibiotics for an infection, who does not need them and if we can stop them, as soon as possible.   

2. Fluid Trial

Giving fluids, through tubing in the arm known as a ‘drip’, is standard practice in treating sepsis, but there is no clear guide on how much fluid is enough or too much, and so a build-up of fluid in the body can occur which may be harmful.  We will test how much fluid should be given and whether to remove any build-up of extra fluid.

For patients in this group, depending on their condition, we will give as little fluid as possible and, when safe, will treat any build-up of fluid which has occurred using medications called diuretics. If the patient is already receiving kidney dialysis, we will use this to remove excess fluid instead of diuretic medications.

3. GM-CSF Trial

GM-CSF is the short name for granulocyte-macrophage colony-stimulating factor.  This is approved in the USA by the FDA as type of protein that helps to make more white blood cells to help the immune system fight infection. The GM-CSF used in this trial is called Sargramostim.

This treatment will only be given to patients who need support for their breathing or other important organs. For patients in this group, an injection under the skin of 250-500mcg Sargramostim is given once a day for up to 8 days.  To help test if this does help patients, they will be compared with other patients who will have a sugar solution made to look the same as the drug.  This is also given once a day for 8 days.  This is known as a ‘placebo’.

PI: Dr Matt Thomas

Planned end date: 30th April 2027

Local ref: 5688

Statins for Improving Organ Outcome in Transplantation (SIGNET)

We wish to investigate whether giving deceased organ donors a single dose of the commonly prescribed drug, Simvastatin, is beneficial for transplant recipients.

All donated organs have suffered some damage. As the brain dies chemicals are released which cause an “inflammation” of the body. Measurements of this “inflammation” link to how well the organs function after transplant.  We know that statins have many benefits, including dampening down inflammation in the body and individual organs. 

Doctors in Finland linked this information in a clinical study. Organ donors, donating their heart, were randomised to receive a statin. The recipients who received a heart from a donor who had statins had less heart damage.  This was a small study but there was a small benefit for lung and liver recipients and no disadvantage in receiving any organ from a donor who had received the drug.   

A significant number of organs offered for transplant are not used; for the heart, this figure is about 75%.  The reason for being so selective is that poor function of the donor heart in the recipient is the most common cause of death after a transplant. Any step in the donor which might improve the transplanted heart, or other organ, could have a major benefit to the recipient.

We plan to enrol 650 adult brain dead donors across the UK per year in a randomised controlled trial.  Half the donors will receive Simvastatin in addition to standard care, compared to standard care only.  The drug will be given after the donor family have consented to both organ donation and involvement in research.  

Half of the recipients will receive a heart from a donor given the drug. We will follow the results of transplant, using data already collected in the national transplant database. No extra data or blood samples will be needed.

Project Details
Principal Investigator: TBC
Planned End Date: TBC
Local Ref: 4145

Airways-3

Randomised trial of the clinical and cost effectiveness of a supraglottic airway device versus intubation during in-hospital cardiac arrest.

A multi-centre, open label, pragmatic, individually randomised, parallel group, superiority trial and economic evaluation to determine the clinical and cost effectiveness of a supraglottic airway versus tracheal intubation during in-hospital cardiac arrest. The trial will include an internal pilot to confirm feasibility.

Chief Investigator – Professor Jonathan Benger

Principal Investigator – Dr Jasmeet Soar

Bonanza

Traumatic brain injury (TBI) is a leading cause of death and long-term disability. Approximately half of those with severe traumatic brain injury will be severely disabled or dead 6 months post injury. Given the young age of many patients with severe TBI, the economic and more importantly the social cost to the community is very high.

Management of patients with brain injuries focusses on the prevention of “secondary” brain injury. This can result from complications of the injury such as insufficient blood flow, or insufficient oxygen in the brain. The mainstay of preventing secondary injury has been the management of patients in the intensive care unit (ICU), with treatment aimed at minimising any rise in intracranial pressure (ICP) and maintaining blood flow. However, rises in ICP may be a late indicator of secondary injury

The brain depends on an uninterrupted supply of oxygen and monitoring the oxygen levels in brain tissue may provide a more useful marker of secondary injury. Several small trials have provided some promising results to support the use of monitoring and optimising brain tissue oxygenation to minimise secondary brain injury.

There have been no robust clinical trials to provide evidence to support the use of this technology. Clinicians are uncertain about the benefit of monitoring brain tissue oxygen levels. This important question would be answered by a trial testing this strategy compared to the standard management of monitoring ICP alone.

The BONANZA trial will enrol 860 patients who have suffered a severe TBI and require ICP monitoring. Each patient will be randomised to either a brain tissue oxygen monitoring strategy (including ICP monitoring) or the standard strategy of ICP monitoring alone. Functional and neurological recovery will be assessed at 6 months post injury to see if there is a difference between both groups of patients.

PI: Dr Matt Thomas

Planned end date: 1st December 2026

Local ref: 5381

GENOMICC

GENOMICC - Genetics Of Mortality In Critical Care

The study will work within the International Severe Acute Respiratory Infection Consortium and International Forum of Acute Care Trialists, two global initiatives , to establish a prospective DNA resource for hypothesis-testing and genome-wide discovery of host genetic variants underlying susceptibility to severe infection, and outcome from life-threatening systemic injury. We will: Obtain a single DNA sample from patients with:

  1. Susceptibility to severe disease;
  2. Susceptibility to specific outbreaks and exposures of public health interest;
  3. Susceptibility to death following onset of severe illness due to specific syndromes,

And;

  1. Susceptibility to death from quantifiable sterile injury.

Obtain DNA from the parents of patients with extreme susceptibility to eligible syndromes (those under 40 and free from significant comorbidity).

Obtain DNA samples, where possible, from appropriate comparison or control groups.

Combine existing DNA resources in a virtual collaborative network to enable rapid hypothesis-testing of candidate variants.

Establish and continually replenish a small cohort of individuals with known profound susceptibility to specific pathogens, who will be invited to provide repeat samples for in vitro studies of cellular responses to relevant stimuli.

Where appropriate and implementable, allow return of clinical relevant information to the NHS regarding participants.

Allow lifetime linkage (and beyond) to healthcare and other relevant data (including registries, healthcare records, research datasets, and lifestyle and other data).

Chief Investigator – Professor JK Baillie

Principal Investigator – Dr Matt Thomas

March

MARCH - Mucoactives in Acute Respiratory failure: Carbocisteine and Hypertonic saline.

When patients are critically ill, one of the main complications is called ‘acute respitatory failure’. This is when the patient’s illness causes their lungs to fail to work. Patients need to be admitted to the Intensive Care Unit and often need to have a breathing machine, or ventilator, to help them breathe and ensure that enough oxygen gets into their blood.

However, one problem that can occur as a result of being on a ventilator, is difficulty clearing secretions from the lungs. This can happen for a number of reasons. Lack of the body’s own natural moisture in the airways can make the secretions become very thick and dry. The breathing tube from the ventilator can also make coughing up secretions more difficult. Patients may also feel too sleepy from their medication to cough by themselves. Not being able to clear secretions from the lungs can make breathing harder, and this may result in developing a lung infection.

To reduce the problem of thick secretions, the air coming from the ventilator can have moisture added to it. Other treatments can include using a suction tube to remove secretions via the breathing tube. Physiotherapists may also use techniques to help clear secretions. In some cases, medications called ‘mucoactives’ may be prescribed for patients. However, even though mucoactive medications are commonly used in patients with lung failure in the ICU, we do not know if these medications really help patients when they have thick secretions that are difficult to clear.

The aim of this study is to determine whether use of mucoactives in critically ill patients with acute respiratory failure improves outcomes and is cost effective, compared to usual airway clearance management. The study objectives are to conduct a large, UK, multi-centre, pragmatic, randomised controlled trial to:

  1. Determine the clinical effectiveness of two mucoactives (carbocisteine or hypertonic saline), or a combination of both, on duration of mechanical ventilation (primary outcome), and a range of secondary clinical and safety outcomes.
  2. Estimate, in an integrated economic evaluation, the cost-effectiveness of the mucoactives.

Chief Investigator – Professor Danny McAuley

Principal Investigator – Dr Matt Thomas

Take Part in Research

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Become one of the thousands of people taking part in research every day within the NHS.

About Research & Development

NBT Researcher

Find out more about our research and how we're working to improve patient care.

Contact Research

Research & Development
North Bristol NHS Trust
Level 3, Learning & Research building
Southmead Hospital
Westbury-on-Trym
Bristol, BS10 5NB

Telephone: 0117 4149330
Email: research@nbt.nhs.uk

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ICU Echocardiography

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Southmead Hospital ICU has a well-established FICE (Focused Intensive Care Echocardiography) service, with 10 FICE-accredited consultants and 6 FICE mentors.

We hold quarterly FICE governance and echocardiography update meetings, which are open to all who are interested and we have previously hosted a FICE training course. We actively encourage ICM trainees to participate in FICE training during their time with us and have helped a number of trainees to achieve FICE accreditation.

FICE scans performed on the unit are archived to our hospital PACS system and we are well-supported by the echocardiography department in Southmead Hospital.

New Meeting topic 18/12/2017: ‘Pearls and pitfalls in Intensive Care Echocardiography’

FICE CPD Meeting Topics 2018:

  • 12/03/2018: EDEC and Extended FICE

FICE CPD Meeting Topics 2017:

  • 19/12/2016 Pericardial effusions and tamponade
  • 27/03/2017 TTE to predict fluid-responsiveness
  • 19/06/2017 Diastolic heart failure on the ICU
  • 18/09/2017 Topic TBC

ICU Operational Delivery Network

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Southmead ICU is a part of the Southwest Critical Care Network. 

The South West Critical Care Network (started in 2014) aims to promote excellence of care for critically ill patients; support critical care providers and commissioners to ensure an integrated approach to the planning and delivery of critical care, and to support continual quality improvements.

ICU Team

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Patients on our Intensive Care Unit are cared for by a highly skilled, specialist multi-disciplinary team of over 300 staff. This includes 27 Intensive Care Consultants, resident doctors, advanced practitioners, specialty medical and surgical teams, nursing staff, physiotherapists, dieticians, speech and language therapists and pharmacists.

ICU Leadership Team 

  • Dr Chris Newell (Clinical Lead for ICU)
  • Dr Andy Ray (Deputy Clinical Lead for ICU)
  • Valentien Crook-Jones (Lead Nurse Critical Care)
  • Mo Maddock (ICU Matron)
  • Jay Parry (ICU Manager)

ICU Administrator

  • Chantelle Stephens 

ICU Consultants

  • Dr Charis Banks
  • Dr Jules Brown
  • Dr Kristina Birch
  • Dr John Cameron
  • Dr Kate Crewdson
  • Dr Keith Davies
  • Dr Scott Grier
  • Dr Dominic Janssen
  • Dr Rachel Jones
  • Dr Anne Kendall
  • Professor David Lockey
  • Dr Aidan Marsh
  • Dr Skylar Paulich
  • Dr Cathy Ross
  • Dr Matt Rowe
  • Dr Liam Scott
  • Dr Aggie Skorko
  • Dr Reston Smith
  • Professor Jas Soar
  • Dr Ian Thomas
  • Dr Matt Thomas
  • Dr Julian Thompson
  • Dr Ben Walton
  • Dr Stephen West
  • Dr Chris Williams

Allied Healthcare Professionals – ICU Clinical Leads

  • Susan Harrison, Zoe Stone, Emma Wickman (Clinical Lead Physiotherapists).
  • Lucy Holmes (Highly Specialised Intensive Care and Theatres Pharmacist).
  • Lynsey Francey (ICU Dietitian Team Leader).
  • Melissa Varia (Speech and Language Therapy Pathway Lead).
  • Emma Bailey (Speech and Language Therapy Team Lead).     
  • Dr Nicholas Ambler (Consultant Clinical Psychologist).

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ICU Visitor Information

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We recognise that having someone close to you in Intensive Care can be distressing. Southmead ICU is a large unit and visiting can feel overwhelming. We are all here to help and support you. Please feel free to ask questions at any time.

Our Intensive Care team has a large number of staff including:

  • Doctors
  • Nurses
  • Critical Care Practitioners
  • Allied Healthcare Professionals
  • Administrative and support staff 

The ICU is divided into four separate areas know as pods, each containing 12 beds. 

  • Pod A beds 1-12.
  • Pod B beds 13-24.
  • Pod C beds 25-36.
  • Pod D beds 37-48.

When your loved one is admitted to the ICU you will be told their Pod and room number. You will also be given a phone number to call directly to that room. You may be asked to set up a password to allow staff to confirm who you are. This makes sure your loved one's privacy and confidentiality is always maintained. You can phone us any time, day or night. We will always try to answer calls to the bedside straight away. Sometimes when we are providing patient care we may not be able to do this. If we do not answer the phone, please do not worry - we ask you to try again in 15 minutes. 

Our ICU reception is open:

  • Monday to Friday, 08:00 to 20:00.
  • Saturday, Sunday, and bank holidays, 08:00to 19:00.

Outside these hours we have an intercom system which links directly to the Pods. Sometimes the clinical areas may be busy so do not be concerned if we do not answer straight away. Please try again in a few minutes. 

Visiting ICU

Our ICU is located at Gate 37 on Level 2 of the Brunel Building. Our reception can be contacted directly on: 0117 414 1400

For information about how to find us visit Southmead Hospital | North Bristol NHS Trust

ICU visiting times are from 11:00 to 19:00.

We have a limit of two visitors at the bedside at any one time. This is in line with the overall Trust visiting policy. This ensures safety on the unit and respects the privacy of other patients and their families. We can allow children to visit when appropriate but please discuss this with one of our senior nurses beforehand.

There may be times when we ask you to leave the room whilst we provide essential patient care. You may wait in the reception waiting area until you are called back in. The rooms at the entrance of the pods are reserved for private discussions so we ask you to keep these rooms free.

Patient rooms

Each patient room has an ‘About me’ board. You can use this to display photographs or information about your loved one that you would like to share with us. This can include things like their favourite music or radio station which can help us to provide personalised care.

Around each bed there is a lot of essential equipment which helps us look after your loved one. Please try not to focus on this and concentrate on spending time with your relative or friend.  They will be supported and encouraged by you being there. You can hold their hand, comfort and talk to them. Familiar faces and voices may help to orientate them and reassure them, even if they cannot respond at the time.

Updates

When a patient is admitted, we may need to perform urgent investigations and procedures. This can take some time and may mean that it is more than an hour before we can update you. We will always update you as soon as possible after your loved one is admitted. 

We record contact details for the patient’s closest family and friends to keep you updated. It is helpful for us to have one member of the family as a point of contact. It is difficult for us to keep multiple relatives updated separately, so we ask to communicate mainly with those closest to the patient. We aim to update you regularly and certainly if there are major changes in your loved one’s condition. If you would like an update directly from the medical team or have any concerns about your loved one’s condition or their care, please let us know. 

Accommodation

For visitors who come from further away we have limited accommodation for up to 48 hours. If accommodation is needed for longer, we can give you details of locally available options.

ICU Garden

We are very fortunate to have a dedicated garden space between Pods B and C in the ICU. This is a fantastic outdoor space which was made possible by support from the ICU charitable fund. It allows us to take patients outside during their recovery and rehabilitation. 

Visiting the garden may not be appropriate for all patients, but will be considered on a case-by-case basis. This depends on each patient’s clinical condition and the treatment they are receiving at that time. If you think your loved one would enjoy or benefit from time in the garden, please discuss this with the nurse looking after them. 

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Dr Sarah J Villar - Rheumatology

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GMC Number: 6165975

Year of first qualification: 2008, University of Edinburgh

Specialty: Rheumatology

Clinical interests: General rheumatology, inflammatory arthritis and temporal arteritis

Secretary: Caroline Reed

Telephone: 0117 340 8510

Dr Villar is involved in all aspects of rheumatology but has a particular interest in inflammatory arthritis and temporal arteritis. She also enjoys teaching and is training in musculoskeletal ultrasound.  

Dr Villar is a member of the British Society of Rheumatology and Royal College of Physicians.
 

Villar

Ms Hannah Lane BSc (Hons)

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Ms Hannah Lane, BSc (Hons)

Speech and Language Therapist

I studied Speech and Language Therapy at Birmingham City University and graduated in 2016. I am now working as a paediatric Speech and Language Therapist for Doncaster and Bassetlaw Hospitals NHS trust. I work in the community and my role is split across community clinics, a severe learning disability school and pyramids of mainstream schools. I have recently been given the new role as Cleft Lip and Palate LINK therapist so am now responsible for the management and therapy for a caseload of children with Cleft Lip and Palate and an important part of my job is liaising with regional Cleft hubs and specialists.
I am working with the Unit on a project as part of my internship with the National institute of Health Research which will take place for the next 6 months. The project I am involved in is aiming to explore the impact of early intervention on speech in children born with cleft palate. This is an area of significant interest to me and I am hoping to expand this research into an MSc project and contribute to the growing evidence-base for children with speech difficulties.

Current research

Exploring the impact of early intervention on speech in children born with cleft palate.

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