Research publications

 

Find all publications organised and funded by the Intensive Care Foundation.

Age of Transfused Blood in Critically Ill Adults


Effect of “collaborative requesting” on consent rate for organ donation: randomised controlled trial (ACRE trial). Open access.


Acute organ failure​


Risk factors for acute organ failure in ICU patients with single organ (respiratory) dysfunction or failure: An international, prospective, cohort study. 
PubMed.


Acute lung injury


Pro: β-agonists in acute lung injury--the end of the story? Open access


ARDS


The rise and fall of β-agonists in the treatment of ARDS. Open access .


BALTI - Prevention


A randomized placebo controlled multicentre UK study of 179 patients undergoing elective oesophagectomy in 12 Critical Care Units did not show any significant improvement in outcome when pre-treated with B2 Agonists. Open access.



A multi-centre trial examining the safety and effectiveness of intravenous salbutamol for ARDS.

The study found that the use of intravenous salbutamol was harmful. UK ARDS and international sepsis guidelines recommend this therapy is no longer used and clinicians should continue with best supportive care. Open access.




The outcome shows a wide variation in practice around the translational of DNACPR national guidelines into local practice. A better understanding from this study of the reasons for this variation and making the users aware of this variation will improve standardisation and adoption across the UK, and will reduce some of the adverse patient and relative experiences which have been frequently described in the media. Open access.


HOPE (HalOPeridol: Effectiveness trial)


Intravenous Haloperidol is the most commonly used therapy in critical care for the treatment of Delirium. 142 critical care patients were randomized to receive intravenous haloperidol v N saline to treat acute onset of delirium. Haloperidol did not reduce the duration of delirium in these patients compared with placebo.

This study has helped us to move onto other strategies which may prove more effective. Open access.


ICAN


An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study. PubMed.


ICON - Intensive Care Outcomes Network


This is a long-term study of patients who have spent at least 24 hours on an intensive care unit. The study was lead by principal investigator Dr Duncan Young from John Radcliffe Hospital Oxford.

It provides a comprehensive assessment of quality of life and psychological health for up to 2 years after discharge and describes the impact of an intensive care stay on development of stress related disorders, anxiety and depression. This has never previously been studied in such detail.​


LeoPARDS


Overwhelming infection, often called sepsis, is a major problem for the health community. Leopards was a double-blind, randomized clinical trial to investigate whether levosimendan a calcium sensitizing drug reduces the severity of organ dysfunction in adults with sepsis. 516 patients in 34 Critical Care Units were randomly assigned to receive a blinded infusion of levosimendan for 24 hours or placebo in addition to standard care. 

The primary outcome was the mean daily Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes included 28-day mortality, time to weaning from mechanical ventilation, and adverse events. The addition of levosimendan to standard treatment in adults with sepsis was not associated with less severe organ dysfunction or lower mortality. New England Journal of Medicine, 2016; 375:1638-1648, October 27, 2016. Access here (behind a paywall).





Paramedic


A pragmatic cluster randomized controlled trial in which 4471 patients in cardiac arrest in the community either received chest compression delivered by a mechanical (Lucas2) device (1652) or manual chest compressions (2819). The device was assigned in a ratio 1:2 ambulances within each of 4 Ambulance Trusts in UK.

This very large study failed to show any benefit of this mechanical device in reducing mortality. Therefore a strong recommendation is that although these devices do no significant harm, a cost benefit of the device cannot be supported. Open access.



A UK wide prospective study, to determine whether collaborative requesting (jointly by transplant coordinator and medical staff), increases successful consent for organ donation from the relatives of patients declared dead by criteria for brain stem death. Completed in 2008. Open access.


Plasma transfusion


A national clinical scenario-based survey of clinicians' attitudes towards fresh frozen plasma transfusion for critically ill patients. PubMed.


SuDDICU


Clinical components and associated behavioural aspects of a complex healthcare intervention: multi-methods study of selective decontamination of the digestive tract in critical care. PubMed.


TRACMAN


TRACMAN (tracheostomy management in critical care) is a study in 70 UK Critical Care Units involving 909 ventilated patients clinically shown to warrant a Tracheostomy to aid on going care were randomized to receive Tracheostomy by Day 4 of Ventilation or delay tracheostomy to day 10 unless extubated before. There was no significant difference in mortality outcome between these groups.

This was a particularly important study, the findings of which reversed a trend to perform early tracheostomy in UK critical care patients. This effectively reduces the risk to patients of unnecessary Tracheostomy giving the clinician more confidence to persevere with conventional extubation strategies for up to 10 days. Open Access.​


VACS


VACS (the interaction of vasopressin and corticosteroids in septic shock: a pilot randomized controlled trial) is a small randomised controlled trial to test for a biological interaction between vasopresssin and corticosteroids to act as a pilot study for further investigation.

The study found that hydrocortisone spared vasopressin requirements, reduced duration, and reduced dose, when used together in the treatment of septic shock, but it did not alter plasma vasopressin levels. Further trials are needed to assess the clinical effectiveness of vasopressin as the initial vasopressor therapy with or without corticosteroids. PubMed.





In focus: Extreme Everest

 

In 2007, The Caudwell Extreme Everest research series were carried out. This was in part funded by the ICF (£50k grant out of total of circa £2.5M). See all publications below.
Acclimatization of skeletal muscle mitochondria to high altitude hypoxia during an ascent of Everest. PubMed abstract.

The role of nitrogen oxides in human adaptation to hypoxia. PubMed abstract.
Cerebral artery dilatation maintains cerebral oxygenation at extreme altitude and in acute hypoxia – an ultrasound and MRI study. Open access.

Sleep at Altitude: A Comparison of Therapies. PubMed abstract.
A novel ambulatory closed circuit breathing system for use during exercise. PubMed abstract.
Cardiac response to hypobaric hypoxia: persistent changes in cardiac mass, function, and energy metabolism after a trek to Mt. Everest Base Camp. PubMed abstract.
Design and conduct of Caudwell Xtreme Everest: an observational cohort studyof variation in human adaptation to progressive environmental hypoxia. PubMed abstract.

The Effect of High-Altitude on Human Skeletal Muscle Energetics: 31P-MRS Results from the Caudwell Xtreme Everest Expedition. PubMed abstract.

Changes in sublingual microcirculatory flow index and vessel density on ascent to altitude. PubMed abstract.

Changes in skeletal muscle oxygenation during exercise measured by near infra-red spectroscopy on ascent to altitude. PubMed abstract.

Arterial blood gases and oxygen content in climbers on Mount Everest. PubMed abstract.

Simultaneous multi-depth assessment of tissue oxygen saturation in thenar and forearm using near-infrared spectroscopy during a simple cardiovascular challenge. PubMed abstract.

The Young Everest Study: Effects of hypoxia at high altitude oncardio-respiratory function and general well-being in healthy children. PubMed abstract.

 

Abnormal blood flow in the sublingual microcirculation at high altitude. PubMed abstract.  


Supplemental oxygen and hyperbaric treatment at high altitude: cardiac and respiratory response. PubMed abstract.

Supplemental oxygen effects on ventilation in acclimatized subjects exercising at 5700 m altitude. PubMed abstract.

 

Angiotensin-converting enzyme genotype and successful ascent to extreme high altitude. PubMed abstract.