Intensive Care Foundation Scientific Achievements
Since its inception in 2003, the activities of the Intensive Care Foundation have increased in an exponential manner.
The Foundation has supported individuals to obtain fellowships in intensive care medicine. These fellowships provide project and salary support for the individual for 3-5 years.
Xtreme Everest 2 Research Project
The Intensive Care Foundation are proud to be able provide a research grant of £2000 to Lucy Brennan who was awarded a place on the fantastic Xtreme Everest 2 research project . This project is made up of a research team of intensive care doctors, nurses and scientists who conducted experiments on themselves and other volunteers at high altitudes in order to develop novel therapies to improve the survival rates of patients in intensive care. In order to simulate the critical conditions of intensive care, the team trekked to Kathmandu, Namche Bazaar and Everest Base Camp. The volunteer groups joining the Xtreme Everest scientists also included lowlanders, identical twins, children and sherpas.
Lucy Brennan was assigned to the children's trekking group which aims to correlate the research findings to intensive care patients at Great Ormond Street Hospital and the Institute of Child Health. Lucy trekked with the children and their families to Namche Bazaar (3,700m) where a mobile lab was set up and investigations carried out. These same investigations were carried out prior to the expedition, in London. The results will be collected to compare how children respond and adapt to low oxygen levels and ultimately provide insight into how children respond to certain treatments in paediatric intensive care.
Upon her return Lucy Brennan updated us on the expedition. "I have now returned from Nepal after a fantastic expedition having made it to Everest Base Camp. The research was successfully completed and all children who were tested have returned home safely. It was certainly a trip that has given me such brilliant research experience as part of such a novel project. "
Lucy added, "I was delighted to accept your grant - it has really made all of the difference to me being a part of the research team and will certainly help with my future career and has ignited a great enthusiasm for intensive care".
We wish Lucy and her research colleagues all the best and hope that their findings provide the insight needed to further the understanding of various treatments and conditions within intensive care.
-Photos to follow-
Further information on the Xtreme Everest 2 research project.
Bi annually members of the society active in research meet to decide upon the research priorities for the ICS Foundation with the Directors of Research. The first study to come out of this exercise was the TracMan trial further details of this trial can be viewed below.
BREATHE: Patients with acute respiratory failure often require help with their breathing. This is done by a mechanical ventilator by means of a breathing tube into the patient’s airway until the cause of the respiratory failure improves and is known as invasive ventilation. However invasive ventilation used over a prolonged period of time might lead to ventilator associated pneumonia which increases the risk of other problems and sometimes proves fatal. For these reasons, doctors caring for patients who need invasive ventilation always try to reduce the duration of this type of ventilation while at the same time working towards the patient’s improvement so that the breathing tube can be removed.
There is some evidence to suggest that use of non-invasive ventilation to wean critically ill adults off invasive ventilation is associated with a reduction in death rates and other benefits to patients.
The BREATHE study involving a number of hospitals is designed to evaluate the clinical benefits and cost effectiveness of using non-invasive ventilation to wean patients off invasive ventilation.
The Foundation has had a major part to play in the delivery of the following trials: To view a full project update please click on the hyperlinks.
ICON: The world’s largest multicentre, long term follow up of ex-ICU patients, which provide a resource for health economic evaluations of nearly all ICU interventions. This has now received funding support from the BUPA foundation.
OSCAR: This study, involving a large number of hospitals, compared two very different ways of supporting patients with severe failure of their lungs. Patients received either conventional treatment with a standard ventilator which delivers air and oxygen constantly, or a different treatment with a specialist ventilator which involved delivering very small amounts of an air and oxygen mixture at very high rates, this strategy was previously found to be effective in very small babies. It was uncertain whether or not it would be beneficial for adults. The results have now been published, and, broadly, the findings were that for the majority of patients with severe respiratory failure it was not possible to demonstrate a difference between the two treatments.
This Trial has now stopped recruiting and the results were published in December 2012.
SimSept: This was a study in which patients were either given a drug which is normally used to control cholesterol or a placebo. This small exploratory study demonstrated that in critical illness the body handles these sorts of drugs in unexpected ways. This forms useful background information for the development of larger studies.
BALTI-prevention: A proportion of patients who are having major surgery to remove part or allof their oesophagus (gullet) will develop significant difficulties with their breathing and possibly acute severe lung failure after their operation. This study, which included a number of hospitals, looked to see whether or not patients who received an inhaled drug commonly used in the treatment of asthma had a reduction in the likelihood of the typical post-operative problems when compared with those on the placebo. The results of the trial were presented in December 2012. Although the treatment did not reduce the number of people that experienced lung failure, the information from the study provided doctors and nurses with valuable new insights into this condition.
This Study stopped recruiting in 2012. Results were presented during the State of the Art meeting 2012
BALTI-2: Beta agonists are drugs that are used routinely to treat patients with lung disease. The BALTI study (Beta Agonist Lung Injury Trial) tested whether an infusion of these drugs was effective for helping patients with severe acute lung damage know as acute respiratory distress syndrome. The trial was stopped early when it was found that treatment with beta agonists was poorly tolerated and might be harmful. The information from this study has been included in international clinical guidelines for treating patients with this condition. It has informed doctors and nurses around the world to stop routinely using this treatment for acute respiratory distress syndrome.
HOPE (HalOPeridol: Effectiveness trial) Many patients in the intensive care unit experience periods where their thinking is very unclear and they become confused – we often refer to this as delirium. In this study Dr Valerie Page at Watford General Hospital gave patients a commonly used tranquiliser-type drug to see if this could be prevented. The study showed this treatment was safe and well tolerated and it played a key role in highlighting the importance of this condition in ITU patients.
MoDUS (Modifying Delirium Using Simvastatin) This follow-on study from HOPE involved giving patients a widely used cholesterol lowering type of drug to see whether it had an impact on delirium. This may seem an odd thing to do, but there is a lot of evidence that these cholesterol-lowering drugs have wide ranging effects in all sorts of biochemical processes including those associated with inflammation. This inflammation can also occur in the brain, and it is conceivable that by using these drugs it may be possible to calm down any inflammatory processes occurring in the brain and benefit patients who are at high risk of delirium.
TracMan: Large numbers of patients who require the support of a mechanical ventilator in the intensive care unit undergo a procedure called a tracheostomy. This involves passing the tube from the ventilator (breathing machine) into the patient’s windpipe through the front of the neck rather than having it going down through their mouth or nose and across the very sensitive vocal cords. The tracheostomy generally makes patients more comfortable and allows them to be nursed while they are much more awake. What was uncertain was whether or not there was a clear benefit of having a tracheostomy placed early in a patient’s stay in the intensive care unit or later on. This large trial, which involved a large number of hospitals, has demonstrated that overall there was no benefit of an early or indeed a late decision to perform a tracheostomy. Thus, the best approach appears to be to make an individual decision for the patient rather than following a particular instruction.
ACRE: A UK wide study of optimal practice in requesting organ donation, which both shapes practice locally and policy nationally. Completed.
PERMIT: A pilot study of a mandatory insulin infusion protocol, which demonstrated this treatment helps prevent muscle degeneration but also highlighted its hazards in routine clinical practice. Completed.
Haloperidol vs. placebo in critically ill ventilated patients: an effectiveness trial: A single centre randomised controlled trial of haloperidol vs. placebo for treatment of delirium. Closed and will be presented at State of the Art Meeting 2012
Balti - Prevention: Trial closed in March 2010. Results published
The Foundation through previous or ongoing collaborations of the Directors of Research has supported the delivery of the following trials:
ISOC study (FFP): An observational study of coagulopathy management in UK ICUs, showing a wide variation in practice.
In addition the ICF is involved in supporting the development of the following trials:
SuDDICU (selective decontamination) project: A proportion of patients who are on a mechanical ventilator in the intensive care unit will develop infections in their lungs and possibly be at risk of acquiring pneumonia. This is thought to be associated with the upper part of their intestinal system (or gut) developing growths of bacteria in places where they normally would not be. Thus, there is a debate over whether or not treating people in the early part of their admission with medicines that reduce the presence of these “colonizing” bacteria to very low levels might reduce the likelihood of pneumonia associated with being on a ventilator. This is called selective decontamination of the digestive track. This treatment has not been taken up by the intensive care community in a very widespread way despite there being some evidence that it is effective. Thus, a large project has been developed which is part of an international collaboration designed to study this area. The first part of the project tried to understand why doctors and nurses adopt particular practices and how that relates to the available evidence. The second part of the project, for which funding is currently being sought, will conduct a very large trial to establish once and for all whether or not this is an effective treatment.
VANISH (vasopressin in sepsis):The VANISH trial is the large scale clinical trial referred to in the last sentence of the VACS trial. Thus, patients with low blood pressure due to severe infection will enter a trial which will aim to establish whether Vasopressin or another drug called Noradrenaline, with or without steroid drugs, will be beneficial. The main “end point” is to establish which treatment is better to reduce the likelihood of patients developing kidney failure. Information from earlier trials suggests that treating patients quickly with Vasopressin may reduce the likelihood of the development of kidney failure which sometimes happens in patients with very severe infections. This needs to be evaluated in a proper clinical trial, hence VANISH.
ISOC-2 study (FFP): A multicentre pilot study of standard versus restrictive use of FFP for the management of coagulopathy in UK ICUs.
Forthcoming projects the Foundation will be involved in
VACS: Many patients in the intensive care unit, especially those with severe infection and whose blood pressure has fallen to dangerously low levels, require drugs to bring their blood pressure up to normal levels. A variety of drugs can be used to restore blood pressure to normal, but there is uncertainty over which is the best one to choose. The VACS trial was a “pilot” trial to see if the use of a drug called Vasopressin, either with or without treatment with steroid drugs, was beneficial. In addition it explored whether or not it would be feasible to conduct a very large scale clinical trial. The outcome of VACS was that Vasopressin appeared to be safe in patients in the intensive care unit, and that it seemed feasible to conduct a large scale clinical trial.
VAP Ventilator Associated Pneumonia: A multi-centre trial looking at rapid detection and treatment of ventilator-associated pneumonia.
The Intensive Care Foundation has an excellent track record in supporting/endorsing successful applications for NIHR clinician scientist awards relevant to ICU. This support involves reviewing and providing feedback on the application as well as being able to state in the application it is supported by the Intensive Care Foundation. We would be happy to provide this support for post doctoral research / clinician scientist / intermediate fellowship applications.
Department of Health National Institute of Health Research Clinician Scientist
Prof Gavin Perkins & Dr Anthony Gordon - The ICF is pleased to congratulate Dr Anthony Gordon, Consultant & Hon. Senior Lecturer in Critical Care Medicine, Charing Cross Hospital, on his award of a National Institute for Health Research Clinician Scientist Fellowship. The NIHR-CS Award is a post-doctoral research training fellowship funded by the Department of Health. These awards are intended to build a cadre of research-led clinical academics capable of leading research in their discipline and provide up to five years post-doctoral funding (salary and some research costs). They will support research aimed at improving the service and/or treatment delivered to patients by the NHS. This is superb achievement by Dr Gordon and a very positive reflection on the status of critical care.
Dr Gordon’s application was based around his “Vasopressin vs Noradrenaline as Initial therapy in Septic Shock (VANISH) Trial” supported by the ICF and selected by the ICS membership in the 2008 research priority setting exercise.
There are now three NIHR-CS award holders in the UK within adult critical care; the others being Dr Gavin Perkins, University of Warwick, ICF Co-Director of Research (BALTI-Prevention trial) and Dr Rupert Pearse, University of London (OPTIMISE trial).
Dr Steven Harris - B Braun ICF MSc Award 2007 has been appointed as a Welcome Fellow.
B Braun ICF funded MSc Distance Learning Courses awarded from 2006 - 2010
The Intensive Care Foundation was established by the Society with the aim of establishing and maintaining a clinical research network. Part of maintaining a clinical research network involves encouraging young energetic researchers to provide future leads in research. Since 2006 this has been done by supporting MSc in Clinical Trials. Four MSc Students have received support since inception, one has gone on to be awarded a Wellcome Research Training Fellowship to complete a PhD. A summary of their experience is available by clicking on the name of the student.
MSc Award Winners
2010: Richard Porter
2009: Dr Michael Irvine
2008: Dr Rashan Haniffa
2007:Dr Steve Harris
2006:Dr Ramini Moonsinghe