Listed below are the projects that have received Intensive Care Foundation research grants and their current status. Should you require any further information, please contact the Foundation.
Principal Investigators: Dr David Gattas, Ms Dorrilyn Rajbhandari, Dr Celia Bradford and Prof Rinaldo Bellomo
Acute kidney failure is a common and clinically important problem for patients in the intensive care
unit (ICU). Continuous renal replacement therapy (CRRT), a type of dialysis treatment, is used to
support these patients. CRRT is also a very resource-intensive treatment to use safely and
effectively in extremely unwell patients.
During CRRT, blood is circulated outside the body and then ‘cleaned’ by passing it through a
complex series of tiny membranes held inside a filter). Unfortunately, this process also stimulates
the blood to clot inside the filter. This clotting is preventable by also treating patients with blood
thinners (anticoagulants). If the filter becomes clotted with blood, the entire apparatus attached to
the CRRT machine must be replaced. This process interrupts CRRT for the patient, may result in
blood loss, and consumes precious time and resources. Anticoagulants, on the other hand, pose a
risk of bleeding elsewhere and they must therefore be used very carefully so that this risk is low but
the CRRT treatment is still able to run smoothly.
This clinical trial will compare two different ways of anti-coagulating the CRRT filter to see which
method is better at making the filter run smoothly without clotting. The two anticoagulants that we
will use are citrate and heparin. Both will be delivered to the filter and blocked by other medications
(calcium and protamine) so that the blood inside the filter is “thinned” but the blood inside the patient
is not.
The trial has the potential to improve the quality and safety of delivering CRRT to patients, decrease
blood loss and conserve substantial ICU resources all at the same time.
Principal Investigators: A/Prof Hayden White, Prof Bala Venkatesh, Dr Teong Chuah
Traumatic brain injury (TBI) is one of the most common causes of morbidity and death in young people. Currently, much of the management is based on empirical evidence and small studies. A mainstay of treatment for brain swelling which accompanies TBI is to administer fluids which help to shrink the brain. The 2 commonest fluids used are mannitol (sugar based solution) and hypertonic saline (sodium chloride solution). These solutions work by drawing fluid out of the brain tissue, thus shrinking the brain and decreasing pressure. Both have significant side effects and neither provides nutrients to the brain tissue.
We intend to use a novel solution containing hypertonic saline and ketone bodies (fatty acids) as a means of treating TBI. Initially however, we need information about the metabolic effects of this sodium ketone solution. The purpose of this study is to investigate these effects before we can advance to human studies. Sodium ketone (NaBHB) solutions of varying concentrations will be administered to rats. The results of this experiment will provide new information regarding the time course and magnitude of changes in blood and CSF levels of ketones, glucose and acid/base. Once the metabolic effects have been confirmed, a head injury study will be designed. This will pave the way for a similar study in humans and if the results are confirmed in humans, may lead to the development of a new treatment for TBI
Principal Investigators: Prof Rinaldo Bellomo, Dr J Prowle
Acute kidney injury (AKI) occurs in more than 30% of ICU patients and is severe (requires dialysis) in 5%. Its treatment with dialysis is invasive and costly. More than 50% of such patients die. Despite the importance of AKI, we have limited understanding of what causes it to happen. Traditionally, doctors have believed that decreased blood flow to the kidneys is responsible for it. However, this is doubtful. Experimental animals with severe infection can develop AKI despite very high kidney blood flow. Small studies in humans have suggested the same. However, the major problem with being able to know if decreased blood flow is really the cause of AKI in ICU is that measuring it safely and accurately has been very difficult and dangerous.
Recently, however, magnetic resonance technology has been developed that makes such measurement possible safely and accurately. This is called “cine phase-contrast MR scanning”. In our hospital, we have developed a combination of unique local expertise in AKI and cine phase-contrast MR imaging with a new software, which now makes such measurements possible. In this study we plan to measure kidney blood flow in critically ill patients with AKI and normal volunteers. This will give us new insights into the causes of kidney failure. With these results, we will then later go on to test potential treatments for AKI in the future using such monitoring of blood flow to guide them. This approach is going to represent a major change in patient monitoring and treatment and will be a “first in the world” investigation.
Principal Investigators: Prof Jeffrey Lipman, A/Prof Steve Webb, Dr Joel Dulhunty, Prof John Myburgh, Prof Rinaldo Bellomo, Prof David Paterson, Dr Jason Roberts, A/Prof Charles Gomersall
Beta-lactam antibiotics are commonly used to treat life-threatening infections in critically ill patients. As a class of antibiotics, beta-lactams are known as "time-dependent" antibiotics because they have their greatest effect when the antibiotic concentration in the blood remains above a critical level (dependent on the organism being treated) for the duration of the course. Continuousinfusion of beta-lactams has been shown to more consistently achieve these time-dependent pharmacodynamic endpoints than the standard practice of bolus dosing. However, the relatively small and often poorly designed randomised controlled trials to date have not shown improved clinical outcomes, such as resolution of infection or lower mortality. Better evidence is required from well-designed trials with adequate numbers of patients.
The purpose of this pilot randomised controlled trial of beta-lactam antibiotics delivered by continuous infusion compared to the standard bolus dosing regimen typically employed in critically ill patients. This pilot trial will be carried out by a multi-centre collaborative team which includes intensive care specialists, an infectious diseases physician and a clinical pharmacist with international recognition research into antibiotic therapy for severe and serious infections in critically ill patients.
Principal Investigators: A/Prof Yahya Shehabi, Dr Ian Seppelt, Dr Kanaka Sundaram Rachakonda, Dr Martin Sterba
Procalcitonin, a substance produced in the body, can be detected in the blood of people with an infection. Procalcitonin may be detected in the early stages of an infection, and levels increase when an infection becomes severe. It cannot be detected in a healthy person’s blood. Recently research studies have looked at using blood levels of procalcitonin to guide doctors in prescribing antibiotic treatment for patients with infections, and compared this with the normal way antibiotics are prescribed. The results have shown that patients who had their treatment guided by procalcitonin levels, were less likely to be prescribed ‘unnecessary’ antibiotics, and received antibiotics for a shorter time without it affecting their outcome. There have been no large research studies in Australia that evaluate using Procalcitonin levels to guide antibiotic treatment in intensive care.
Patients in this study will be randomly placed into one of two groups. One group will have their antibiotic treatment guided by their doctor based on their Procalcitonin levels, and the other group will have their antibiotic treatment guided by the treating doctor in the usual way. The purpose of this study is to investigate if Procalcitonin guided therapy improves the accuracy and suitability of antibiotic treatment in patients with presumed infection. Procalcitonin therapy may lead to a potential reduction in hospital acquired infections, including antibiotic resistant infections such as ‘golden staph’,resulting in a reduced length of stay in ICU and hospital. This will be investigated by comparing the two groups.
Principal Investigators: Dr Ian Seppelt, Prof John Myburgh, Prof Simon Finfer, Prof Jeffrey Lipman, Prof David Paterson, Prof Brian Cuthbertson, Dr Jillian Francis, Dr Parisa Glass
Infections acquired in hospital are a major cause of illness and death for patients, and markedly
increase health care costs. Intensive care patients are particularly susceptible to these infections
and do badly if they acquire them. Simple interventions such as hand washing can reduce the
frequency of these infections but are not enough alone to prevent them from occurring.
Selective Decontamination of the Digestive tract (SDD) is one lintervention which may reduce
infection rates and deaths from these hospital acquired infections is. SDD involves the application of
antibiotic pastes to the mouth, throat and stomach and a short course of antibiotics into a vein. The
evidence supporting the use of SDD is strong with 28 randomised controlled studies in the medical
literature. However, intensive care staff have been reluctant to use SDD, due to fears that perceived
overuse of antibiotics will lead to infection with organisms such as MRSA and Clostridia Difficile, as
well as concerns that Australia and New Zealand are a very different environment to the European
countries where these studies were done.
The proposed research is designed to understand why SDD has not been fully implemented into
Intensive Care practice in Australian and New Zealand. It may be that a definitive study is needed to
determine the role of SDD in Australian practice, where infections with multi-resistant organisms are
more common. But since there are so many factors that may affect clinicians’ decisions about
whether to use this controversial therapy, we believe we need to first understand the reasons why
clinicians have not implemented SDD to date. This study will define the barriers to implementation of
this potentially live saving treatment and to identify what further information is required before a
definitive large clinical trial can be undertaken.
Principal Investigators: Prof Doug Elliott, Prof L Aitken, Prof T Bucknall, Dr Ian Seppelt, Dr Steve Webb, Ms L Weisbrodt, Prof S McKinley
A Point Prevalence study is an important and systematic way of understanding what the current
practice is for specific aspects of patient care across many health care organisations. For intensive
care unit (ICU) patients, this snapshot of practice provides important information in planning and
implementing new ways to manage this group of patients. The ANZICS Clinical Trials Group (CTG)
in partnership with the George Institute of International Health has established a systematic Point
Prevalence Program, where a number of point prevalence studies can be conducted simultaneously
on two specified days each year.
The aim of this study is to determine the prevalence of specific practices related to sedation,
analgesia and delirium for patients managed in ICUs across Australia and New Zealand. A range of
options currently exist for the assessment and management of ICU patients in relation to sedation,
analgesia and delirium. Determining the similarities and variations in practice across our two
countries for these three common clinical activities will be an important element in understanding the
practice base in relation to the research evidence. Findings will be used to provide baseline
information for planning further intervention studies to improve the delivery of care and patient
outcomes.
Principal Investigators: Belinda Howe, Dorrilyn Rajbhandari, Ms Patricia Williams
Traditionally, the ethical review process has involved large, multi-centred studies being submitted for ethics approval locally at each individual site. This process has engendered criticism from sponsors, industry and researchers in regards to the issues of time delays, high financial cost and duplication of effort.
To address these issues a single ethical review process has recently been introduced in New South Wales and a national system will follow. New Zealand introduced a regional ethics approval process in 2004 due to similar issues. The single ethical review system, as introduced in NSW and New Zealand, has yet to demonstrate any savings on cost or reduction in time taken to complete the ethical and essential document review process.
This study seeks to explore and compare the issues of the time taken to gain site approval, financial cost and research staff time required to prepare and support the ethical review process for a multi-centre clinical trial in Australia and New Zealand. The sites utilizing a single ethical review system will be compared to other sites, which submit to locally.
The study results have the potential to highlight the performance of the new single ethical review system compared to the traditional ethical review process. It will determine, in a real situation, if the new system is meeting its expectations and if any shortcomings are apparent. This comparison may display the advantages of the single ethical review process and expedite its national implementation or may highlight deficiencies which need to be addressed before national implementation.
Last updated November 2008
Principal Investigators: Dr Tony Burrell, KM Hewson, Prof D Elliott, Dr Ian Seppelt, Dr Steve Webb
The aim of this project is to determine compliance with delivery of a range of accepted and recommended routine processes of care on ICU patients. Deficiencies in the delivery of routine interventions have been well-documented across the U.S., the U.K. and Canada. Early evidence also suggests this might also be the case in Australia and New Zealand, although these findings are limited to single centre studies.
A point prevalence study will determine the extent to which recommended processes of care are actually delivered across Australia and New Zealand ICUs.
The results of this study will be of importance to clinicians, administrators, and providers of healthcare. The finding that compliance is high, low or variable will have important implications for health policy. The results will be used to develop strategies to improve the delivery of care; and provide unique baseline information for the planning of further studies to evaluation methods to improve compliance.
Last updated November 2008
Principal Investigators: Professor Rinaldo Bellomo, Ms Alisa Higgins, A/Prof A Harris, Dr Anthony Delaney, Dr Sandra L Peake, Dr Alistair Nichol
This research project will determine the cost effectiveness of a treatment known as “Early Goal Directed Therapy” compared to standard treatment for patients with severe sepsis. When a person has severe sepsis they have a severe infection and their body reacts to the infection, affecting important organs in the body such as the heart and lungs.
Standard treatment for sever sepsis in Australia involves treatment with fluids given into the vein and medications to support the blood pressure and keep the heart working properly.
Early goal directed therapy (EGDT) is the name given to a new way of giving these standard treatments by following a strict protocol. A study performed at one hospital in the United States has shown that this strict protocol works better than standard treatment. A large study of EGDT compared to standard treatment for severe sepsis (the ARISE study) will start in Australian and New Zealand hospitals in late 2008 to see if EGDT is better than standard treatment.
Intensive Care Treatment is expensive and consumes a significant portion of hospital resources. This study will collect this information on a group of patients enrolled in the ARISE study to determine the costs of EGDT and standard treatment. These costs will be combined with measures of effectiveness such as survival to determine how much it costs for each additional survivor with EGDT, and how much it costs for each life year gained with EGDT.
Last updated November 2008
Principal Investigators: Susan Kelly, Dr Sandra Peake, RN Patricia Williams, RN Jennie Phillips-Hughes, RN Lesley Sheffield, Dr John Moran
Paracetamol is frequently prescribed for the treatment of fever and/ or pain in intensive care. It is available in three forms – tablet, suppository and intravenous (through a drip). However, reduced blood pressure has been described with both the tablet and, more commonly, the intravenous forms of paracetamol. Of note, the paracetamol product information leaflet states that the chance of low blood pressure with intravenous paracetamol is rare.
Intensive care patients are often too unwell to swallow tablets and absorption of drugs into the bloodstream may be reduced. Therefore, many drugs are commonly given through a drip in the critically ill. However, whilst intravenous paracetamol may be an effective way to administer the drug, the potential risk of low blood pressure may prevent its use in many such patients.
The aim of the study is to assess the effects if intravenous paracetamol on blood pressure in intensive care patients. Patients requiring paracetamol for fever or pain relief will receive tablet, suppository or intravenous paracetamol every 6 hours and blood pressure and other vital signs will be regularly recorded. Blood samples will also be collected regularly to measure the level of paracetamol in the blood and the relationship between the effect of paracetamol on blood pressure and blood paracetamol levels will be examined.
Last updated November 2008
Principal Investigators: A/Prof. John Santamaria, Dr David Pilcher, Dr Graeme J Duke, Prof D James Cooper
The aim of our study is to identify the factors associated with mortality after discharge from intensive care and then develop methods to reduce preventable deaths.
Over 5,000 patients discharged from ICU in Australasia each year will die before hospital discharge and a similar number will be readmitted to ICU. International and local studies have suggested that survival is not only linked to the severity of illness but also to processes of care surrounding discharge from ICU. For example, patients discharged after hours and those requiring re-admission to ICU have less chance of leaving hospital alive. The care on wards and emergency services within the hospital may also contribute to outcomes. Unfortunately, most of these studies used information within intensive care databases which contain little or no information about the condition of patients around the time of ICU discharge.
Our study has been designed to examine a range of factors at ICU discharge including the nature of disease, the severity of illness, whether the patient has untreatable conditions, the nature of handover of information to ward staff, and the presence of emergency or follow-up ICU teams who continue to manage patients in general wards. We will follow a large number of patients (about 10,000) after discharge from ICU. However this could be achieved within 2-3 months of study onset.
With the information obtained, we hope later to implement evidenced-based solutions to ensure that more ICU patients leave hospital alive and in a shorter duration of time.
Last updated November 2008
Principal Investigators: Suzanne Eliott, Ms. Andrea Doric, A/Prof David Ernest, Prof Wendy Chaboyer
The Intensive Care Unit (ICU) Liaison Nurse (LN) assists in managing patients with complex care needs in hospitals and facilitates the smooth transition of patients admitted to and discharged from the ICU. A recent Victorian survey illustrated the diverse nature of ICU LN services with substantial variations in ICU LN services.
To date, there has been little uniformity in the roles or functions undertaken by these specialist nurses, which has made evaluation of the role difficult. In order to develop a clearer understanding of the role, the aim of this study is to document this diversity in practices of the ICU LN workforce. An electronic survey of all public and private hospitals within Australia and New Zealand will be undertaken.
The survey instrument includes demographic and clinical characteristics as well as questions about the LN service. Donabedian’s structure, process outcome framework was used in survey development. Structural questions relate to staffing levels, hours of service and other resources. Process elements include the types of services provided, key responsibilities and extended practices undertaken. Outcomes focus on the and key performances indicators used as markers of the quality of the ICU LN service. A preliminary study using the proposed survey has been completed in Victoria.
The results of this project will identify the scope of practice of this specialist group of nurses. It will highlight the extent to which the service contributes to improved patient care and will provide an essential framework for the future development and evaluation of the ICU LN role.
Last updated November 2008
Principal Investigators: Dr Ian Seppelt, Prof John Myburgh, Prof DJ (Jamie) Cooper, Prof Simon R Finfer, Ms Rhiannon Elliott
When commencing any research program the researchers need information about current practice, before they can make any intelligent attempt at designing research that might improve on current practice. Colloquially, this means asking ‘what do we do now?’ [perhaps also ‘what do we think we do now?’] before moving on to ‘what should we do next?’
A Point Prevalence study is a systematic snapshot of current practice. It is an observational study, without any intervention, and involves collecting data on topics of interest, in patients in multiple Intensive Care Units, on a specific day or days. It provides no information on outcomes, but provides very important information on how common a problem is, and what is currently being done to manage that problem. The ANZICS Clinical Trials Group has done many point prevalence studies in the past which have provided crucial information, but each of these has been a stand alone study designed anew each time.
The Clinical Trials Group in partnership with the George Institute of International Health wishes to establish a systematic Point Prevalence Program, where multiple point prevalence studies will be done simultaneously, on two specified days each year. The mechanics of running a point prevalence study will be streamlined for researchers, while duplication of effort is avoided.
As a piece of research infrastructure the program will also foster junior researchers and encourage Intensive Care Units which have not previously participated in intensive care research, and will provide data necessary for the design of many future research projects.
Last updated November 2008
Chief Investigators: Professor D J (Jamie) Cooper, Dr Andrew Westbrook, D Alistair Nichol, Dr Stuart M Lyon
Patients who are admitted to the intensive care unit with traumatic brain injury (TBI) are at a significant risk of developing blood clots in their legs because 1) they are immobile, 2) their blood clots more quickly (part of the stress response to TBI) and 3) they tend not to be prescribed anti-clotting medication as they are at risk of further bleeding in their brain. About 30% of blood clots in the lower leg extend into the thigh and if untreated half of these will travel to the lung. Of those clots that travel to the lung 25% cause death. There is no current Australian or international data concerning the rate of blood clots in the legs in TBI. We plan to assess all patients with TBI on admission to the intensive care unit for blood clots by performing an ultrasound of their legs and repeating this twice weekly until discharge.
We also plan to determine each participant’s propensity to develop clots: this shall be done by performing a blood test (1 teaspoon) called a thromboelastogram and these tests shall be done whenever a patient has an ultrasound.
The results of the study will provide currently unknown data regarding the rate of lower limb blood clots in this at risk population. This in turn will help in the design of a future clinical trial comparing different clot prevention strategies in these patients.
Last updated November 2008
Principal Investigators: Professor David James Cooper, Prof Jeffrey Rosenfeld, Dr Ruwan Wijemunige
Each year, close to 5000 people in Australia suffer a severe traumatic brain injury (TBI). The traumatized brain is very vulnerable to further injury in the first few days after the injury, and studies have showed that despite current best practice, approximately 50% of patients with severe TBI suffer a secondary injury during their stay in ICU. These secondary injuries occur due to two main reasons. The first reason is our inability to continually monitor the function of the brain leaving the unconscious patient vulnerable to “silent” injuries occurring to the brain despite being in intensive care. The second reason is the difficulty in optimizing the metabolic requirements of the brain (such as oxygen and blood).
One of the factors that affects the metabolism of the brain is the level of carbon dioxide in the blood. High levels of carbon dioxide in the blood lead to brain swelling and decreased blood supply to the brain tissue. Therefore, patients with TBI had their carbon dioxide levels kept very low to decrease brain swelling. However, 10 years ago it was demonstrated that low carbon dioxide levels lead to constriction of the blood vessels in the brain and therefore cause long term damage to the brain.
Now patients’ carbon dioxide levels are kept in a range that is neither high nor low. However it is unclear whether there is an optimum level of carbon dioxide in the blood which maximizes the blood supply to the brain.
This study involves using technology to directly measure brain metabolism in 30 patients with severe TBI as there carbon dioxide level varies within this “normal” range. This will help us determine if there is an optimum carbon dioxide level for each patient and whether this optimal level changes as the medical condition of the patient changes. This will also help us develop experience in directly monitoring brain metabolism (which is currently not done routinely) and tailoring treatment for each patient based on the individual characteristics of their brain.
Last updated November 2008
Chief Investigator: A Bersten
Chief Investigator: Leonie Weisbrodt
Background
Intensive care patients often require help with their breathing via the insertion of a breathing tube and connection to a mechanical ventilator which controls the flow of air into and out-of the lungs. This experience can be quite uncomfortable and distressing. To help tolerate ICU treatments, patient are often given continuous infusions of sedative drugs while there are ventilated, sometimes for days or weeks and occasionally even months. It is thought by some that the continuous nature of these infusions leads to an accumulation of the drugs in the patient’s tissues, delaying recovery from ICU.
There is an expanding body of literature regarding sedation management and its impact on patient outcomes, however there is limited work based on the unique Australian intensive care context. It is hoped that the AROUSE study will provide Australian clinicians with information regarding the likelihood of a routine daily interruption to sedation improving patient outcomes from critical illness.
The Study
The AROUSE Study will look at whether ceasing these sedative infusions for a defined period each day improves a patient’s recovery from their illness in terms of how long they require mechanical ventilation, what they remember about ICU and how that makes them feel.
The AROUSE Study is a pilot study which will be conducted at 2 large ICUs in Sydney, NSW. The data generated by the study will help investigators determine if a larger multicentre study should be conducted.
This is an ANZICS Clinical Trials Group endorsed study.
Outcome
The AROUSE study commenced in August 2005 and is still running.
Last updated August 2007
Chief Investigator: Barry Dixon
Background
Nebulised heparin can be delivered safely to critically ill patients that require the support of a mechanical ventilator. This is the first step in assessing whether this treatment can prevent patients dying from severe lung injury caused by pneumonia.
The Study
This research hopes to demonstrate that nebulised heparin prevents patients from dying from severe lung injury caused by pneumonia.
Outcome
The first trial of inhaled heparin in ventilated critically ill patients with acute lung injury (ALI) has been completed. The trial demonstrated that inhaled heparin can be administered to critically ill patients without serious adverse events. The trial’s results also indicated that nebulised heparin may be a practical method to systemically anticoagulate patients. International groups have commenced work on nebulised heparin in ALI as a result of this trial. The next trial will assess if inhaled heparin improves lung function in critically ill patients.
Last updated October 2008
Chief Investigator: Marianne Chapman
Background
Critically ill patients need good nutrition to help them recover as quickly as possible. Abnormal contractions of the oesophagus, stomach and small intestine commonly occur in critical illness and may prevent effective feeding of patients at a time when they are especially vulnerable to malnutrition.
The Study
This project will investigate the causes of these abnormal contractions and the effectiveness of chemical and non chemical therapeutic strategies designed to improve delivery of nutrition to critically ill patient.
Last updated April 2007
Chief Investigator: Barry Wilkins
Background
Bronchiolitis is a common infection of the bronchioles, the tiny airways that lead to the lungs.The airways swell and fill with mucus making it difficult to breathe, especially for young children. Yearly around 300 children with severe bronchiolitis are admitted to Paediatric Intensive Care Units in Australia and New Zealand. These children experience significant breathing difficulty and around 60 percent are ill enough to need help with breathing through a breathing machine (mechanical ventilation).The normal treatment is to support their breathing and give nutrition and fluids until recovery.
The Study
This research project aims to see if aminophylline, commonly used to treat asthma, chronic bronchitis, emphysema and other lung diseases – can be also used as a treatment for children with bronchiolitis. The researchers will compare the duration of mechanical ventilation, length of stay in Intensive Care and other variables of two groups of children.One group will receive the standard treatment for bronchiolitis and the other group of children will receive standard treatment and aminophylline.
This study had recruited only a small proportion of the required number of patients when glass ampoules of saline (needed for the control group) were removed from the market, so the trial had to be suspended. The project will be starting again in August 2008 as arrangements have been made to have the ampoules especially made for the trial.
Outcome
Benefits of the trail to date have only been indirect with the main one being that it is one of the first controlled trials conducted by the ANZICS Paediatric Study Group.
If it is proven that aminophylline reduces the proportion and duration of patients being ventilated, there could be a saving of 40 hours of intensive care per patient, saving $1-2 million of health service resources per year Australia and New Zealand wide. This study is due to commence.
Last updated October 2008
Principal Investigators: Prof Rinaldo Bellomo, Dr Frank van Haren, Dr Shay McGuinness
Background
Injury to the kidney with loss of function is common after cardiac surgery, especially in patients with previous kidney disease, old age, diabetes and others with the need for complex open heart surgery. It is associated with increased ICU and hospital length of stay and an increased risk of death. No reliable treatment has yet been found to reduce the incidence and severity of this secondary kidney injury.
Although the mechanisms involved in kidney injury after cardiac surgery are not fully understood, some evidence suggests that release of free haemoglobin from red blood cells may be a contributing factor. Experimental studies suggest kidney toxicity and free haemoglobin can by reduced by giving intravenous bicarbonate. Recently, a multiple blind, controlled, randomised pilot study of 100 patients demonstrated that intravenous administration of bicarbonate decreased kidney injury to these patients.
The Study
Based on the pilot results, this study plans to enrol 470 high risk patients having open heart surgery in four hospitals to further evaluate the role of intravenous bicarbonate in reducing acute kidney injury following cardiac surgery. If the results of the pilot are confirmed, given the low cost of the intervention and the importance of the complication, bicarbonate infusion may be tested in a much larger trial. Identifying an effective treatment has important implications for the treatment for more than a million patients every year world wide.
Outcome
A positive outcome from this project will provide strong evidence that bicarbonate protects the kidney during cardiac surgery.
Last updated October 2008
Principal Investigators: Dr Alistair Nichol, Dr Megan Robertson, Prof Jamie Cooper, Dr Jeffrey John Presneill, Dr Steven Webb
Background
In Australia and New Zealand, around five thousand patients are admitted to intensive care every year with severe infection (sepsis). Despite aggressive treatment, around 35% of these patients do not survive.
Most patients admitted to ICU receive heparin injections to prevent the formation of blood clots in their leg veins from decreased physical activity. The clots are dangerous as they can travel to the lungs and cause death. As technology has advanced, more purified forms of heparin have replaced the traditionally used unfractionated heparin (low and ultra low molecular weight heparins) because of reported increased effectiveness in preventing blood clots.
Recent studies have suggested that unfractionated heparin may have beneficial therapeutic effects in infection in addition to its action to prevent blood clots. These immune-active effects are related to molecular size and therefore may be lost with the current trend to use purified heparin forms.
The Study
A pilot study to investigate whether unfractionated heparin is beneficial for patients with severe sepsis is currently underway. This additional grant supports the Intensive Care Foundation’s grant last year and allows the researchers to measure sensitive blood markers of the inflammatory response to sepsis to confirm whether unfractionated heparin use is of additional benefit.
If unfractionated heparin is shown to be beneficial to these patients, this would be a simple, cheap and widely applicable additional treatment for severe infection that could save lives world wide, both in first and third world countries.
Outcome
Due to inadequate recruitment this project was stopped early. The findings from this project have encouraged a rethink of the best strategy to determine if Heparin is a useful treatment in patients with severe sepsis.
The project investigators are currently working on a new distinct design of a trial that will be feasible, safe and will determine if Heparin is a useful treatment in severe sepsis.
While this project will not proceed in its current form, it is hoped that these findings will lead to a world class trial which will determine the efficacy of Heparin. This larger trial will inform clinical practice.
Last updated October 2008
Principal Investigators: Dr Andrew Davies, Mrs Suzanne S Morrison, Dr James (Jamie) Cooper, Ms Merrilyn Banks
Background
Pancreatitis is an inflammatory disease of the pancreas which ranges in severity from mild to lethal. At least six hundred patients a year are admitted to ICUs in Australasia with pancreatitis. These patients often have a long and complicated hospitalisation and usually need to stay in ICU twice as long as other patients. At least one in thirteen will die from this condition.
It was previously thought that resting the digestive system by fasting was the best treatment for these patients. Nutrition was typically provided directly into the blood stream via an intravenous drip until the patient improved. Studies have shown that providing nutrition into the digestive system is better than via intravenous methods as it reduces complications, length of stay and possibly even organ failure. This has now led to the view that nutrition is now a therapy which should be an important component of the management strategy of patients with acute pancreatitis.
We currently do not know how nutrition is provided for the treatment of patients with pancreatitis in Australasia.
The Study
This study will provide a baseline of current standard treatment of patients with severe acute pancreatitis in Australia and New Zealand and allow for world comparison. It will also provide information to plan a future interventional trial to investigate how nutrition should be provided to these patients.
Outcome
The six month recruitment period for this project has finished. The data is currently being collected and entered into the database. A data analysis plan has been formulated. The data cleaning and subsequent analysis will proceed in due course.
The objectives of this study are to:
- Describe the clinical and epidemiological features of severe acute pancreatitis within Australasia
- Describe current nutritional management in Australasia of patients with severe acute pancreatitis
- Measure patient outcomes, including all-cause in-hospital mortality, duration of mechanical ventilation, duration of intensive care (ICU) stay, and duration of hospital stay
- Benchmark Australasian nutritional management practices against local and international guidelines
- Assess the feasibility of a multicentre, randomized, controlled trial to investigate nasogastric feeding vs. nasojejunal feeding in patients with severe acute pancreatitis
It is envisaged that by achieving these aims this study will demonstrate the need to improve nutritional management of patients with severe acute pancreatitis within Australasia. The data obtained will allow clinicians to benchmark their sites performance with regard to international guidelines; and it is hoped this will facilitate the decrease in complication rates and improve patient outcomes.
Last updated October 2008
Principal Investigators: Prof. D . James (Jamie) Cooper, Dr Alistair Nichol, Dr Andrew Davies, A/Prof David Tuxen, Ms Carol Hodgson
Background
This randomised, controlled trial will compare a new mechanical ventilation strategy called Permissive Hypercapnia and Alveolar Recruitment with Limited Airway Pressures (PHARLAP) with current best practice ventilation in patients with an inflammatory response following acute lung injury.
Acute lung injury and the more severe acute respiratory distress syndrome are inflammatory conditions of the lungs which result in a mortality of 30 to 40%. Patients with acute lung injury are at high risk for ventilator-associated lung injury which in turn contributes to the high mortality. In ventilator associated lung injury, the lungs have been demonstrated to act like an ‘engine’ of inflammation, increasing blood levels of chemical mediators which cause inflammation and even failure in other organs in the body or death.
Reducing the size of each breath delivered by the ventilator and an occasional sustained deep breath have been used to try to prevent the damaging effects of lung injury on patients. These protective strategies frequently result in higher than normal levels of carbon dioxide, a gas produced by normal tissue and organs which we exhale. These higher levels of carbon dioxide than normal may actually be protective to the body.
The PHARLAP ventilation strategies, which have all been individually shown to benefit patients, when packaged together could potentially provide superior protection and benefit.
The Study
Beginning in February 2008, PHARLAP is a mechanical ventilation trial which aims to determine the ideal method of assisting respiration in critically ill patients with acute lung injury.
To date the study has recruited 14 of the anticipated 30 patients required. On completion of the study, blood sample taken from these patients will be analysed to see if the new method of ventilation reduces the inflammatory response.
Outcome
It is hoped that this study will provide the key evidence required proceeding to a future larger trial in Australia and New Zealand which will show that PHARLAP ventilation improves survival.
Last updated October 2008
Principal Investigators: A/Prof Gavin Leslie, A/Prof GJ Dobb, Ms TA Williams, Prof PV van Heerden, Ms BL Roberts
Background
Increased pressure in the skull following a severe head injury or other non traumatic brain injuries can cause further damage to the brain. This pressure can be reduced by draining excess fluid out of the skull through a catheter. Because of the invasive nature of this treatment there is an increased risk of infection (ventriculitis). Up to 45% of intensive care patients with these drainage catheters have been reported to get ventriculitis, which can become life-threatening.
Antibiotic treatment needs to commence as soon as the infection starts to give any chance of successful treatment. Samples of the fluid (cerebro-spinal fluid) are routinely taken from the drainage system to test for infection. However there is no consensus on how often this should be done as sampling itself may present an infection risk.
The Study
This study aims to assess whether decreasing the frequency of routine testing for ventriculitis to 3rd daily can reduce the incidence of the infection without compromising surveillance.
Outcome
It is hoped that by reducing the number of times fluid is sampled from around the brain in patients with an Extra Ventricular Drain (EVD) in place there will be a reduction in the inflammation and infection rate, which will reduce costs to patients and the community for sampling equipment and antibiotic use, length of stay and potential serious brain injury following the infection of CSF.
Last updated October 2008
Chief Investigator: Sandra Peake
Background
Each year approximately 13,000 people in Australia and New Zealand develop sepsis. Sadly, many of them will end up critically ill in ICU and approximately 4,000 each year don’t survive. The effective management of sepsis remains one of the most important areas of intensive care research.
A study conducted in one hospital in the USA has suggested that delivering targeted interventions based on a specific protocol to manage severe sepsis very early during the patient’s hospital admission may significantly reduce the number of people who die from the condition. However, it is not known whether this type of protocol-driven care would have the same effect, and be appropriate for use, in Australian and New Zealand.
The Study
The ARISE Study is an observational study designed to provide essential information about the current management of severe sepsis in Emergency Departments (EDs) across Australia and New Zealand. The information collected during the ARISE Study will help the investigators and the ANZICS Clinical Trials Group design a large trial to examine the best way to treat people with sepsis in the ED before they require admission to ICU.
This is an ANZICS Clinical Trials Group endorsed study.
Outcome
The ARISE Study was conducted between October 2006 – January 2007. A total of 288 patients were studied during this time across 32 different hospitals giving a thorough overview of sepsis treatment practices in Australasia. Results have been collated and a large trial investigating protocol-driven management of severe sepsis has been designed based on the results of this important study.
Last updated September 2007
Principal Investigators: Clinical Associate Professor Steve Webb, Prof Judith C Finn, Dr David Blythe, Dr Mary Pinder, Clinical Associate Professor Geoffrey J Dobb, Associate Professor Ian G Jacobs, Prof Lyle J Palmer,
Background
Large population based research studies, such as the Framingham Study in the United States, have played a pivotal role in improving medical knowledge. Intensive care represents a vital component of the health system serving to save the lives of patients with many different forms of life-threatening critical illness. About 125 000 Australians are treated in an ICU each year at a cost of about 1 billion dollars. Despite the importance of intensive care there have been no large population based research studies of ICU patients- either in Australia and New Zealand or elsewhere in the world.
The Study
Such a study would have the potential to substantially improve the understanding of all aspects of critical illness. Western Australia possesses unique advantages for the conduct of this type of research study. However, these studies are expensive and require complex planning.
Outcome
The purpose of this grant is to conduct a pilot study to determine the feasibility of conducting a large population based research study that would aim to recruit all ICU patients in WA on an indefinite basis. The purpose of this feasibility project is to provide a demonstration of large scale accurate data collection and to evaluate rates of recruitment in a single ICU in WA. This data is essential for the planning and funding of the proposed large population based research study.
Last updated October 2008l
Chief Investigator: A Ramelet
Chief Investigator: Sandra Peake
Chief Investigator: J Harding
Chief Investigator: Gordon Doig
Chief Investigator: Jamie Cooper
Background
Trauma is the most common cause of death in Victorians under the age of 44 years and nearly all the trauma patients who die after reaching hospital have significant traumatic brain injury as a major contributing factor. Many patients who are managed in intensive care for severe traumatic brain injury develop brain swelling and increased brain pressures during the first week after injury. These pressures are carefully managed in the ICU, but in some patients standard therapies are not sufficient to control the pressure and reduce ongoing brain injury.
A surgical operation called decompressive craniectomy is very effective to control these brain pressures but has only been used occasionally in ICU trauma patients to date. Because the operation is promising but controversial, the researchers are performing a study to test whether the early use of this operation in addition to standard ICU and neurosurgical therapies improves outcome in patients with severe brain injury. Until the study is complete we will not know whether possible benefits of the operation are greater than the possible complications, or whether increased patient survival translates to increased numbers of patients with “favourable outcomes”.
The Study
The first phase of the study was to undertake a single centre pilot study which commenced at the Alfred Hospital, Melbourne since December 2002. The pilot study confirmed that about 10% of patients with severe injury are eligible, and that the study design although challenging, is feasible and achievable.
The next phase was to invite other Australian and international neurotrauma hospitals to join a unique multicentre, multinational study. This will be the first randomised study of this therapy ever to have been done. Clinicians around the world anxiously await the results of this landmark trial.
This is an ANZICS Clinical Trials Group endorsed study.
Outcome
A pilot study of early Decompressive Craniectomy was completed in 2003 and currently a large Multicentre Randomsied Controlled trial of early Decompressive Craniectomy is in progress at 20 sites throughout Australia, New Zealand, Canada, Saudi Arabia, USA and India.
This trial will comprise 165 patients and will determine whether the early use of this surgery improves neurological function in patients when measured six months after the injury. This trial is the first of its kind in adults and is required before early Decompressive Craniectomy could become routine therapy for all appropriate patients.119patients were enrolled in this study at May 2008.
Last updated October 2008
Chief Investigator: Andrew Davies
Background
This important study is looking at two different ways to feed people in ICU who are on a ventilator and not able to eat or drink normally. It is widely accepted that being able to deliver adequate nutrition to critically ill people plays a vital role in their recovery. By examining the most effective feeding method, the results of this study may eventually help to reduce complications and improve the outcomes of hundreds of people in ICU each year.
The Study
The ENTERIC Study is a multicentre randomised controlled trial which will compare nasogastric feeding (via a tube from the nose to the stomach) to nasojejunal feeding (via a frictional tube which passes beyond the stomach to deliver nutrition directly into the small bowel). The study aims to determine which is the most effective method of delivering nutrition and to compare how the two methods affect patient outcomes.
This is an ANZICS Clinical Trials Group endorsed study.
Outcome
The ENTERIC study has now recruited146 patients from a required total of 180 and has caused an increase in awareness of the importance of nutritional support in critical care.
At the completion of this study it will have been established whether early jejunal feeding (using a frictionalnasojejunaltube) increases the amount ofenteral nutrition delivered during ICU admission in mechanically-ventilated, medical-surgical critically ill patients with reduced gastric motility when compared to standard feeding. This study will also compare the effects of both feeding strategies on other clinical outcomes and examine success and complication rates ofthe frictional NJ tube.
Last updated October 2008
Chief Investigator: Ken Hillman
Background
Many people who suffer cardiac arrests or unexpected death in hospital or require unplanned admission to ICU from the hospital ward will display signs of deterioration in the hours before the crisis. Some hospitals around the world have introduced an early detection and treatment system where a specialised Medical Emergency Team (MET) is called to review and treat any patient who is observed to be showing altered vital signs or evidence of deterioration. What is not known is whether the introduction of these teams actually saves lives or reduces the number of people who need to go to intensive care.
The Study
The primary aim of this study is to test the hypothesis that the implementation of the hospital-wide MET system will reduce the aggregate incidence of unplanned admissions to Intensive Care Units, cardiopulmonary arrest and in-hospital death where resuscitation is offered (non-DNR events).
The MERIT Study is a cluster-randomised controlled trial involving 23 hospitals in Australia. Half will continue with normal care and half will introduce a Medical Emergency Team for a period of six months.
This is an ANZICS Clinical Trials Group study.
Outcome
The landmark MERIT Study was conducted in 2002 and published in the Lancet in 2005. The results of the study indicated that the introduction of a Medical Emergency Team did not significantly reduce the incidence of cardiac arrests, unexpected deaths or unplanned ICU admissions. Importantly, the study generated valuable information about how to better study and implement these types of system changes. Further research about MET systems is now being carried out by this team of investigators.
Last updated September 2007
Chief Investigator: Megan Robertson
Background
In Australia and New Zealand, around 5000 patients are admitted to Intensive Care every year with severe infection (sepsis).Despite aggressive treatment, around 35% of these patients do not survive, making severe sepsis the most common non-cardiac cause of death in intensive care patients.Even surviving patients often suffer a period of multiple organ failure.
Most patients admitted to ICU receive heparin injections to prevent the formation of blood clots in their leg veins which can travel to the lungs.As technology has advanced, more purified forms of heparin (low and ultra low molecular weight heparins) have replaced the traditionally used unfractionated heparin because of reported increased effectiveness in preventing blood clots.
Recent studies have suggested that unfractionated heparin may have beneficial therapeutic effects in infection in addition to its action to prevent blood clots. These immune-active effects are related to molecular size and therefore may be lost with the current trend to use purified heparin forms.
The Study
This research will be a pilot study to assess the feasibility of conducting a large multicentre trial to investigate whether unfractionated heparin is beneficial to patients with severe sepsis. If unfractionated heparin is shown to be beneficial to these patients, this would be a simple, cheap and widely applicable additional treatment for severe infection that could save lives world wide, both in first and third world countries.
This is an ANZICS Clinical Trials Group endorsed study.
Outcome
The Heparin in Severe Sepsis Pilot Study is due to commence in September 2007
Last updated September 2007
Chief Investigator: Jamie Cooper
Chief Investigator: John Beca
Background
Traumatic Brain Injury (TBI) is the leading cause of death in childhood and exceeds all other causes combined . Survivors of severe injuries commonly have life long disabilities. Hypothermia or cooling is believed to protect the brain and reduce damage from a variety of causes. Adult TBI cooling studies are inconclusive and the only trial in children has shown no benefit with a short period of cooling (24 hours), however prolonged cooling (72 hours) has been shown to reduce brain damage in newborn infants with asphyxia (lack of oxygen).A study capable of determining whether prolonged hypothermia is beneficial in children with TBI is needed.
The Study
This pilot study will look at 50 children admitted to intensive care with severe Traumatic Brain Injury in Australia and New Zealand. The randomised controlled trial will compare the effects of prolonged cooling versus maintaining normal body temperatures. Data from the pilot study will help investigators determine whether a large multicentre trial is needed to provide conclusive evidence, and how it should be designed.
This is an ANZICS Clinical Trials Group endorsed study.
Outcome
The HiTBIC pilot study is still in the recruitment phase of the project. Do date the study has enrolled a total of 27 children with a severe head injury.
The purpose of this pilot study is to establish the feasibility of doing a larger study with other international centres. It will also establish the safety of more prolonged cooling and protocol adherence. If feasibility is established, this study will form a template for a larger collaborative study with international centres.
The purpose of the larger study will be to determine if keeping children cold for 72 hours improves their outcome when compared to keeping children at a normal body temperature for the same period of time.
Last updated October 2008
Chief Investigator: Ray Raper
Chief Investigator: D McWilliam
Chief Investigator: Rinaldo Bellomo
Chief Investigator: Rinaldo Bellomo
Background
Bacterial infection (Septic) Acute Renal Failure (ARF) is the most common type of ARF in critically ill patients and represents about 50% of cases of ARF, a condition which affects close to 30% of ICU patients. There is currently no treatment of this condition and initial evidence from the researchers justified the idea that angiotensin II would improve kidney function in this setting.
The Study
This study tries to understand how a hormone called angiotensin II given by continuous intravenous infusion might affect kidney function in animals with acute renal failure due to septic ARF.
If this proved true in animals it would open the door to human experiments a timed at establishing whether similar beneficial effects can be seen in man. The researchers have begun a series of experiments aimed at testing this hypothesis using two different models of sepsis: a short term one and a long-term one. The results of the short-term model are very promising. Those from the long-term model are being obtained in an ongoing series of experiments.
Outcome
This project studied the effect of a new treatment for acute kidney failure due to serious infection. This new treatment is based on the delivery of a drug called Angiotensin II into the vein of experimental animals that have kidney malfunction due to severe infection (germs in the blood).
In these animals the kidneys malfunction and the amount of urine produced falls from 80 ml/hr to 20 ml/hr. Once Angiotensin II infusion is started, the amount of urine produced increases from 20 to 300 ml/hr.
This treatment offers promise as a possible treatment in human beings with kidney malfunction. As a consequence of this study they are about to test this treatment in humans.
Last updated October 2008
Chief Investigator: Barry Dixon
Chief Investigator: Lara Sherkerdemian
Background
Heart disease is a serious problem in children. Ever year in Australia and New Zealand, more than 1300 children undergo major heart surgery.In the modern era of cardiac surgery we can now offer surgery and hope to the families of most babies born with heart defects (congenital heart disease).Unfortunately half of these babies who survive to adulthood are likely to have a significant disability.Most frequently the disability is related to brain injury such as a stroke, occurring around the time of cardiac surgery.
Without early, targeted investigations and careful follow up on brain function, even major brain injury can remain undiagnosed for days, months or even years after surgery, therefore the window of opportunity for early intervention is often missed.As with many brain injuries, the earlier the treatment, the better the outcome.
The Study
This unique study will investigate early brain injury in babies undergoing surgery for congenital heart disease. Early MRI, ECG and brain development tests will be performed on one hundred babies less than six weeks old who are undergoing heart surgery to accurately identify brain injury; to determine the risk factors and to define its impact on early and later childhood development.
Outcome
This study is currently underway
Last updated April 2007
Chief Investigator: Simon Finfer
Chief Investigator: Yahya Shehabi
Chief Investigator: Leanne Jack
Background
Can yoghurt reduce diarrhoea?Intensive Care patients often receive nutrition via a tube because they may not be able to eat or may require additional nutrition. Diarrhoea remains a common digestive system problem in these patients for many reasons including electrolyte imbalance, disturbance of normal digestive system function and infections.The primary concern for these patients is to stabilise their vital organ function and as a result, effective bowel care within the ICU can be somewhat overlooked.
Probiotics, bacteria naturally found in yoghurt - has been shown to exhibit significant clinical benefits in the prevention and management of both gastrointestinal and non gastrointestinal disease and illness.The beneficial effect is suggested to include the protection of the body’s natural bacteria in the digestive tract; however this is scientifically un sustained.
The Study
This study aims to evaluate the effectiveness of probiotic therapy with early tube feeding (early enteral nutrition) to reduce the incidence of diarrhoea in the critically ill, emergency admission, adult ICU patient.The researchers will also investigate how this treatment impacts on other related problems such as the reduction of ventilator caused pneumonia and sepsis, and other secondary infections.
This will be a two phase study. Phase 1 is a retrospective clinical chart audit investigating the incidence of diarrhoea in critical illness, whilst Phase 2 is a prospective, single centre, randomised control trial using two strains of probiotics in the form of yoghurt and early enteral nutrition to reduce the incidence of diarrhoea in critically ill patients.
Outcome
The study is being conducted in two phases with the first having been completed. The purpose of the first phase was to determine the sample size required for a randomised control trial. The power calculation identified that 1,400 patient admission days are required for each of the three RCT arms. This is equivalent to 300 patients or 100 patients for each of the three RCT arms.
The study used non probability, retrospective, sequential, sampling of emergency admission ICU patients. Patients were included if they: were >18 years; had an ICU length of stay (LOS) >5 days; and were ETF. Patients were excluded if their admission diagnosis included burns and hepatic failure, or were immunocompromised or elective post operative patients.
Diarrhoea was experienced by 88% of patients. Total admission days were 536 and diarrhoea was reported on 191 days. Males at 50% were more likely to experience diarrhoea than females at 38%. The average ICU LOS was 10.7 days and the median APACHE III score was 55. Antibiotics were administered to 94% of patients. The results of this study highlight a high incidence of diarrhoea in this patient population.
The data obtained by phase two will be analysed to determine the effect of the intervention.
Last updated October 2008
Chief Investigator: A Limpus
Chief Investigator: Jon Iredell
Background
Infections such as MRSA/ Golden Staph and vancomycin-resistant enterococci (VRE) are increasing problems in Australian hospitals, and are responsible for many hundreds of deaths every year. The test for golden Staph/ MRSA s is important because the drugs used for suspected MRSA are not as good at treating staphylococcal infection as are the usual anti-staphylococcal drugs, and also because the use of these drugs encourages other dangerous resistant bacteria such as VRE.
The Study
The researchers looked at developing a test for Staph/MRSA.
Outcome
A number of high-speed tests capable of determining the cause of life-threatening infection and whether it will respond to antibiotic treatment have been developed through this research. These are presently being trialled in all those patients who have grown bacteria in their blood. Such tests can be done as soon as it is known that bacteria are present and they give clinically useful information about a day before the answers would normally be available. This is important because we know that early information of this type saves lives.
The benefit from this study is that a cheaper, faster, and more accurate ways to identify not only the infecting pathogen but the genes which determine whether it will respond to antibiotics, has been developed. This will improve the control of infection in individuals and in hospitals generally, and can be expected to save lives and money.
Last updated August 2007
Chief Investigator: C Corke
Chief Investigator: B Venkatesh
Background
Trauma, shock and severe infection frequently result in admission to the intensive care and the requirement for life support systems. Despite control of bleeding, appropriate antibiotics and reversal of shock and, a substantial number of people still die. This is because of vital parts of the body such as the liver, kidney and lungs may have been deprived of oxygen. This results in damage to the machinery of life at the level of the cell, which in turn results in its death in these vital organs. A cell may die naturally (apoptosis) or unnaturally (necrosis). In disease such as above, apoptosis may occur prematurely and contribute to further damage.
Prevention or reduction of cell death may improve recovery of the critically ill patients. It appears that amount of oxygen available to the cell may be an important factor in ensuring survival.
The Study
This study will determine what the critical amount of oxygen is required at the cell level to prevent cell death. The initial research for this study involves conducting experiments in the laboratory. This exciting study is using state of the art scientific technology and is being done in collaboration with a number of laboratories around Australia including those in the Division of Critical Care of the Royal Brisbane and the Mater Misericordiae Hospitals, the Apoptosis laboratory of the University of Queensland. To date no study like this has been attempted.
Outcome
If successful, then the results of this study might form the basis for clinical trials that will one day have the potential to save more lives in the intensive care unit. Also, if such drugs can be developed, patients will get better more quickly and result in reductions in the time spent in the hospital and ultimately in the cost of health care.
Last updated April 2003
Chief Investigator: Flabouris, A
Background
The collective capabilities and service provision of inter-hospital patient transport services in Australia and New Zealand required investigation.
The Study
Surveys were sent to all retrieval services to obtain data including: adult, paediatric and neonatal retrieval service distribution, resources (equipment and personnel), operations, capabilities, quality characteristics and funding within Australia and New Zealand. Extensive follow-up occurred to ensure a good return of data. This data was then entered into a specially-designed ACCESS-database.
Information obtained will allow identification of the variability amongst retrieval services and the interaction between the retrieval clinical components and transport vehicle providers. This information will be combined with regional geography, population demographics and available ICU resources to identify relationships amongst these elements. The results will be used to generate "models" of demand for retrieval service responses at a regional, state and national level (eg to future changes in health service distribution and responses to disasters and other mass casualty events).
Outcome
Statistical analysis of the data will enable a clear understanding of the capabilities and service provision of inter-hospital transport. The results will be used to generate "models" of demand for retrieval service responses at a regional, state and national level (eg to future changes in health service distribution and responses to disasters and other mass casualty events). Potentially ideal retrieval service resource distribution in terms of volume of activity and transport vehicle utilisation/availability will be able to be described to help implement best practice.
Last updated November 2006
Chief Investigator: N Watkins
The Largest ICU trial completed in the world (S.A.F.E) has generated significant international interest. (ANZICS Clinical Trials Group initiated study). This study involved comparing the effects of fluid replacements liquids, albumin and saline in intensive care patients.
Chief Investigator: Jon Iredell
Chief Investigator: F Hawker
Chief Investigator: Rinaldo Bellomo
Chief Investigator: AD Bernsten
Chief Investigator: J Fraser
Chief Investigator: B Venkatesh
Chief Investigator: F Hawker
Chief Investigator: J Presneill
Chief Investigator: Bellomo, R
Chief Investigator: Louise Rose
Background
Mechanical ventilation is a complex intervention used in Intensive Care Units (ICUs) to support patients with breathing difficulties. Risks associated with mechanical ventilation increase when it is applied inappropriately or for a prolonged duration.
The Study
The objective of the study was to document the current practice of mechanical ventilation and methods used to successfully restore patients to normal breathing (termed “weaning”) in Australia and New Zealand (ANZ) ICUs. Data was also collected from nurse managers of participating ICUs on role responsibility and nursing scope of practice for key ventilation and weaning decisions.
Outcome
Within ANZ, 55 ICUs representing 30% of all adult ICUs with the ability to ventilate patients participated in the study. ANZ ICU ventilatory practices were similar between these two countries, but differed substantially from published international survey results in terms of the clinical methods used for ventilation and weaning.
Units identified high levels of nurse staffing with considerable numbers of nurses holding tertiary level postgraduate qualifications. These factors are identified as important components of a unit’s ability to provide safe and effective care and positive patient outcomes. Nurses were perceived to have a considerable role in ventilation decision-making processes with direct responsibility for initiation of a number of ventilator setting changes in some centres.
Last updated July 2007
