Critical Care – Research

Research

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ROSProx

Does repetitive occlusive stimulus at the proximal lower limb reduce myopenia in severely ill patients?

The CAG recently received an NIHR RfPb award for £150k for the proposal “Preventing muscle wasting in critically ill patients by repetitive occlusive stimulus (ROS): a feasibility study”.

The award funds will pay for a non-doctor research fellow for up to 18 months to support the study.

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Microvascular monitoring during liver resection surgery (MicroHepFlow)

The state of a patient’s cardiovascular system is commonly assessed with measurement of the heart rate and blood pressure and, in some situations, the central venous pressure and cardiac output. However, it is increasingly recognised that these ‘macro-haemodynamic’ variables do not provide adequate insight into a patient’s circulation.

Research question:

Is microvascular perfusion impaired following macrohaemodynamic stabilisation after liver resection surgery, compared to microvascular perfusion measured pre-operatively?

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MAMAs – Muscle wAsting in Major Abdominal Surgery

Prospective observational cohort study

Patients undergoing major elective surgery may develop acute muscle wasting (myopenia) and associated weakness that impedes their recovery.

By characterizing the myopenia, its risk factors and its consequences, we will improve our understanding which will inform future studies aimed at developing studys to establish effective prevention and treatment.

Furthermore, peri-operative muscle wasting provides an unrivalled model that can provide mechanistic insight into ICU-AW.

Primary objective:

 To characterise changes in muscle size (RFCSA) and strength (HGS and SNIP) in patients undergoing major elective abdominal surgery for cancer at 2 stages: pre-operative and at day 7.

Analysis:

The primary analysis will compare the changes in muscle size (RFCSA) between the 2 times (pre-operative and at day 7) using paired t-test method or Wilcoxon non-parametric method as appropriate. The same method will be used to compare the changes in the muscle strength (HGS and SNIP).

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RIPnoC – Remote ischaemic preconditioning (RIPC) in non-cardiac surgery

This is a single-centre, interventional pilot study

Aim:

To allow successful design of a randomised controlled trial that will assess whether RIPC improves outcomes following non-cardiac surgery and to assess the feasibility of identifying eligible patients, providing RIPC and examining biochemical and clinical outcomes between the control and intervention groups.

Recruitment will be 100 patients over 12 months. Subjects will be adults undergoing non-cardiac surgery under general anaesthesia with invasive arterial blood pressure monitoring and at increased risk of cardiac events.

Clinical outcomes:
RIPC has the potential to protect organ systems from ischaemic events and as such may help to reduce postoperative complications associated with inadequate organ perfusion. Assessment of all clinical outcomes involves examining the patients’ notes following their discharge. This will be done following the recruitment and discharge of every 25-30 patients (3-4 times during the study).

Other Active Projects
We recruit patients into multi-centre and local investigator-led studies

ADRENAL     PI – Prof Lui Forni.

International multicentre. Intends to definitely answer the question that the CORTICUS study didn’t – do corticosteroids improve outcome in septic shock?

PREVENTT   PI – Chris Jones.

A UK multi-centre RCT phase III study to compare the efficacy and safety of intravenous ferric carboxymaltose with placebo in patients with anaemia undergoing major open abdominal surgery.

Euro-HYP1     PI – Ben Creagh-Brown (ICU) and Kath Pasco (stroke)

International multicentre. RCT of awake cooling vs. best medical treatment in acute ischaemic stroke.

PECC (Pleural Effusions in Critical Care) PI – Justin Kirk-Bayley

Defining the evolution of pleural effusions in critical care patients.

©2018 Surrey Health Partners

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