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Areas of research in critical care

• Respiratory management
  • OSCAR
• Epidemiology
  • Blast lung injury
  • ROTEM
• Pathophysiology
  • ALI and ARDS
  • Near infrared spectroscopy in trauma
• Infection and inflammation
  • ProMISe
  • SIR
  • Cytomegalovirus (CMV) in critical illness
  • GenOSept/GAINS
  • Epidemiology of fungal infection
  • Matching Michigan project
  • Fluid resuscitation in burn injured patients
  • Diagnostics and point-of-care testing
  • Liver failure
  • Rehabilitation
  • RAIN
• Further information

Respiratory management

OSCAR

This work is funded by the Health Technology Assessment Programme. This national trial looks at conventional versus oscillatory ventilation in adults with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). UHB is currently the highest recruiting centre and will recruit 802 patients with ARDS.

Lead centre:

• John Radcliffe Hospital, Oxford

Local principle investigator:

• Dr Bill Tunnicliffe

• Links

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Epidemiology

Blast lung injury

Blast lung and acute lung Injury in trauma: defining its epidemiology, clinical features and outcomes.

Chief investigators:

• Dr Iain MacKenzie
• Professor Mahoney
• Professor Sir Keith Porter

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ROTEM

The ROTEM study looks at the role of thromboelastography and Factor VII in the management of polytrauma. Thromboelastography is a method of testing the efficiency of coagulation in the blood and Factor VII is a protein which plays a role in coagulation. Polytrauma is a condition defined by serious multiple injuries, caused by major incidents like car crashes, industrial accidents or bomb blasts.

The study has been designed to identify the body’s transition after injury from a state when blood will not clot to a situation when it clots excessively.

Chief investigators:

• Professor Mark Midwinter
• Dr Alistair Billington

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Pathophysiology

ALI and ARDS

Mechanisms of ALI and ARDS. This work is funded by the Queen Elizabeth Hospital Birmingham (QEHB) Charity. It looks at two key issues:

• The role of Vitamin D in modifying immune response to acute lung injury
• The impact of statins on modifying neutrophil function in ARDS. Statins are a class of drugs which affect a particular enzyme known to reduce cholesterol levels in the liver. Neutrophils are a common type of white cells, playing an important role in fighting infection

Both of these are basic science and clinical studies.

Chief investigator:

• Dr David Thickett (University of Birmingham)

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Near infrared spectroscopy in trauma

This work is funded by the Ministry of Defence.

Chief investigators:

• Dr Tom Clutton-Brock
• Professor Sir Keith Porter

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Infection and inflammation

ProMISe

This national, multi-centre trial of 1,500 patients is funded by the Health Technology Assessment Programme and examines the management of severe sepsis and septic shock. It links with an international nine-year programme of best practice research by the Surviving Sepsis Campaign. Professor Julian Bion is a member of the executive committee of this campaign and of the study’s steering committee.

Local principle investigators:

• Dr Catherine Snelson
• Dr Barry Boland
• Dr Nandan Gautam

• Links

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SIR

Characterisation of the inflammatory and endocrine impact of severe military and civilian trauma. Part-funded through local military resources.

PhD research fellow:

• Dr Mark Foster

Supervisors:

• Professor Mark Midwinter
• Professor Janet Lord
• Professor Weibke Arlt
• Professor Julian Bion

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Cytomegalovirus (CMV) in critical illness

This trial will look at ways of preventing the recurrence of an infection called cytomegalovirus (CMV) in patients in critical care. As people age they are more likely to contract CMV, but most healthy people will never know they have it. The infection can be very dangerous if it recurs in patients whose immune system is less effective due to medication or illness. A particular anti-viral will be tested to see if it stops CMV recurring.

• Dr Nick Cowley (Research Registrar)
• Professor Julian Bion
• Professor Paul Moss

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GenOSept/GAINS

This study of the genetics of sepsis and septic shock is funded by the EU’s FP7 programme. It is a Europe-wide collaboration studying the genetics of sepsis with around 2,000 patients in the database. Genetic analysis is being conducted by Professor Adrian Hill in Oxford, Professor Hinds at the William Harvey Research Institute at Barts and The London School of Medicine and Dentistry, as well as at and centres in Bonn and Paris. The study closed recently and the data is being analysed.

Co-chief investigators:

• Professor Julian Bion
• Professor Frank Stüber (Bern)

• Links

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Epidemiology of fungal infection

This study of infection in both military and civilian trauma is designed to determine risk factors related to the nature and circumstances of injury. It also looks at establishing guidelines for antifungal treatment, costs and outcomes. A grant application to the Gilead Foundation is underway.

Principle investigator:

• Professor Mahoney

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Matching Michigan project

This national intensive care study is funded by the Department of Health (DH) through the National Patient Safety Agency (NPSA). It is designed to establish a national critical care infections database and implement evidence-based interventions to minimise central venous catheter bloodstream infections. Matching Michigan is based on a model developed in the United States which, over 18 months, saved around 1,500 patient lives. It took place at intensive care units (ICUs) in Michigan and introduced changes in clinical practice and non-technical interventions (linked to leadership, teamwork and culture change). These changes, when applied together, have been shown to significantly reduce the incidences of central venous catheter bloodstream infections.

Chief investigator:

• Professor Julian Bion

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Fluid resuscitation in burn injured patients

This is a European multi-centre study.

Principle investigator:

• Dr Peter Gosling

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Diagnostics and point-of-care testing

Microsensors for drug and inflammatory markers point-of-care testing (HTD 627 grant). Proof of concept demonstrated for drug analysis (propofol); next studies will focus on antimicrobials and biomarkers of inflammation.

Chief investigator:

• Dr Tom Clutton-Brock (University of Birmingham/UHB)

Research fellow:

• Dr Nick Cowley

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Liver failure

A pilot study is underway to look at the artificial liver support (ELAD) for patients with acute liver failure.

Principle investigator:

• Dr Nick Murphy

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Rehabilitation

The Military Nutrition study is led by the Royal Centre for Defence Medicine (RCDM), with collaboration with Imperial and University of Surrey.

Local principle investigator:

• Jo Fallowfield, RCDM

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RAIN

The Risk Adjustment in Neurocritical Care (RAIN) study is funded by the Health Technology Assessment Programme. It is designed to develop a risk model for traumatic brain injury.

Lead organisation:

• Intensive Care National Audit and Research Centre (ICNARC)

Local principle investigator:

• Dr Tom Gallacher

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Further information

For more information on research into critical care medicine at Queen Elizabeth Hospital Birmingham (QEHB), including opportunities for collaborative work, please see the "Contact Research and Development" page (link below).

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