Supervisor View Full Details 2nd

• Other

critical illness, acute respiratory failure, rehabilitation, methodology

• Medicine
• Public Health
• Sports and Exercise Medicine

• Clinical Trials
• Respiratory Medicine
• Other

Critical care, rehabilitation

The focus of work spans four key themes of respiratory, rehabilitation, recovery, and resilience, within the specialty of critical care centred on the optimisation of acute management, survivorship, and long-term outcomes of critically ill patients. All research themes have strong translational, methodological, multi-professional, and collaborative profiles.

Specific examples include a current NIHR HTA-funded multi-centre, randomized controlled trial investigating the effectiveness of mucoactive drugs in acute respiratory failure, the development of a core outcome set for trials of physical rehabilitation in critical illness, and national evaluation of follow-up services for post critical illness patients.

Acute respiratory failure (ARF) accounts for the majority of patient admissions to the intensive care unit (ICU). Mechanical ventilation is the cornerstone of treatment but increases the risk of respiratory tract secretion retention due to altered secretion rheology and impaired mucociliary clearance. Mucoactive drugs may be used to enhance usual airway clearance management in these patients, however evidence for their effectiveness is limited despite their widespread use in clinical practice. We are currently in the preparatory stages for commencing a large-scale, multi-centre, randomised controlled trial to answer the question: what is the clinical and cost effectiveness of mucoactive drugs in acute respiratory failure?

We are employing a 2x2 factorial study design to investigate two of the most commonly used mucoactive drugs in UK intensive care units – systemic carbocisteine and topical hypertonic saline. In addition to data acquisition of clinical (including duration of invasive mechanical ventilation, duration of stay, mortality, adverse events, health-related quality of life) and cost effectiveness outcomes, we will additionally obtain consent for long-term follow-up to characterise recovery trajectories following critical illness (aligning with relevant core outcome sets). Furthermore we will acquire blood and sputum samples from patients during the acute stages of illness to allow for analysis in exploratory mechanistic studies to understand the mechanism of action of these health interventions. Measurements in these studies will include dynamic rheology (sputum viscoelasticity), sputum inflammation, bacterial load, and composition, systemic inflammatory responses, and indices of pulmonary and systemic epithelial and endothelial function and injury.