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Future Solutions In Progress


Theme 2: Time-Critical Intervention: Solutions for Effective Management of Deteriorating, Acutely Ill and Injured Patients

 

Theme 2 Projects:

 

Immediate point of care molecular diagnostics for lung inflammation/infection in critical care
Immediate point of care molecular diagnostics for lung inflammation/infection in critical care
Principal Investigator:  Professor Chris Haslett
Organisation: University of Edinburgh
Start Date 1st September 2011
End Date: 31st July 2016

View Abstract

At least 40% of all patients in an intensive care unit (ICU) need a ventilator to support their lungs, with many associated complications. Once established on mechanical ventilation, critically ill patients are at risk of acute lung injury (ALI) and secondary infection resulting in ventilator associated pneumonia (VAP). Both ALI and VAP increase hospital mortality, illness costs and result in poor functional long-term patient outcomes.

This project aims to develop a technology susceptible to revolutionising the diagnosis of these lung diseases. The team will synthesise and test three novel smart probes, both in vitro and in vivo. These novel imaging agents will be used in conjunction with confocal endoscopy and will be designed to detect:

  • the presence of neutrophilic infiltration
  • the presence of bacteria at sites of inflammatory lung injury
  • the gram-status of the bacteria
  • the presence of MRSA.

This technology has the potential to determine at the earliest possible stage those patients in ICU that are developing secondary infection and to identify the organism responsible, allowing rapid and accurate detection/exclusion of hospital-acquired infections – a priority for the NHS. It could also provide a rapid, ‘real-time’ in situ approach to establishing mechanism-based efficacy of new drugs.

Real-time detection of the onset of secondary brain injury in the intensive care unit
Real-time detection of the onset of secondary brain injury in the intensive care unit
Principal Investigator:  Professor Martyn Boutelle
Organisation: Imperial College London
Start Date 30th September 2011
End Date: 31st March 2016

View Abstract

Traumatic brain injury (TBI) – a major cause of death and disability in all age groups and the most important cause of these outcomes in working people – is now recognised as a ‘silent epidemic’ in the UK, and worldwide. Central to TBI’s devastation is a delayed ‘secondary’ injury that occurs in 30% of TBI patients each year, while they are receiving intensive care. Currently, secondary injury is unpredictable, hence unpreventable.

This project will deliver a new solution: a real-time brain injury index. This will be produced with a new clinical instrument that will collect electrical and chemical signals from the injured brain, process them and, for the first time, derive clinically-useful risk factors in real time that will assist doctors with diagnosis and treatment.

The healthcare implications are important: the brain injury index will show clinicians when secondary damage is starting and what is causing it. This will allow them to start the best treatment for that patient at the right time. The brain injury index instrument will save lives, and reduce incidences of severe disability and its huge personal cost to patients and their families.

Immediate point of care molecular diagnostics for lung inflammation/infection in critical care
The HAEM (Haemorrhage and Antifibrinolytics in Emergency Medicine – WOMAN TRIAL)
Principal Investigator:  Professor Ian Roberts
Organisation: London School of Hygiene & Tropical Medicine
Start Date 1st June 2011
End Date: 30th September 2017

View Abstract

Sudden severe bleeding is an important medical problem in the UK and worldwide. Recent results from a large international clinical trial in bleeding accident victims show that a cheap drug called tranexamic acid reduces the chances of dying from the injuries and improves other patient outcomes without any increase in side effects.

Tranexamic acid is not a new drug. It has been used to control bleeding during major surgical operations for many years. The realisation that this drug could be used to treat a much wider range of bleeding conditions holds the promise of important benefits for patients at low cost.

The research team responsible for the accident victim research will conduct a trial to see if this drug improves outcome in post-partum bleeding. The team is experienced in carrying out this type of research and will work with an established network of doctors from all around the world to enable them to answer this important medical question.

The detection and treatment of ventilator-associated pneumonia – towards improved antibiotic stewardship
The detection and treatment of ventilator-associated pneumonia – towards improved antibiotic stewardship
Principal Investigator:  Professor John Simpson
Organisation: University of Newcastle upon Tyne
Start Date 1st February 2012
End Date: 31st May 2017

View Abstract

Critically-ill patients whose lungs are supported by breathing machines (ventilators) commonly develop new lung infection, called ventilator-associated pneumonia (VAP). Because VAP is often fatal, antibiotics are administered whenever it is suspected. However VAP is hard to distinguish from several non-infective lung conditions and most patients with suspected VAP do not have pneumonia. Therefore many patients receive unnecessary antibiotics for several days, promoting the emergence of so-called superbugs.

Laboratory infection results for VAP typically return in three days. A simple test that rapidly and confidently excludes VAP would improve patient care, reduce unnecessary antibiotics and decrease costs.

Professor John Simpson and his team have recently showed that low levels of specific proteins in fluid from the lungs of patients with suspected VAP effectively exclude VAP within four hours. The test used is an extension of existing technology produced by the team’s commercial partner Becton Dickinson (BD) Biosciences. This test will be rigorously analysed in a clinical trial and if rapid, safe, cost-effective reductions in unnecessary antibiotics are confirmed, the test will be rapidly introduced into hospitals through the commercialisation expertise of the University of Newcastle technology transfer team and BD Biosciences.

Tissue oxygen monitoring for detecting impending shock states and guiding therapy in the critically ill and those at high risk
Tissue oxygen monitoring for detecting impending shock states and guiding therapy in the critically ill and those at high risk
Principal Investigator:  Dr Andrew Obeid
Organisation: Oxford Optronix
Start Date 3rd January 2012
End Date: 31st July 2017

View Abstract

Complications frequently occur following trauma, infection and major surgery. This can lead to failure of organs (e.g. lung, kidney, gut) necessitating admission to intensive care for organ support. Mortality rates are high and long-term disability common in survivors. Studies already show how early resuscitation of the circulation in these patients can considerably improve outcomes. Although it is possible to gauge how much blood the heart is pumping to the tissues (cardiac output) better bedside monitors are needed to assess if the cardiac output is actually adequate for perfusing the organs.

Patients who are unwell or undergoing major surgery routinely have a bladder catheter placed to drain urine. Dr Andy Obeid of Oxford Optronix Ltd, together with Prof. Mervyn Singer at University College London, plan to use this catheter to co-insert a small, flexible fibre-optic based sensor to continuously monitor oxygen levels within the bladder wall. This device will indicate whether or not the local blood supply transporting oxygen to the bladder is indeed adequate and whether oxygen measurements from the bladder reflect the situation in other parts of the body. Their aim is to assess whether this new technology provides an easy and readily applicable solution to monitoring tissue health during acute injury. This will pave the way for a further clinical investigation in which the circulation is optimised using the device to see if a reduction in post-trauma complications can be achieved.

Post-intensive care risk-adjusted alerting and monitoring (PICRAM)
Post-intensive care risk-adjusted alerting and monitoring (PICRAM)                                  
Principal Investigator:  Dr Duncan Young
Organisation: University of Oxford
Start Date 4th September 2011
End Date: 20th November 2016

View Abstract

One tenth of the 85,000 patients discharged annually from UK intensive care units (ICUs) apparently recovering from their acute illness, die before leaving hospital. Frequent visits to the patients’ wards by the ICU nursing team reduce this risk, but suitably-trained nurses are expensive and in short supply.

The research team plans to develop a comfortable, wearable physiological monitoring device linked to computers with ‘knowledge’ of patterns of vital signs in post-ICU patients. This device will automatically measure vital signs and detect the warning signs of serious problems in patients discharged from the ICU.

Using the hospital wi-fi network, they will monitor the patients’ vital signs continuously using a computer system programmed with information on each individual patient’s risk of deterioration, obtained during their ICU stay. If the computer detects a change in the patients’ vital signs, it will alert medical staff. This approach will allow hospitals to monitor far more patients for a far longer time than would be possible using nurses alone, whilst minimising false alarms by tailoring the alarm limits to each individual patient.

Even modestly reducing these post-ICU deaths to one in twelve discharged patients would save 1,400 lives annually – equivalent to more than half the road deaths in Great Britain. Compliance with government guidance, reduced costs, improved safety and a reduction in insurance premiums will all be used to persuade healthcare teams to adopt the system.