AAGBI/Anaesthesia Research Grants

University College London

Title
Feasibility and safety of delivering a ketone drink to comatose survivors of out-of-hospital cardiac arrest

Amount
£32,643

Scientific Abstract
In the UK approximately 30,000 episodes of out-of-hospital cardiac arrest receive treatment every year. Of the 6,350 admitted to intensive care, 46% die due to neurological injury. Half the survivors suffer long-term neurological impairment. Apart from targeted temperature management, there are no known treatments to protect the brain or improve outcome.

Ketone bodies are naturally produced by the human body under conditions of starvation. Human and animal evidence suggests they may be cerebroprotective during or shortly after periods of reduced oxygen supply, such as cardiac arrest. Thus, in animals, ketones improve metabolic efficiency, reduce oxygen demand, protect against reactive oxygen species, prevent cerebral neuronal apoptosis, and reduce stroke volume after carotid ligation. In humans, they have proven anticonvulsant activity.

Ketone bodies have now been manufactured, and safely used in drink form by athletes for several years. However, data relating to therapeutic applications are lacking. We propose a single-centre, open-label pilot study to establish the feasibility and safety of delivering a ketone drink to 10 comatose survivors of out-of-hospital cardiac arrest. The drink will be given via nasogastric tube for 48 hours. Regular blood samples will assess any ill-effects and patients will undergo non-invasive tests of cardiac and neurological function.

Queen Alexandra Hospital, Portsmouth

Title
CANDLE - The Critical Appraisal of the Nocturnal Distribution of Light Exposure in Intensive Care

Amount
£4,995

Scientific Abstract
CANDLE is a project aimed at humanising the Intensive Care Unit (ICU). Patients on ICU have disrupted circadian rhythms (1). This can lead to increased morbidity, mortality and length of ICU stay in the critically unwell (2, 3). Light is the most efficacious influence on the circadian rhythm and has an under recognised impact on patient outcome within ICU. CANDLE will quantify who, when and why patients are exposed to nocturnal lux in ICU with the ultimate goal of influencing guidelines, developing solutions and improving patient outcome. A single centre pilot study has already been performed. This pilot study demonstrated that low acuity patients are exposed to similar average lux levels as those who are sicker. Also, there is a positive correlation between how sick a patient is, and the maximum lux they are exposed to. This study needs to be replicated and expanded in order to be confident of our preliminary findings. There are no medical guidelines for the levels of light patients are exposed to in ITU, and once complete the data CANDLE produces will help influence the creation of these overdue recommendations.

Royal Free Hospital, London

Title
Alterations in coagulation profile following orthotopic liver transplantation

Amount
£32,423

Scientific Abstract
Haemostasis in end stage liver disease is "re-balanced", and despite the prolonged PT/INR, thrombin generation is normal or even increased (1, 2). Liver transplantation (LT) introduces further stresses to this fragile haemostatic balance, and both excessive bleeding and thrombosis are potential risks in the perioperative period (3, 4). To date, there have been very limited studies on coagulation profiles following LT, but it appears that there may be an underestimated intrinsic hypercoagulable state following transplantation, associated with low anticoagulant levels and high factor VIII, together with fibrinolysis suppression (5, 6). To complicate matters marginal grafts, with a risk of initial poor function or primary nonfunction, have delayed synthetic function and coagulation may not improve immediately after transplantation, with consequent risk of bleeding (7).
We aim to conduct the first comprehensive study of coagulation changes in the early postoperative period following LT. This observational study will evaluate the coagulation profile changes of 30 patients at five specific time points, beginning immediately following surgery and concluding on the 3rd postoperative day. An in-depth understanding of postoperative coagulation will enable tailored administration of clotting products where necessary and inform anticoagulation protocols, resulting in a reduction in bleeding and thromboembolic complications following surgery.

Royal Hallamshire Hospital, Sheffield

Title
Assessment of ventilatory management during general anaesthesia for robotic surgery and its effects on postoperative pulmonary complications (AVATaR): A prospective observational multicenter study

Amount
£14,589

Scientific Abstract
Introduction: Despite the growing numbers of patients undergoing robotic surgery, the need for pneumoperitoneum and Trendelenburg position significantly affects respiratory mechanics causing a worsening in compliance and airway resistance. Therefore a better understanding of the impact of robotic surgery and mechanical ventilation on the respiratory system and postoperative pulmonary complications is vital.

Objective: The aim of this study is to assess the incidence of postoperative pulmonary complications in this group of patients, to characterise current practices of mechanical ventilation during general anaesthesia for robotic surgery and to evaluate a possible association between ventilatory parameters and postoperative pulmonary complications.

Study design: This is a prospective observational multicenter study. Centres invited to participate will include patients consecutively submitted to mechanical ventilation during anaesthesia for robotic surgical procedures during a period of one month.

Main parameters to be studied: The incidence of postoperative pulmonary complications and the effects of the different parameters of mechanical ventilation during general anaesthesia in robotic surgery on postoperative pulmonary complications will be investigated for 5 days after surgery or hospital discharge, whichever occurs first.

Nature and extent of the risks associated with participation: Considering the observational nature of the study, there will be no risk for participating patients.