Association of Anaesthetists/Anaesthesia Research Grants

Sheffield Teaching Hospitals NHS Foundation Trust

Title
Plastic levels in intravenous crystalloid solutions stored in fluid-warming cabinets

Amount
£1,920

Scientific Abstract
A recent paper in Anaesthesia showed that a widely used in-line fluid warmer releases aluminium into balanced crystalloid solutions. This device has been withdrawn from the market.

Many hospitals are now using fluids administered following their storage in a warming cabinet. We know that the electrolytes are stable at elevated temperatures, but it is unknown if components of the plastic storage bag leech into intravenous solutions when kept at an elevated temperature.

Gas chromatography-mass spectrometry will be used to determine if there is any change in the components (specifically plastics) in two commonly used intravenous fluids. Analysis will be carried on bags of 0.9% saline and Hartmann's solution (Fresenius Kabi Ltd) after they have been stored for 30 days at either 21°C (room temperature - control) or after storage at 40°C for either 14 or 30 days. The results will be repeated twice for each solution resulting in a total of 12 samples for analysis.

We expect to confirm that there is no plastic leaching into the intravenous solution after storage in fluid-warming cabinets at 40°C for up to 30 days. This would mean that this common practice can continue to be recommended as a cost-effective way of warming intravenous fluids.

University Hospitals Birmingham NHS Foundation Trust

Title
Moral distress amongst intensive care unit professions in the UK (MODEST)

Amount
£4,867

Scientific Abstract
Moral distress is the negative feelings one experiences when faced with a situation when one knows the ethically appropriate course of action to take, but is prevented from doing so. More broadly, moral distress occurs in clinical and ethical situations that make us feel uncomfortable or that go against our moral code. These situations appear commonplace in ICUs. Previous research in North America has shown that moral distress is widespread amongst ICU staff and results in feelings of guilt, anxiety, frustration, and powerlessness. Worryingly, it is associated with burnout and a tendency to leave the profession. Poor staff wellbeing and high rates of staff turnover are likely to negatively impact patient care. Despite this, moral distress remains poorly studied in the UK. This multi-centre study aims to assess moral distress amongst ICU professions in the UK using a mixed-methods design. An observational study will utilise a quantitative measure of moral distress to examine whether ICU professionals experience moral distress and determine its relationship with demographic and professional characteristics. Semi-structured interviews will characterise the experience of moral distress and identify potential targets for intervention. The results will inform a wider programme of research to develop and investigate targeted moral distress interventions.

Cardiff & Vale University Health Board

Title
mSeP: Improving outcomes in maternal sepsis using physiological and biological markers

Amount
£30,661

Scientific Abstract
Target condition: Maternal Sepsis

Study design: A prospective observational cohort study investigating physiological parameters and biological markers of septic and non-septic pregnant women, including a novel description of genomic sepsis biomarkers.

Sample size: 200 mothers on their pregnancy journey from booking to 24-hours after birth. 100 mothers on the local maternal sepsis pathway.

Main inclusion criteria: Pregnant women with viable pregnancy confirmed on ultrasound at dating scan and over 18 years of age.

Main exclusion criteria: Pregnant women under the age of 18 or wishing not to consent.

Study centre: University Hospital of Wales, Cardiff

Patient study duration: Nine months

Overall study duration: One year

Study objectives: To describe physiological parameters, currently available biomarkers and genomic sepsis biomarkers in the context of healthy pregnant women and those with a clinical diagnosis of sepsis.

To evaluate the effectiveness of physiological parameters in predicting maternal sepsis.

To evaluate the effectiveness of biomarkers in diagnosing sepsis; such as lactate, procalcitonin and genomic sepsis-test.

Primary outcome measures: Descriptive data on physiological parameters, currently available biomarkers and genomic sepsis biomarkers in pregnant women who are healthy and those with clinical diagnosis of sepsis.

Positive predictive value of physiological parameters and biomarkers in identifying women with confirmed sepsis based on culture positive specimens and or strong clinical suspicion.

Secondary outcome measures: Analysis of the genomic-lipidomic time dependent alterations with maternal physiological parameters and biochemical tests including CRP, lactate, white blood cells and procalcitonin during pregnancy and whilst on the sepsis pathway.

University of Liverpool

Title
PREdiction of new-onset atrial FIBRillation In criticaLly iLl septic pATiEnts (PRE-FIBRILLATE)

Amount
£11,751

Scientific Abstract
Sepsis is a life-threatening complication of infection affecting more than 274,000 people in the UK each year. Patients admitted with sepsis have a six-fold increased risk of developing new onset atrial fibrillation (NOAF). Septic patients that develop NOAF have an increased risk of haemodynamic compromise, thromboembolic complications and suffer an increase in mortality of 14% to 29%.

Development of NOAF occurs as a two-step process. Inflammatory damage to atrial myocytes produces an arrhythmogenic atrial substrate after which an arrhythmogenic trigger such as atrial premature complexes (PAC), increased sympathetic stimulus or catecholamines induce NOAF. These processes produce characteristic changes in the ECG tracing in cardiac patients. It is not known if these ECG changes are present in septic patients without previous arrhythmias that develop NOAF.

In this pilot feasibility study, we will record detailed ECG via Holter monitoring in septic patients. We will assess a number of ECG characteristics including, p-wave duration, p-wave amplitude, p-wave axis, PR interval, QRS duration, heart rate variability measures, and burden of PAC by multiple logistic regression to assess if they predict NOAF in septic patients. We will generate receiver operation characteristic curves and assess the sensitivity and specificity of our model.

The ability to predict patients at increased risk of NOAF may allow targeted anti-arrhythmic therapy and preventive strategies.

Sheffield Teaching Hospitals, NHS Foundation Trust

Title
To assess the feasibility of using the 6-minute walk test during a patients first visit to surgical outpatient clinic to identify those individuals with a significantly reduced level of cardiorespiratory fitness

Amount
£12,820

Scientific Abstract
The aim of this study is to assess the feasibility of using the 6-minute walk test (6MWT) as a cardiorespiratory fitness (CRF) screening tool. The screening would take place when the patient attends the hospital for their initial surgical outpatient appointment. By screening, all potential major intra-abdominal surgery patients for a period of 6 months and recording the distance walked in the 6 minutes (6MWD) the aim is to produce a threshold distance for the patients of Sheffield that would identify those with sufficient CRF what would allow them to proceed to surgery without further investigations or fitness interventions. Having identified the fit it would allow the perioperative team to focus resources on the less fit with the aim of improving CRF and other elements that would lead to reduced postoperative morbidity and mortality. Other primary aims include noting the time to surgery. This data will inform on wither instigation of the early screening test would facilitate enrolment and completion of an exercise programme before surgery. The secondary aim is to assess the relationship between the 6MWD and routine CPET to confirm if those that walk the furthest are in fact the fittest.

University Hospitals Birmingham NHS Foundation Trust

Title
Can continuous non-invasive monitoring improve stability of intraoperative blood pressure (iSTABILISE) - a feasibility controlled trial

Amount
£6,330

Scientific Abstract
Intra-operative hypotension is increasingly strongly associated with adverse postoperative outcomes; acute kidney injury, myocardial damage, increased risk of stroke and of mortality. Emerging evidence suggests that in patients who would otherwise have intermittent non-invasive blood pressure monitoring during anaesthesia, using continuous non-invasive blood pressure monitoring may lead to less haemodynamic instability, and thus may improve outcomes.

This trial is a feasibility trial to determine whether it is possible to run a large-scale trial. It will test whether in adults undergoing hip fracture surgery, the use of continuous noninvasive blood pressure monitoring, compared to standard intermittent monitoring (control) improves intraoperative haemodynamic stability, post-operative outcomes (such as kidney or myocardial injury, rates of stroke or post-operative infection and risk of death), and hospital length-of-stay.

We will recruit 30 patients in two sites in a before-and-after controlled design; the first 15 patients will receive the control treatment with additional blinded continuous monitoring. The following 15 patients will have continuous non-invasive blood pressure monitoring fully visible to the treating anaesthetist. The primary outcome for the feasibility study will be the proportion of eligible patients enrolled and completing the trial protocol with complete follow up.