BJA/RCoA Project Grant

The successful applicants for the BJA / RCoA Project Grant were:

Principal Applicant
Dr Iain Moppett
Associate Professor of Anaesthesia, University of Nottingham

Feasibility and metabolic effects of carbohydrate loading in patients with fragility hip fracture - a randomized double blind pilot study


Scientific Abstract
Hip fracture is associated with poor functional outcome and muscle function is an independent predictor of functional outcome. The stress response following trauma and surgery may have deleterious effects on muscle metabolism. Previous research has demonstrated that muscle metabolism following feeding in the elderly is qualitatively different to younger subjects. Research in elective surgery has demonstrated beneficial effects of pre-operative carbohydrate rich drinks on ameliorating the stress response, development of insulin resistance and reducing thirst, nausea and vomiting in the peri-operative period. There is limited research into this approach in hip fracture patients. We wish to undertake a clinical and basic science study into the feasibility of giving carbohydrate drinks to this group of patients looking at: feasibility (tolerability of drinks, practical considerations in emergency patients), effects on insulin resistance and effects on muscle metabolism. Thirty hip fracture participants will be randomized to normal care or carbohydrate drink (night before and 2 hours before surgery). Insulin resistance will be assessed by blood tests on the morning after surgery. A group of age-matched patients undergoing elective surgery will act as non-trauma controls. The results from this study may allow us to undertake targeted interventions in larger multicentre studies in the future.

 Interim report from Dr I Moppett R1 2012 (54 KB)

Principal Applicant
Dr Michael O'Dwyer
Senior Lecturer, Queen Mary's University of London

A characteristic cytokine gene expression signature may predict the development of post-operative pneumonia following major gastrointestinal surgery


Scientific Abstract
Pneumonia is a potentially fatal complication following gastrointestinal surgery. The lead applicant has demonstrated that it is possible to identify patients destined to develop pneumonia following thoracic surgery by analysing peri-operative cytokine gene expression and inferring specific immune deficiencies in T Helper cell 1(Th1) and Th17 pathways. Analysis of a group of patients undergoing major gastrointestinal surgery, also enrolled in the Vascular events In noncardiac Surgery cOhort evaluation (VISION) UK study, will validate and extend these findings.
VISION-UK will recruit 4000 to 6000 patients over the next 18 months and from these, 300 consecutive patients undergoing major gastrointestinal surgery will be included in the proposed study. We will assay cytokine gene expression pre-operatively, at 6-12, 24 and 72 hours following surgery. Gene expression will be inferred from mRNA quantification of genes involved in innate immunity and the Th1, Th2, Treg and Th17 pathways. Global immune status will be assessed in a subset by analysis of monocyte HLA-DR expression. Patients developing a post-operative pneumonia will be identified according to predefined criteria.
The aim is the early identification of a group at high risk of developing post-operative pneumonia and furthering our understanding of the mechanisms involved. These data may help guide future interventions.

 First year report from Dr M O Dwyer (87 KB)
 Final report from Dr M O Dwyer.pdf (93 KB)

Crit Care. 2014 Oct 1;18(5):541. doi: 10.1186/s13054-014-0541-x