February 2015
The NIAA-AAGBI Grants Committee met on 20 February 2015 and considered 9 applications for a total sum of £284,096.17.
Three awards were made to a sum of £74,448.17 and the scientific abstracts from the three successful applicants appear below. The lay abstracts can be accessed via the left-hand link.
Professor Dave Lambert
NIAA Grants Officer
Principal Applicant
Dr Kieran Donnelly
City Hospital, Birmingham
Title
The six minute walk test as a predictor of morbidity following major colorectal surgery
Amount
£20,236.17
Scientific Abstract
Poor performance in exercise tests can predict patients at risk of post-operative mortality and morbidity, as the body is unable to meet the increased metabolic demands of the recovery period. Formal cardiopulmonary exercise testing is validated but expensive, time consuming, and with limited availability. Although the 6-minute walk test (6MWT) may be a useful alternative in predicting morbidity following major surgery, it has not yet been directly tested. We propose performing the 6MWT in 100 adult patients awaiting major colorectal surgery;
- To test the 6MWT as a predictor of 30- and 90-day morbidity
- To compare it to the POSSUM score as a predictor of morbidity
- To combine results with the POSSUM score to improve the predictive power of either alone
- And to measure its acceptability to patients within this context.
The 6MWT is safe, reproducible, simple and well established as a measure of cardiorespiratory function in range of disease states. It has potential as an objective indicator of post-operative risk for patients about to undergo major surgery.
Principal Applicant
Dr Iain Moppett
University of Nottingham
Title
Evaluation of benefits, risks and barriers to implementation of an ISO 26825 colour coded anaesthetic drug tray
Amount
£5,614
Scientific Abstract
Background
Drug maladministration is relatively common in anaesthetic practice (around 1 in 140 anaesthetics). The causes of these are multifactorial but relate to the need for the anaesthetist to complete the process of prescription, drug selection, preparation and administration in a distracting environment. The consequences can be catastrophic: intravenous local anaesthetic can be fatal; NAP5 reported drug errors as the cause of 1 in 8 reports of accidental awareness. Previous attempts to reduce drug error such as human or automated drug checking have had little clinical impact in the UK; in part due to perceived difficulty in consistent application and cost. A common industrial approach to reducing error is to standardise and provide clear visual cues to workflow.
Method
We propose an observational and interview based three-centre study to examine the utility of a novel, bespoke anaesthetic drug tray which combines ISO 26825 colour coding, compartmentalisation and infection control at achievable cost. The study will assess the potential benefits and risks from use of the tray. In addition we will explore potential barriers to its use in clinical practice.
Outcomes
Evidence to inform development / implementation of this or similar drug trays in UK anaesthesia practice.
Principal Applicant
Prof Rupert Pearse
Barts & The London School of Medicine & Dentistry
Title
Prevention of Respiratory Insufficiency after Surgical Management (PRISM) Trial:
An international pragmatic randomised controlled trial of continuous positive airway pressure to prevent respiratory complications and improve survival after major abdominal surgery
Amount
£48,598
Scientific Abstract
Background: Over 230 million patients undergo surgery worldwide each year with reported hospital mortality of 1 - 4%. Complications and deaths are most frequent amongst high-risk patients who are older or have co-morbid disease and undergo major abdominal surgery. Respiratory complications, in particular pneumonia, are amongst the most important, both in terms of frequency and severity. However, standard treatments, like physiotherapy or supplemental oxygen, commonly fail to prevent these complications. Evidence from small trials suggests that the use of continuous positive airway pressure (CPAP) to provide non-invasive respiratory support early after abdominal surgery, may reduce pulmonary complications. However, this treatment has not been introduced into routine practice because evidence from large clinical effectiveness trials is lacking.
Design: We will recruit 4784 patients into a pragmatic, international, multi-centre randomised controlled trial to confirm whether CPAP immediately after major abdominal surgery reduces a composite outcome of pneumonia, re-intubation or death within 30 days of surgery. Secondary outcomes include infection, secondary mechanical ventilation, days in critical care, duration of hospital stay, 180-day mortality, hospital readmission and quality adjusted life years at 180 days after surgery. The trial will be reviewed by a research ethics committee and conducted according to standards of Good Clinical Practice (GCP).
Trial conduct: This international collaboration is led by Prof. Pearse (UK) and Prof. Ranieri (Italy). The UK team will lead day-to-day trial management.
