February 2016
The NIAA-AAGBI Grants Committee met on 19 February 2016 and considered seven applications for a total sum of £88,090.
Seven awards were made to a sum of £83,002 and the scientific abstracts from the seven successful applicants appear below. The lay abstracts can be accessed via the left-hand link.
Professor Dave Lambert
NIAA Grants Officer
Principal Applicant
Dr Matthew Charlton
University Hospitals of Leicester NHS Trust
Title
Can infrared thermal imaging be used to quantify abnormal skin perfusion in sepsis?
Amount
£6,511
Scientific Abstract
Primary Aim
To establish whether infrared thermal imaging can be used to quantify skin perfusion in septic patients by measuring skin surface temperature gradients in a clinical setting.
Background
Microcirculatory dysfunction plays an important role in the pathophysiology of sepsis, with decreased capillary density and heterogeneous blood flow in all organ systems including the skin. This can sometimes be seen clinically as mottling, which when present, is associated with increased mortality amongst critically ill patients. However, mottling is a late, subjective sign and cannot be seen in all skin colours.
Highly sensitive thermal imaging cameras allow visualisation and measurement of small cutaneous temperature differences associated with sepsis that are not apparent to the naked eye.
Detecting cutaneous microcirculatory abnormalities before they become visually evident may allow earlier treatment aimed to correct the underlying pathophysiology and potentially improve outcome.
Plan of investigation
Single-centre observational cohort trial of 105 participants in three groups; healthy volunteers, sepsis and severe sepsis. Participants will undergo assessment of the anterior leg using a thermal imaging camera. Images will be compared between groups in conjunction with conventional markers of sepsis and disease severity.
Principal Applicant
Professor Peter Collins
University Hospital of Wales
Title
Characterising the coagulopathy of postpartum haemorrhage
Amount
£18,499
Scientific Abstract
The coagulopathy caused by postpartum haemorrhage (PPH) is not well-defined and likely to differ from trauma-induced-coagulopathy. It is not known how PPH-induced-coagulopathies vary according to the cause of the bleeding or evolve as bleeding progresses and resuscitation is started. Treatment guidelines recommend that PPH should be treated with regimens designed for major trauma and advocate formulaic fixed-ratio RBC:FFP transfusion. This is unlikely to be the optimal treatment strategy for PPH and potentially causes harm because many women will receive FFP unnecessarily.
In this study we propose to recruit 100 women early during a PPH and monitor haemostasis at least every 30 minutes until the bleeding is controlled. These women will be compared with 25 term women who are not bleeding. We will monitor coagulation factors, global haemostatic assays and look for evidence of fibrinolysis, dysfibrinogenaemia, disseminated intravascular coagulation and activation of protein C. Data will be analysed according to the cause of bleeding. The effect of crystalloid and colloid infusions will be examined. The impact of haemostatic replacement with FFP and fibrinogen concentrate will be documented.
These data will allow targeted and evidence-based strategies to be developed for the treatment of haemostatic impairment during PPH.
Principal Applicant
Dr Alex Looseley
Southmead Hospital, Bristol
Title
Satisfaction and Wellbeing in Anaesthetic Training (SWeAT)
Amount
£11,685
Scientific Abstract
Background
Evidence of high stress, depression, burnout syndrome and increased suicide risk exists among anaesthetists and particularly, anaesthetic trainees. UK anaesthetic training is changing; so too are the expectations and associated pressures. Thorough exploration of stress, depression and burnout in UK anaesthetic trainees is required in order to attempt to optimise the health and wellbeing of this vital workforce and improve the safety of the patients it treats.
Aims
To establish the prevalence of, and factors contributing towards, professional satisfaction, perceived stress, depression and burnout syndrome amongst anaesthetic trainees within Southwest England and Wales.
Methods
A collaboration of trainee-led research networks, targeting approximately 500 trainees within Severn, Peninsula and Wales Deaneries. Quantitative estimation of prevalence will be achieved by using validated assessment tools distributed via anonymous electronic questionnaires with selected participants invited for semi-structured confidential interviews.
Results
Statistical analysis will consider frequencies and percentages to describe our sample and correlations and associations between variables. Qualitative research will employ thematic analysis to explore potential contributing factors.
Potential benefits
This study will provide current, accurate information to those involved with training, supervising, managing and mentoring UK anaesthetic trainees and inform current and future support resources.
Principal Applicant
Dr Guillermo Martinez-Munoz
Papworth Hospital, Cambridge
Title
Effect of spontaneous ventilation versus positive pressure ventilation in patients undergoing diagnostic thoracoscopic biopsy for Interstitial Lung Disease (ILD) under General Anaesthesia (GA).
Amount
£13,516
Scientific Abstract
Interstitial Lung Disease (ILD) is a progressive fibrotic process of the lung parenchyma. It can be difficult to treat, and is frequently fatal. Surgical lung biopsy is required in 33% of patients to determine the sub-type of disease and guide therapy to slow progression and prolong life. The procedure is not without risk, and has an average mortality of 3.8%, usually due to progressive post-operative respiratory failure.
Animal studies have suggested that mechanical ventilation can accelerate ILD progression. It has been shown that ICU patients with ILD have a higher susceptibility to ventilator induced lung injury. We hypothesise therefore that if positive pressure ventilation could be avoided during surgical lung biopsy under general anaesthesia, patient outcomes could be improved.
Consequently, we have developed an innovative anaesthetic technique for surgical lung biopsy utilising spontaneous ventilation through a supraglottic airway device and spontaneous pneumothorax to achieve lung isolation.
We propose a pilot randomised, controlled trial to ascertain if this technique decreases the length and improves the quality of post-operative stay, decreases the incidence of acute exacerbation of ILD post-operatively, and has improved lung function at six months post-procedure, relative to the current gold standard of general anaesthesia with mechanical ventilation via a double-lumen endotracheal tube.
Principal Applicant
Dr Iain McCullagh
Freeman Hospital, Newcastle upon Tyne
Title
Modifiable perioperative risk factors for postoperative delirium in older adults undergoing major elective non-cardiac surgery: a feasibility cohort study (PODIUM 1 study).
Amount
£7,499
Scientific Abstract
Over the last decade an increasing number of older adults are undergoing major elective surgery in the United Kingdom. Postoperative delirium (POD) is an important complication of major surgery yet remains poorly understood. Importantly, the few, good-quality prospective cohort studies are now more than twenty years old and pre-date major improvements in anaesthesia and perioperative care. More recently, studies into POD have mostly focused on patients undergoing emergency hip fracture or elective cardiac surgery. This feasibility study and the subsequent larger study will provide contemporary data on modifiable pharmacological and physiological risk factors for POD in a cohort of older patients undergoing major elective surgery, in the UK NHS.
We propose a feasibility study aiming to recruit 100 patients aged 65 years and older from five hospitals across the North of England who are scheduled to undergo major elective surgery. They will be assessed pre-operatively and then tested for delirium during the first four days postoperatively. We will record pre-existing health data, choice and dose of anaesthetic agents, use of depth of anaesthesia monitoring, regional versus general anaesthesia and post-operative analgesia as well as incidence of POD. During this study (PODIUM 1) we will assess how easy (or not) it is to recruit patients, how long it takes to gain consent and collect study data, and how best to utilise a regional trainee research network in delivering this research project. We will use this information to construct a definitive, large-scale cohort study to determine the modifiable risk-factors for postoperative delirium (PODIUM 2) in the UK NHS. The overall aim of our research is to develop a perioperative care bundle to decrease the incidence and severity of postoperative delirium which could be tested in a randomised clinical trial.
Principal Applicant
Dr Julian Sonksen
Russells Hall Hospital, Dudley
Title
Recovery after emergency laparotomy (REmLap). A prospective observational feasibility study.
Amount
£10,292
Scientific Abstract
Regaining baseline Health Related Quality of Life (HRQoL) and returning to 'normal life' after surgery are of vital importance for patients. Our knowledge of the trajectory and degree of long-term functional recovery following emergency laparotomy, including the regaining of optimal HRQoL is limited as most research relating to this field has been done in patients undergoing planned surgery. Furthermore, a comprehensive understanding of the pattern of recovery and restoration of baseline HRQoL is also important to researchers wishing to assess the full impact of interventions in order to improve outcomes following emergency laparotomy. Assessing HRQoL in this surgical population remains a challenge in the absence of a validated instrument. We plan to undertake a feasibility study to assess utilisation of four patient questionnaires, well established within other surgical populations, to describe the quality of early and long-term recovery following emergency laparotomy. We will utilise the QoR-15 to describe short-term (in-hospital) recovery metrics and versions of the WHO-DAS and the SF-36 to describe longer term disability free survival and return towards baseline HRQoL. The Post-Operative Morbidity Survey (POMS) will help capture the onset of complications at different points during recovery. The study also aims to test the feasibility of assessing the impact of pre-operative co-morbidities, age, quality of peri-operative and intra-operative care, surgical indication and findings as well as post-operative complications on long-term HRQoL.
Principal Applicant
Professor Michael Y.K. Wee
Poole Hospital NHS Foundation Trust
Title
Producing a Physical Prototype Patient-specific Epidural Simulator for Training
Amount
£15,000
Scientific Abstract
This research will involve development of a prototype epidural simulator integrating with our existing patient-specific virtual reality software.
This will provide a realistic and immersive experience for training and assessment. Our epidural simulator could be used to train epiduralists to perform epidural procedure in a safe environment. The proposed patient-specific simulator will allow practice for virtual patients of any shape, size or BMI applying a data-driven approach.
This will be the first epidural simulator using virtual reality interface and able to simulate multiple patient positions including flexing and bending the spine which is achieved by creating 3D vertex models of each vertebra. Stereoscopic 3D glasses are incorporated allowing the 3D graphical visualisation and ligaments to be viewed with depth perception which is an important aspect of epidural needle placement learned with experience. Models of human tissues including skin, fat, ligament and bone will be developed as soft and hard materials using real-time deformation based on spring-mass-damper model.
The virtual reality simulator will simulate various BMIs to match patient characteristics. Epidural assessment criteria has been developed and incorporated into our simulation to critically assess trainees and provide feedback on performance.
