The appropriate dosing of antibiotics for patient admitted to ICU after a traumatic injury is poorly defined and based on intuition rather than evidence. Doctors need to predict which patients may develop very high antibiotic clearances and dose accordingly so that potentially life-threatening infections do not occur. Given these patients are unknown, this research seeks to identify such patients and recommend which antibiotic and which dose is appropriate to ensure adequate treatment.
Impact Of Gastrointestinal Dysmotility On Enteral Nutrition In The Critically Ill
Funder
National Health and Medical Research Council
Funding Amount
$533,792.00
Summary
Critically ill patients require nutrition for optimum recovery. Ideally, this is provided via the gut, but oesophageal reflux, slow gastric emptying and small intestinal dysfunction frequently prevent adequate delivery of nutrients to these patients, exposing them to complications such as pneumonia and gastrointestinal bleeding. The work performed by the applicants will improve the ability of doctors in the Intensive Care Unit to feed patients and prevent the development of such complications.
Upper Gastrointestinal Motor And Absorptive Function In Critically Ill Patients
Funder
National Health and Medical Research Council
Funding Amount
$260,760.00
Summary
A major concern in critically ill patients is the provision of adequate nutrition to facilitate recovery from devastating metabolic insults. Abnormal contractions of the oesophagus, stomach and small intestine appear to be common in critically ill patients. These may prevent effective feeding of patients at a time when they are especially vulnerable to malnutrition and also result in major complications such as pneumonia, septicaemia and gastrointestinal haemorrhage. However little is known abou ....A major concern in critically ill patients is the provision of adequate nutrition to facilitate recovery from devastating metabolic insults. Abnormal contractions of the oesophagus, stomach and small intestine appear to be common in critically ill patients. These may prevent effective feeding of patients at a time when they are especially vulnerable to malnutrition and also result in major complications such as pneumonia, septicaemia and gastrointestinal haemorrhage. However little is known about the reasons underlying these dysfunctions. The applicants, with ongoing support from the NH and MRC have had a longstanding interest in motility disorders of the gut and have made important contributions to knowledge about both the causes and treatments of these conditions. These contributions have been underpinned by pioneering the development of new methodologies to examine gut function. In collaboration with the intensive care specialists in Adelaide, we now seek to apply this knowledge to evaluate gut function in patients in the Intensive Care Unit. The proposed studies will provide the most comprehensive studies to date of the gut function in critically ill patients and have important implications for treatment.Read moreRead less
Oesophageal, Gastric And Small Intestinal Motility In Critical Illness
Funder
National Health and Medical Research Council
Funding Amount
$494,250.00
Summary
A major concern in critically ill patients is the provision of adequate nutrition to facilitate recovery from devastating insults. Abnormal contractions of the oesophagus, stomach and small intestine occur commonly in critically ill patients. These may prevent effective feeding of patients at a time when they are especially vulnerable to malnutrition and also result in major complications such as pneumonia, septicaemia and gastrointestinal haemorrhage. The applicants, with the support of the NH ....A major concern in critically ill patients is the provision of adequate nutrition to facilitate recovery from devastating insults. Abnormal contractions of the oesophagus, stomach and small intestine occur commonly in critically ill patients. These may prevent effective feeding of patients at a time when they are especially vulnerable to malnutrition and also result in major complications such as pneumonia, septicaemia and gastrointestinal haemorrhage. The applicants, with the support of the NH and MRC, have had a longstanding interest in motility disorders of the gut and have made important contributions to knowledge about both the causes and treatments of the disturbances that occur in the oesophaus, stomach and small intestine. In the previous grant (207753) these studies have provided the most comprehensive studies to date of the motor abnormalities associated with gut dysfunction in critical illness which have important implications for treatment. The applicants now seek to continue their work by investigating the mechanisms underlying these motor abnormalities and the impact of therapeutic strategies designed to enhance delivery of nutrition to critically ill patients.Read moreRead less
Improved Patient Outcomes By Early Intervention With Therapeutic Cooling For Patients With Severe Traumatic Brain Injury, And By Optimising Patient Blood Transfusion Practice In Critically Ill Patients.
Funder
National Health and Medical Research Council
Funding Amount
$380,450.00
Summary
First, a large multicentre trial (POLAR) will complement my previous successful trials in traumatic brain injury (TBI) patients and will establish whether active therapeutic cooling, commenced early after brain injury and continued in intensive care units, will achieve its promise of improving patient outcomes. Second, a national multicentre trial (TRANSFUSE) will establish whether transfusing blood units with a shorter than usual storage time will improve patient outcomes.
My program of research will focus on one of the most common interventions in medicine _ determining the best resuscitation fluid for resuscitation of critically ill patients. The program includes completion of a major clinical trial in intensive care followed by a series of comparative studies of past and current studies in Australia and internationally. These results will produce clear evidence that will be incorporated in practice guidelines to inform clinicians about optimal practice.
I am an intensive care physician, clinician and researcher, interested in studying new therapies to improve outcomes in patienst with acute trauma, sepsis and lung injury. A main focus is independent phase 111 clinical trials in critically ill patients
Does Increased Non-Linear Behavior Caused By Dynamic Variables Increase Ventilatory-Induced Lung Injury (VILI)?
Funder
National Health and Medical Research Council
Funding Amount
$109,625.00
Summary
Acute lung injury (ALI) is precipitated by a variety of different insults, either directly to the lung or elsewhere to the body. Approximately 50% of the patients die. ALI is characterized by an increase in the leakiness of the barrier that normally separates the blood from the airspaces. The fluid which consequently floods the airspaces not only makes it difficult for patients to adequately obtain oxygen, but also dramatically increases the work of breathing by changing the surface forces withi ....Acute lung injury (ALI) is precipitated by a variety of different insults, either directly to the lung or elsewhere to the body. Approximately 50% of the patients die. ALI is characterized by an increase in the leakiness of the barrier that normally separates the blood from the airspaces. The fluid which consequently floods the airspaces not only makes it difficult for patients to adequately obtain oxygen, but also dramatically increases the work of breathing by changing the surface forces within the lungs. As a result, the patients must be mechanically ventilated. However, the very act of using a positive pressure to inflate the lungs often creates further damage, either through repeated opening and closing of collapse tissue or through its over distension. Ventilatory-induced lung injury (VILI), in itself is estimated to contribute to ~30% of the mortality. The best way shown to minimize VILI is through the use of small programmed breaths so as not to overinflate the lungs while still allowing adequate gas exchanges, superimposed upon a background pressure, in order to pre-inflate the lungs and prevent them from repeatedly collapsing. A remaining problem is that just as a rubber band changes its elasticity as it is stretched, so too the lung changes its mechanical properties during distension. Moreover, the lung is considerably more complex since different regions have different elasticities, which change differentially as air flows in and out of them. Airflow in turn depends on regional differences in the location, size, and number of conducting airways. Indeed, we have recently shown for the first time that dynamic changes in lung mechanics may contribute to VILI in patients, despite the use of safe ventilation modalities. This application proposes to examine the extent to which dynamic changes in lung mechanic contribute to VILI in an animal model, as a prelude to more costly, large scale clinical trials aimed at improving mortality.Read moreRead less
A Randomised Controlled Trial Of Prophylactic Hypothermia In Severe Traumatic Brain Injury.
Funder
National Health and Medical Research Council
Funding Amount
$2,061,506.00
Summary
Patients who suffer from a severe head injury (traumatic brain injury) have a 50% chance of having severe long term neurological disability or death. Some of this damage occurs after the initial injury and may be reduced by artificially lowering the body termperature for up to 7 days to protect the brain from further damage. This project will determine if early, sustained cooling is safe and if it can improve the long term neurological outcomes of patients with traumatic brain injury.