Early Parenteral Nutrition Vs. Standard Care In The Critically Ill Patient: A Level I Randomised Controlled Trial.
Funder
National Health and Medical Research Council
Funding Amount
$1,852,333.00
Summary
Nutritional support is accepted as a standard of care for the hospitalised patient however there is little agreement as to how it should be provided to the critically ill patient. Despite the fact that studies consistently link malnutrition to worse outcomes, the provision of nutritional support to the critically ill patient is highly variable. Although there is general agreement that it is best to feed critically ill patients via the gastrointestinal tract (stomach tube feeding), there is no ge ....Nutritional support is accepted as a standard of care for the hospitalised patient however there is little agreement as to how it should be provided to the critically ill patient. Despite the fact that studies consistently link malnutrition to worse outcomes, the provision of nutritional support to the critically ill patient is highly variable. Although there is general agreement that it is best to feed critically ill patients via the gastrointestinal tract (stomach tube feeding), there is no general agreement as to when intravenous artificial nutrition should be begun if a patient cannot tolerate a feeding tube. A recent systematic review of all available clinical trials suggests that if a critically ill patient cannot be fed by a stomach tube for at least 24 hours, they may benefit from intravenous artificial nutrition. This is not what currently happens under standard care. The purpose of this multi-centre randomised controlled trial is to determine if early intravenous nutrition saves lives. Because of the cost, and possible risk of increased infections, a study of this type is required before early intravenous nutrition could become a routine therapy in Australia. Informed consent to participate in the study will be obtained from next of kin, or directly from the patient themselves. The study will be managed at the Royal North Shore Hospital, University of Sydney and will include 26 collaborating ANZ hospitals over 18 months.Read moreRead less
Rapidly giving intravenous fluid to prevent or treat shock (fluid resuscitation) is one of the commonest treatments given to critically ill patients. Current guidelines recommend crystalloid solutions but it is unknown whether any particular crystalloid is better than others. This trial will determine whether the use of one of two crystalloid fluids, saline or PlasmaLyte, reduces the risk of organ injuries, such as kidney failure, and improves patients chances of surviving critically illness.
Improving The Outcome Of Critically Ill Patients Through The Generation Of Evidence And Its Translation Into Practice
Funder
National Health and Medical Research Council
Funding Amount
$329,822.00
Summary
This research program will test new approaches to sepsis, traumatic brain injury, kidney protection, nutrition, post-operative care, sedation, cardiac arrest, and mobilisation of acutely ill patients to deliver better outcomes. Experimental research will help understand kidney injury during severe infection and develop new ways of protecting the brain during cardiac arrest. Database investigations will identify successful patterns of treatment and potential new fields of investigations.
Early Identification Of Disability To Inform Better Care And Outcomes In High Risk Patients
Funder
National Health and Medical Research Council
Funding Amount
$97,000.00
Summary
Australia has achieved marked improvement in hospital survivorship. We face the challenge of an ageing population, and healthcare resources need to prioritise good value care, clearly identifying high-risk patients who will not benefit from invasive and expensive interventions. This proposal takes the required next step to enable health providers to predict patients at risk of ongoing disability, optimise discharge planning, and to measure long-term health outcomes.
Demystifying The Burden Of Intensive Care Survivorship - Understanding Muscle Wasting And Falls
Funder
National Health and Medical Research Council
Funding Amount
$314,644.00
Summary
For individuals who survive an intensive care admission, there is no prevention or cure for the development of intensive care acquired weakness. This project aims to examine the impact of muscle loss and weakness on balance, falls and the ability to walk. These outcomes are important to patients as it directly impacts on the ability to undertake day-to-day activities, their confidence and return to work. Results will be used to inform clinical practice and improvement in patient care.
Treatment Of Invasively Ventilated Adults With Early Activity And Mobilisation
Funder
National Health and Medical Research Council
Funding Amount
$1,467,137.00
Summary
The sickest patients in intensive care units (ICUs) receive prolonged, invasive support for their breathing. This is currently managed with complete bed rest, and results in severe muscle weakness, increased duration of hospital stay and poor recovery. We have found that early activity and mobilisation during invasive breathing support is safe and may improve survival and recovery. We will test early activity and mobilisation in a large randomised controlled trial of 750 ICU patients.
Causes And Management Of Abnormally Elevated Blood Glucose Concentrations In The Critically Ill
Funder
National Health and Medical Research Council
Funding Amount
$430,770.00
Summary
Increased glucose concentrations occur commonly in ICU patients and are associated with increased mortality and morbidity. There is a need to improve the understanding of the causes underlying so-called 'critical illness induced hyperglycaemia' as well as new therapies to reduce blood glucose in this group. The proposed studies will focus on the potential role of incretin hormones, which have the capacity to stimulate insulin without increasing the risk of abnormally low blood glucose levels.
Optimising Nutrient Delivery And Absorption In Critically Ill Patients
Funder
National Health and Medical Research Council
Funding Amount
$560,715.00
Summary
Patients surviving ICU are frequently discharged malnourished. Adequate nutrition is essential for optimal outcomes. It is considered best practice to administer nutrition as a liquid formula via a tube passed through the nose into the stomach, however this is frequently limited by impaired gastrointestinal function. We aim to develop more effective strategies for the provision of nutrition to improve nutritional and thereby clinical outcomes in critically ill patients.
The Generation Of High Quality Evidence In Critical Care Medicine Through Multicentre Randomized Controleld Trials And Its Translation Into Practice
Funder
National Health and Medical Research Council
Funding Amount
$240,121.00
Summary
This research program will establish new approaches to sepsis, traumatic brain injury, kidney protection, transfusion, post-operative care, sedation, antibiotics and mobilization of acutely ill patients. Experimental research will help understand why the kidney malfunctions during severe infection. Database investigations will identify of successful patterns of treatment and potential new fields of investigations. Informatics based studies will use electronic data to develop decision support sys ....This research program will establish new approaches to sepsis, traumatic brain injury, kidney protection, transfusion, post-operative care, sedation, antibiotics and mobilization of acutely ill patients. Experimental research will help understand why the kidney malfunctions during severe infection. Database investigations will identify of successful patterns of treatment and potential new fields of investigations. Informatics based studies will use electronic data to develop decision support systems to improve patient care.Read moreRead less
A Randomised Controlled Trial Of Normoglycaemia Versus Conventional Glycaemic Control In Intensive Care Unit Patients.
Funder
National Health and Medical Research Council
Funding Amount
$1,773,507.00
Summary
The concentration of sugar in the blood is often increased in patients in intensive care and patients with increased blood sugar levels are more likely to die. A recent study performed in a Belgian intensive care unit found that using high doses of insulin to lower blood sugars levels to normal increased the number of patients who survived. The chance of surviving to leave hospital was increased from 89% to 93%. Whilst the result is very encouraging, Intensive Care Specialists in Australia are u ....The concentration of sugar in the blood is often increased in patients in intensive care and patients with increased blood sugar levels are more likely to die. A recent study performed in a Belgian intensive care unit found that using high doses of insulin to lower blood sugars levels to normal increased the number of patients who survived. The chance of surviving to leave hospital was increased from 89% to 93%. Whilst the result is very encouraging, Intensive Care Specialists in Australia are unsure if the treatment would work in their patients because of differences in the types of patients found in intensive care units in Australia, and because of other treatment given to the patients in the Belgian study. In particular the doctors in the Belgian unit studied only patients who had had operations and gave large amounts of intravenous sugar to their patients. This is not normally done in Australian Intensive Care Units and the safety of giving high dose insulin to patients not receiving large amounts of intravenous sugar is not known. This is of particular interest as reducing blood glucose to abnormally low levels can cause serious side effects and even result in permanent brain damage. The Australian and New Zealand Intensive Care Society proposes to conduct a new study involving 4,000 patients from intensive care units in Australia and New Zealand and will study all patients regardless of whether or not they have had an operation. These patients will be randomly assigned to receive insulin to control blood sugar levels to normal or to slightly above normal levels as has been tradition in intensive care units around the world. Outcome and serious side effects will be closely monitored. The results will be available within three years of starting the study, and these are likely to influence the treatment of the majority of patients admitted to intensive care units both in Australia and worldwide.Read moreRead less