I am an intensive care clinician who performs clinical trials and experimental large animal research in multiple aspects of acute and intensive care medicine
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
Fluid resuscitation is widely used in the management of critically ill patients. There are a variety of different fluids available to doctors but there is little evidence regarding how effective they are. One of the most commonly used fluids, a hydroxyethyl starch was recently approved by the TGA for use in Australia. This project aims to compare how effective and safe this fluid is compared to another widely used fluid, saline, for resuscitation of critically ill patients in intensive 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.
A Randomised, Placebo-controlled Trial Of Erythropoietin In ICU Patients With Traumatic Brain Injury
Funder
National Health and Medical Research Council
Funding Amount
$1,950,735.00
Summary
Patients who suffer a moderate or severe head injury (traumatic brain injury) have a 50% chance of having a long term neurological disability or death. Erythropoietin is a medication which encourages red blood cell formation but its other beneficial effects are likely to improve outcomes after traumatic brain injury. This study will examine the safety and effects of erythropoietin on long term neurological function in patients who have suffered a traumatic brain injury.
STandaRd Issue TrANsfusion VersuS Fresher Red Blood Cell Use In IntenSive CarE (TRANSFUSE) – A Randomised Controlled Trial.
Funder
National Health and Medical Research Council
Funding Amount
$2,890,335.00
Summary
In Australia, blood for transfusions has a “use by” date of 42 days after collection. The actual age of blood given to patients depends on what is available at the time and the rate of usage. Some research has been done to suggest it might help patients in the intensive care unit reach a better recovery if they receive blood transfusions that are younger than this. This project will test whether patients who receive ‘fresher’ blood do better than patients who receive ‘standard issue ’ blood.
Randomised Comparison Of Fluid Resuscitation With Human Albumin Solution Or Normal Saline Among Critically Ill Patients
Funder
National Health and Medical Research Council
Funding Amount
$611,728.00
Summary
Human albumin solution is widely used for the emergency treatment of severely ill patients requiring fluid replacement, both in Australia and worldwide. However, a recent report suggests that compared to the other standard treatment (salt solution), the use of human albumin solution may be associated with a higher death rate (about six additional deaths among every one hundred patients treated). But, this report was based on data from a relatively small number of patients among whom there was a ....Human albumin solution is widely used for the emergency treatment of severely ill patients requiring fluid replacement, both in Australia and worldwide. However, a recent report suggests that compared to the other standard treatment (salt solution), the use of human albumin solution may be associated with a higher death rate (about six additional deaths among every one hundred patients treated). But, this report was based on data from a relatively small number of patients among whom there was a relatively small number of deaths, and there is widespread uncertainty among doctors about the reliability of the evidence and the implications for patient care. This is reflected in the large difference between intensive care units in the use of human albumin solution (in Australia, its use ranges from 10-90% of all patients needing fluid). Human albumin solution costs, about thirty times more than salt solution, and during 1998 more than 200,000 bottles of human albumin solution were administered to patients in Australia, at a cost of about A$35 million. In an effort to provide definitive evidence about the effects (and cost-effectiveness) of fluid replacement with human albumin solution, the Australia and New Zealand Intensive Care Society, in collaboration with the Australian Red Cross Blood Services and the Institute for International Health, has proposed the conduct of new large-scale study (SAFE - Saline vs Albumin Fluid Evaluation). This study will involve 7,000 patients from 15 intensive care units in Australia and New Zealand. These patients (all of whom require fluid replacement) will be randomly assigned to receive either human albumin solution or salt solution and outcome in terms of deaths and other serious events will be monitored over 28 days. Results will be available within 2 years of starting the study, and these are likely to influence the care of the majority of seriously ill patients admitted to intensive care units worldwide.Read moreRead less
Re-EValuating The Inhibition Of Stress Erosions (REVISE): Gastrointestinal Bleeding Prophylaxis In ICU
Funder
National Health and Medical Research Council
Funding Amount
$2,955,164.00
Summary
Around 50,000 patients in Australian Intensive Care Units receive a drug called pantoprazole each year with the aim of preventing bleeding from the gut. Recent research suggests this practice is ineffective and may harm patients by increasing their risk of serious infections. We will perform a definitive study to determine whether the widespread use of pantoprazole is beneficial or harmful.
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
The Augmented Versus Routine Approach To Giving Energy Trial (TARGET)
Funder
National Health and Medical Research Council
Funding Amount
$3,696,854.00
Summary
Critically ill patients are routinely underfed. The investigators have developed a simple strategy that reliably delivers 100% of caloric goals. The strategy is to substitute standard nutrient with energy dense nutrient and deliver it at the same rate. The aim of this study is to determine the effect of increased calorie delivery on long-term survival and function following critical illness. A 4000-patient, multicentre, double-blind, randomised, clinical trial will be performed.