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.
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.
Multi-centre Randomised Trial Of Early Decompressive Craniectomy In Patients With Severe Traumatic Brain Injury
Funder
National Health and Medical Research Council
Funding Amount
$490,500.00
Summary
Despite optimal neurosurgical and intensive care therapy, many trauma patients with severe brain injury (typically young males) have very poor long term neurological outcomes. Current knowledge suggests that a key contributor to secondary brain damage which occurs after injury and to poor neurological outcomes is brain swelling and subsequent increase in brain pressure. Present intensive care therapies to control brain pressure are often not effective, and favourable neurological outcomes occur ....Despite optimal neurosurgical and intensive care therapy, many trauma patients with severe brain injury (typically young males) have very poor long term neurological outcomes. Current knowledge suggests that a key contributor to secondary brain damage which occurs after injury and to poor neurological outcomes is brain swelling and subsequent increase in brain pressure. Present intensive care therapies to control brain pressure are often not effective, and favourable neurological outcomes occur in only 20-30% of these patients. Small studies suggest that a surgical operation called decompressive craniectomy (DC) may decrease brain pressure and improve neurological outcomes in these patients. DC involves temporarily surgically removing a piece of skull bone (during the swelling period) and replacing it when the swelling has subsided. DC is done under general anaesthetic in unconscious patients and is used occasionally at present, although due to insufficient research the benefits are controversial. The proposed study is a multi-centre randomised controlled study of best current therapies plus early decompressive craniectomy vs best current therapies alone in selected unconscious patients with severe head injury. The study outcome is patient neurological function measured 6 months after the injury. A study of this type is required before early DC could become a routine therapy in Australia. Next of kin will sign informed consent for the study and then also for the surgery if patients are randomised to surgery. The study will be managed at the Alfred Hospital-Monash University in Melbourne and includes fifteen collaborating ANZ neurotrauma centres over 3.0 years. There are >200 patients in Australia annually in this category with potential for DC to increase favourable outcomes in >40 patients annually. Lifetime costs for these patients with severe disability are > $2.4 million, so there may be substantial economic and social impact.Read moreRead less
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.
Therapeutic Thermal Regulation In Critical Illness
Funder
National Health and Medical Research Council
Funding Amount
$189,384.00
Summary
Patients who are admitted to intensive care units often develop abnormalities of their body temperature as part of their illness. Common illnesses include infections and injuries to the brain from trauma or strokes. Clinicians are unsure of how to react to these changes in temperature. My research is designed to provide high quality evidence on body temperature and the use of treatments, so that clinicians can improve patient outcomes.
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.
The Prophylactic Hypothermia To Lessen Traumatic Brain Injury-randomised Controlled Trial : Continuation Of Funding Request
Funder
National Health and Medical Research Council
Funding Amount
$266,321.00
Summary
Traumatic brain injury (TBI) is a major cause of death and long term disability. About half with severe TBI will die or have a poor outcome. The social and economic costs to the community are high. Treatment focuses on optimising oxygen and blood flow to the brain. Cooling may protect the brain. POLAR is a randomised trial of early cooling in patients with TBI. Cooling is started within 3 hours of injury. Data about the injury management and safety is collected. Recovery is measured at 6 months.
Improving Outcomes For Critically Ill Patients After Traumatic Brain Injury And Blood Transfusion
Funder
National Health and Medical Research Council
Funding Amount
$418,049.00
Summary
The Fellowship will support an academic clinician to lead the Alfred Intensive Care Department, and the Monash ANZIC Research Centre. Two pivotal NHMRC supported clinical trials, led by the Fellow, are each the largest and most definitive trials in their fields, and will complete during Fellowship and provide extensive data for research outputs. Concurrently, a new research program to improve patients function and quality of life after critical illness, will be supported.
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.