ARDC Research Link Australia

ORCID Profile
Orcid icon. 0000-0002-6883-9246

Current Organisations
The University of Manchester, Faculty of Medical and Human Sciences , King's College London , King's College Hospital , Manchester University NHS Foundation Trust , Faculty of Intensive Care Medicine , University of Manchester , University of London , University Hospital of South Manchester NHS Foundation Trust , Royal College of Physicians

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Publications

Publication

Effect of Noninvasive Respiratory Strategies on Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure and COVID-19

Publisher: American Medical Association (AMA)

Date: 08-02-2022

DOI: 10.1001/JAMA.2022.0028

Publication

Intrapleural Use of Tissue Plasminogen Activator and DNase in Pleural Infection

Publisher: Massachusetts Medical Society

Date: 11-08-2011

DOI: 10.1056/NEJMOA1012740

Publication

Pulmonary Penetration of Piperacillin and Tazobactam in Critically Ill Patients

Publisher: Springer Science and Business Media LLC

Date: 13-06-2014

DOI: 10.1038/CLPT.2014.131

Publication

Effect of Opioids vs NSAIDs and Larger vs Smaller Chest Tube Size on Pain Control and Pleurodesis Efficacy Among Patients With Malignant Pleural Effusion

Publisher: American Medical Association (AMA)

Date: 22-12-2015

DOI: 10.1001/JAMA.2015.16840

Abstract: For treatment of malignant pleural effusion, nonsteroidal anti-inflammatory drugs (NSAIDs) are avoided because they may reduce pleurodesis efficacy. Smaller chest tubes may be less painful than larger tubes, but efficacy in pleurodesis has not been proven. To assess the effect of chest tube size and analgesia (NSAIDs vs opiates) on pain and clinical efficacy related to pleurodesis in patients with malignant pleural effusion. A 2×2 factorial phase 3 randomized clinical trial among 320 patients requiring pleurodesis in 16 UK hospitals from 2007 to 2013. Patients undergoing thoracoscopy (n = 206 clinical decision if biopsy was required) received a 24F chest tube and were randomized to receive opiates (n = 103) vs NSAIDs (n = 103), and those not undergoing thoracoscopy (n = 114) were randomized to 1 of 4 groups (24F chest tube and opioids [n = 28] 24F chest tube and NSAIDs [n = 29] 12F chest tube and opioids [n = 29] or 12F chest tube and NSAIDs [n = 28]). Pain while chest tube was in place (0- to 100-mm visual analog scale [VAS] 4 times/d superiority comparison) and pleurodesis efficacy at 3 months (failure defined as need for further pleural intervention noninferiority comparison margin, 15%). Pain scores in the opiate group (n = 150) vs the NSAID group (n = 144) were not significantly different (mean VAS score, 23.8 mm vs 22.1 mm adjusted difference, -1.5 mm 95% CI, -5.0 to 2.0 mm P = .40), but the NSAID group required more rescue analgesia (26.3% vs 38.1% rate ratio, 2.1 95% CI, 1.3-3.4 P = .003). Pleurodesis failure occurred in 30 patients (20%) in the opiate group and 33 (23%) in the NSAID group, meeting criteria for noninferiority (difference, -3% 1-sided 95% CI, -10% to ∞ P = .004 for noninferiority). Pain scores were lower among patients in the 12F chest tube group (n = 54) vs the 24F group (n = 56) (mean VAS score, 22.0 mm vs 26.8 mm adjusted difference, -6.0 mm 95% CI, -11.7 to -0.2 mm P = .04) and 12F chest tubes vs 24F chest tubes were associated with higher pleurodesis failure (30% vs 24%), failing to meet noninferiority criteria (difference, -6% 1-sided 95% CI, -20% to ∞ P = .14 for noninferiority). Complications during chest tube insertion occurred more commonly with 12F tubes (14% vs 24% odds ratio, 1.91 P = .20). Use of NSAIDs vs opiates resulted in no significant difference in pain scores but was associated with more rescue medication. NSAID use resulted in noninferior rates of pleurodesis efficacy at 3 months. Placement of 12F chest tubes vs 24F chest tubes was associated with a statistically significant but clinically modest reduction in pain but failed to meet noninferiority criteria for pleurodesis efficacy. isrctn.org Identifier: ISRCTN33288337.

Publication

Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers

Publisher: American Society of Tropical Medicine and Hygiene

Date: 05-05-2021

DOI: 10.4269/AJTMH.20-1445

Abstract: Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6–12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.