Improving diagnosis and treatment of patients in the ICU
We use our expertise with routine data and systematic reviews to improve outcomes for patients treated within critical care units. Recent examples include:
The Renal Replacement Anticoagulation Management (RRAM) study (NIHR 16/111/136): a collaboration with the Intensive Care National Audit and Research Centre, combining data from over 69,000 patients who received renal replacement therapy in ICUs in England and Wales. Comparing outcomes in the real world when regional citrate-based anticoagulation was used rather than systemic heparin, we demonstrated that the change to citrate-based therapy was unlikely to have had patient benefit but substantially increased NHS costs.
The Critical care Atrial Fibrillation Evaluation (CAFE) study (NIHR 17/71/04): a collaboration with the Intensive Care National Audit and Research Centre, completing a scoping review of the evidence for different atrial fibrillation therapies and national-scale database analyses. We showed substantial increased risks of heart failure, stroke and atrial fibrillation in the years following discharge home from intensive care if a patient had a new episode of atrial fibrillation during their ICU stay and developed research recommendations leading to the NIHR funding a large scale randomised controlled trial.
The Threshold for Platelets (T4P) study (NIHR 131822): here we published database analyses and undertook a national survey to understand current (disparate) practice prior to obtaining funding to undertake a large multi-centre national randomised controlled trial to define the optimum platelet threshold below which platelets should be transfused prior to an invasive procedure such as central venous catheter insertion in critically ill patients.