Critical care/ICU studies

A placebo controlled randomised trial of intravenous lidocaine in accelerating gastrointestinal recovery after colorectal surgery

Summary: A common problem in about 40% of patients having bowel surgery is that their bowel takes longer than normal to start working again. In most patients the bowel will start working after surgery in 3- 4 days, but in some it takes a week or more. We call this delayed recovery of gut function. This delayed recovery causes nausea, vomiting, complete constipation, tummy pain and tummy swelling (distension). As a result, patients cannot eat or drink until gut function returns, their recovery is slower and they have to stay longer in hospital. There is no immediate cure, and although it gets better on its own in most cases, it can take from 3-7 days to do so. During this time patients have to have a continuous intravenous drip and often insertion of a nasogastric tube to empty the stomach to reduce vomiting (most patients find this very unpleasant). One of the common drugs used in hospitals is the local anaesthetic Lidocaine, used to “freeze” parts of the body, for example for minor skin operations or dental procedures. Recently lidocaine has been used intravenously (through the vein) as part of a general anaesthetic. It reduces pain and inflammation caused by surgery, and seems to help other aspects of recovery that may be important for return of gut function, for example reducing nausea and vomiting, and shortening the time from surgery to first bowel movement. However, previous studies were small and the true benefit of Intravenous (IV) lidocaine is uncertain. We hope to find out if giving IV Lidocaine improves recovery of gut function after colorectal surgery for NHS patients.

The EFFORT trial is aiming to answer the question ‘What is the optimal dose of protein or the effect of high amounts of protein provided to critically ill patients?’

Prior studies from the lead research group in Canada have demonstrated that increased provision of protein and calories to critically ill patients is associated with reduced infectious complications, more ventilator-free days, improved long-term physical recovery, and lower mortality. However, the optimal amount remains unknown even though experts recommend, from weak evidence, that critically ill patients should receive 1.2-2.5 g/kg/day of protein. This study will be a registry based, randomised controlled trial which will aim to determine the optimal dose of protein (less than 1.2g/kg/day or more than 2.2g/kg/day). These numbers were chosen based on International Nutrition Survey (INS; a registry with data collection done by volunteers around the world) data that has shown that even though patients were prescribed an average of 1.3 g/kg/day (interquartile range, 1.0-1.5 grams/kg/day, overall range, 0.5-3.8 grams/kg/day) they actually received only 55% of their prescribed amounts. However, there was significant variability in the protein prescription at each individual sit with the median prescription being 1.2 gram/kg/day and the range 0.86 to 2.6g/kg/day.

FLuid Optimisation in Emergency LAparotomy. Open, multi-centre, randomised controlled trial of cardiac output -guided haemodynamic therapy compared to usual care in patients undergoing emergency bowel surgery.

Genetics of susceptibility and mortality in critical care (GenOMICC)

Summary: Our genes determine how susceptible we are to life-threatening infection. When a patient is already sick, different
genetic factors determine how likely they are to survive. The GenOMICC (Genetics of Susceptibility and Mortality in Critical Care) study will identify the specific genes that cause some people to be susceptible to specific infections and consequences of severe injury. Our hope is that identifying these genes will help us to use existing treatments better, and to design new treatments to help people survive critical illness. To do this, we will compare DNA and cells from carefully selected patients with samples from healthy people.

Susceptibility to COVID-19 is almost certainly, in part, genetic. GenOMICC can find the genes that cause susceptibility, which may help us to prioritise treatments to respond to the global crisis. GenOMICC was designed for this crisis. Since 2016, the open, global GenOMICC collaboration has been recruiting patients with emerging infections, including COVID-19. All patients with confirmed COVID-19 in critical care are eligible for GenOMICC.