AAGBI/Anaesthesia Research Grant

The successful applicants for the AAGBI/Anaesthesia Research Grant were:

Principal Applicant
Dr Timothy Dawes

Title
Qualitative Methods in Understanding Patient Safety in Intensive Care

Amount
£1,039

Scientific Abstract

Over 90,000 US patients die each year as a result of health-­‐worker errors. 45.8% of intensive care admissions include an adverse event and the complex medical background of this patient group suggests that errors will be poorly tolerated.

Traditional approaches to patient safety contend that adverse events (AEs) are primarily due to single, causative errors, that such errors are isolated, and that the best lessons for improvement are to be found in the most serious AEs. Systems approaches suggest that AEs are due to several contributory factors broadly split into latent and active failures, and have gained credence in several safety-critical environments. Surveys and checklists are typically used to assess these factors, though consistently suffer from poor return-rates , an inability to explore pertinent threads and a lack of contextual information. Qualitative methods offer a more flexible approach to understanding the causes of error though have not been investigated in intensive care.
This study applies a qualitative approach to identifying the barriers to safe practice in adult intensive care. We hypothesize that qualitative methods access a larger number, and a more diverse spectrum, of errors with significant consequences for clinician working practices and unit design across intensive care.



Principal Applicant
Professor Gary Mills
Northern General Hospital

Title
Evaluation of the microstructure and functional changes in the lung during recovery after major abdominal surgery, using functional hyperpolarized helium and xenon magnetic resonance imaging

Amount
£19,950

Scientific Abstract

Patients are at high risk of postoperative respiratory complications, partly because of the effect of the operation and mechanical ventilation/anesthesia. Functional magnetic resonance imaging (MRI) is now able to provide pathophysiological data down to alveolar level. Therefore, we will examine the changes seen in the lungs of patients with a moderate/high risk of pulmonary complications following major abdominal surgery, general anaesthesia and ventilation. We aim to image 14 patients primarily using MRI with hyperpolarized helium and xenon on three occasions; including before surgery, one week after surgery and at two months post-surgery. We will assess the microstructure down to the 100 micron level (alveolar dimensions) using Apparent Diffusion Coefficient measurements. These allow the size and changes in airways and alveoli to be inferred. We will assess regional ventilation heterogeneity, regional partial pressure of oxygen in the lung and transfer of xenon across the alveolar capillary membrane. Proton anatomical and contrast-enhanced perfusion images will allow assessment of lung morphology and blood perfusion of the lung parenchyma. We anticipate this will contribute to understanding the changes seen in the lung after surgery and so inform future developments in ventilation and postoperative care.



Principal Applicant
Dr Gary Minto
Derriford Hospital

Title
Coronary Anatomy & Dynamic Exercise Testing (CADET)

Amount
£5,957

Scientific Abstract

The primary aim of the study ( funded ) is to characterise the degree of pre-existing coronary disease (using Computed Tomographic Imaging of coronary arteries, CTCA) and functional heart failure (with cardiopulmonary exercise testing, CPET) and the relationship between them in a cohort of patients ( n = 185) presenting for major surgery. Our hospital has highly developed services and research track records in both these tests

A secondary aim (subject of grant application) is to check feasibility for a definitive investigation into whether routine CTCA adds value (or might substitute for CPET) through provision of unique information which can be used to risk stratify patients prior to surgery. For this we will measure clinical outcomes (estimated n = 140) and perform cardiac biomarker surveillance (high sensitivity cardiac troponin T, HS cTnT) (estimated n = 100 patients) on those patients from the primary cohort who proceed to have major resection surgery. Elevations in HS cTnT above the upper limit of normal are associated in a dose dependent manner with post-operative complications. Our preliminary work will explore the association between severity of CAD before surgery, functional capacity and postoperative complications and changes in HS cTnT.



Principal Applicant
Dr Judith Partridge
St Thomas' Hospital

Title
A pilot observational study to evaluate the feasibility and effectiveness of an Enhanced Recovery Pathway (ERP) in complex thoracoabdominal aortic aneurysm repair

Amount
£19,588

Scientific Abstract

Advances in fenestrated endovascular aneurysm repair have resulted in the potential to repair complex aortic aneurysms that previously would have been unsuitable for fixation. In addition to the surgical risk the frequency of multimorbidity, frailty and cognitive issues in patients with aortic aneurysms presents medical and functional risk. At present preoperative patient preparation and management throughout the hospital pathway is poorly standardised both within and between trusts. This proposal builds on the literature showing benefit of enhanced recovery programmes (ERP) in other surgical subspecialties and evaluates the implementation of an ERP for those undergoing complex thoracoabdominal aortic aneurysm repair.

  • Preoperatively the ERP consists of a standardised comprehensive assessment to describe known pathology and identify previously undiagnosed conditions. Patients will be investigated and optimised with respect to cardiac risk, anaemia, frailty, cognitive impairment. Shared decision making will be facilitated through anaesthetic, vascular medical MDM which will inform a full consultation with patients/family/carers regarding risks and benefits.
  • Intraoperatively a standardised approach will be taken to monitoring, maintenance of homeostasis and spinal drain management.
  • Postoperative site of care, analgesia and mobility goals will all be standardised.

We will describe adherence to this novel ERP reporting both clinician and patient reported outcomes.