AAGBI/Anaesthesia Research Grant

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

Principal Applicants
Prof Gary Mills
Royal Hallamshire Hospital, Sheffield

PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients - The PROBESE Randomized Controlled Trial (UK)


Scientific Abstract

Probese is an international project to follow on from Provhilo. Provhilo looked at ventilation during abdominal surgery for patients with an ARISCAT score >26. It demonstrated no reduction in postoperative pulmonary complications and a higher incidence of hypotension or inotrope use in the high PEEP and lung recruitment group compared to those who received PEEP between 0 and 2 cm H2O.

However, obese patients may require a higher PEEP, because of their greater potential for lung collapse due to the extra weight of their chest wall and abdomen compressing the lungs. Therefore in Probese, both groups will receive tidal volumes of 7ml/kg ideal body weight, together with PEEP of 12 or 4 cmH2O. Lung recruitment manoeuvres are permitted in the higher, but not the lower PEEP group and involve increasing tidal volume in steps of 4 ml/kg IBW until plateau pressure reaches 40 to 50 cmH2O. This is used after a disconnection or once an hour during the surgery in the high PEEP group or as rescue therapy.

The aim is to recruit 748 obese adult patients (374 randomised to each arm) with BMI ≥ 35 kg/m2. This study may help us to determine, how much PEEP and in whom?

Principal Applicants
Dr John Williams and Dr Matthew Brown
The Royal Marsden Hospital, London

Development of a Personalised Care Plan Designed to Reduce Persistent Post-
Surgical Pain Following Breast Surgery


Scientific Abstract


Surgery remains a key treatment for breast cancer and thousands of women undergo breast surgery in the UK every year. Approximately 50% of these women will develop a persistent post-surgical pain syndrome. For affected individuals this proves devastating, causing marked disability and placing a substantial burden on health resources.


Risk factors for developing persistent pain following breast surgery have been identified, additionally multiple studies have explored the influence of single interventions on reducing its occurrence. However, to-date, no attempts have been made to combine these evidence-based interventions in an integrated care plan. We have developed a 'complex intervention' of numerous smaller, evidence-based interventions, applied before, during and after breast surgery aimed at reducing the incidence of persistent pain after breast surgery.


The efficacy of the plan will be compared with 'usual care' using a randomised control trial (RCT) design enrolling 154 participants.


The primary endpoint measured is the difference in pain scores, secondary endpoints include the difference in levels of anxiety and depression, general health outcomes and participant satisfaction. Additionally quality-adjusted life years (QALYs) will be calculated, enabling a cost-utility analysis of introducing the integrated care pathway to be made.