September 2015

The NIAA-AAGBI Grants Committee met on 18 September 2015 and considered 10 applications for a total sum of £131,267.14.

Four awards were made to a sum of £37,114.60 and the scientific abstracts from the four successful applicants appear below. The lay abstracts can be accessed via the left-hand link.

Professor Dave Lambert
NIAA Grants Officer



Principal Applicant
Dr Maurizio Cecconi
St George's Hospital, London

Title
ALPINE: adoption of lung protective ventilation in patients undergoing Emergency laparotomy

Amount
£8,117

Scientific Abstract
Emergency laparotomy patients present a unique challenge due to their increased risk of morbidity and mortality. Post-operative pulmonary complications are common and have been linked to an increased length of stay. It currently remains unclear how these patients should best be ventilated intraoperatively.

Recent evidence has demonstrated that implementation of a protective lung ventilation (PLV) strategy may have potential benefits for patients undergoing abdominal surgery with a reduction in the development of pulmonary associated morbidity.

The primary outcome of this study is to assess how patients undergoing an emergency laparotomy are currently being ventilated and to determine to what extent PLV strategies have been adopted. The secondary outcome is to determine whether a correlation exists between mode of ventilation and the incidence of pulmonary complications in the post-operative period.

This will be a continuous observational study involving approximately 40 centres in London. The study will prospectively collect data in conjunction with the National Emergency Laparotomy Audit (NELA) and in collaboration with the Perioperative London Audit Network (PLAN). The study aims to recruit all patients undergoing an emergency laparotomy over a period of 6 months. Pre-determined intra-operative and post-operative pulmonary complications will be recorded from the medical notes for 48 hours.



Principal Applicant
Dr James Plumb
University of Southampton

Title
Measuring total haemoglobin mass (tHbEmass) in ventilated patients - a feasibility Epilot study

Amount
£17,990.80

Scientific Abstract
Haemoglobin is the oxygen-carrying pigment of red blood cells (RBCs), and anaemia is defined as a fall in its concentration (Hb) below defined limits. Perioperative / critical care anaemia may develop if blood (and thus Hb) is lost of RBCs destroyed. However, it may also occur without any change in the total amount of haemoglobin in the circulation (tHb-mass), if the volume of plasma in which it is suspended rises. To date, the relative roles of these two processes (RBC loss or destruction vs. haemodilution) are not known.

A means by which to measure tHb-mass would, with (Hb) known, permit calculation of plasma volume (PV) and blood volume (BV) in the ventilated intensive care unit (ICU) or perioperative patient. In this way, the relative contributions of haemodilution and Hb loss to any fall in (Hb) could be calculated. Accurate assessments of blood loss in theatre and intensive care may become possible.

Without the use of radiolabelling techniques, total haemoglobin mass (tHb-mass) can only be measured in an awake spontaneously breathing subject using a carbon monoxide rebreathing method ('standard technique'). We have adapted this methodology for use in mechanically ventilated patients ('new technique'), and will evaluate the feasibility and reliability of this approach.



Principal Applicant
Dr John Williams
The University of Nottingham

Title
Pre-emptive paracetamol for post-operative pain: a randomised, double-blind two-way cross-over trial

Amount
£1,150

Scientific Abstract
Pre-­emptive analgesia has been proposed as a potential strategy to improve postoperative pain management. However, it is unknown whether paracetamol is a potential pre-­emptive analgesic. A recent review has suggested a potential pre-emptive effect although trials were at unclear or high risk of bias. We intend to undertake a randomised controlled trial of 1000mg of intravenous paracetamol administered before surgical incision versus the same dose administered after surgery. Intravenous sodium chloride will be used as a placebo to ensure double-­‐blinding. We will recruit 50 participants undergoing non-­malignant cervical spine surgery to one of the two study groups using pharmacy-­conducted randomisation via stratified random permuted blocks. Outcomes include postoperative pain scores in the first 24 hours, 24-­hour morphine consumption and opioid side effects. Should this trial demonstrate positive results, a larger trial will be conducted. The clinical implications would be significant, as a simple change in clinical practice such as the timing of paracetamol administration would have important implications for postoperative pain management.



Principal Applicant
Dr Vasileios Zochios
Papworth Hospital, Cambridge

Title
A randomised controlled trial of high-flow nasal oxygen (Optiflow™) in high-risk patients after cardiac surgery.

Amount
£9,856.80

Scientific Abstract
Patients after cardiac surgery are at risk of respiratory complications that may prolong hospital stay and worse outcomes. The incidence of respiratory complications is increased in patients with intrinsic respiratory disease. Continuous positive airway pressure or non-invasive ventilation administered prophylactically postoperatively can improve functional performance and decrease respiratory complications. However, these are poorly tolerated and their use may be limited by increased staffing and monitoring requirements. High-flow nasal oxygen is well tolerated and can be administered on a standard postoperative ward. It also provides a low level of continuous positive airway pressure and reduces work of breathing. In a recent trial, we showed that high-flow nasal oxygen, administered for 24 hours after thoracic lung resection surgery, reduced hospital stay and improved patient-reported functional recovery. Routine use of high-flow nasal oxygen after tracheal extubation in patients undergoing a normal postoperative trajectory after low risk cardiac surgery is not recommended. The therapeutic effectiveness of high-flow nasal oxygen in high-risk cardiac surgical patients has not been studied before. Our hypothesis is that prophylactic use of nasal high-flow oxygen therapy for at least 24 hours in cardiac surgical patients at high-risk of developing postoperative pulmonary complications is associated with shorter hospital length of stay.