AAGBI/Anaesthesia Research Grant
The successful applicants for the AAGBI/Anaesthesia Research Grant were:
Principal Applicants
Dr Tom Clark, Dr Charles Gibson, Dr Gary Minto
Plymouth Hospitals NHS Trust
Title
Comprehensive mouth-care to reduce Post-operative Pneumonia (CUPPA)
Amount
£7,428
Scientific Abstract
Postoperative pulmonary complications (PPCs) are the leading cause of death in both cardiac and non-cardiac surgery. They increase morbidity, ICU admission rates and length of hospital stay, with considerable financial burden. Aspiration of oropharyngeal secretions plays an important role in the pathogenesis of post-operative pneumonia. A large body of evidence supports improved oral hygiene as a method to prevent ventilator-associated pneumonia but there is little evidence for such a regimen in non-ventilated patients.
We propose to recruit 120 elective major abdominal surgery patients at moderate or high risk of PPCs to a pilot multicentre randomised controlled trial. Patients will be block randomised to either a control group (a patient's normal oral hygiene regime) or a comprehensive oral hygiene group (daily teeth brushing and twice daily mouthwashing with chlorhexidine product and demonstration of oral plaque removal) for up to 7 days post-operatively. We anticipate the incidence of PPCs in the control cohort to be at least 8%. The primary objectives of the trial are to test patient compliance with the oral hygiene regime, to prove our researcher network's ability to conduct a multi-centre trial and to acquire pilot data in preparation for a definitive later study.
Principal Applicant
Dr Louisa Chrisman
Royal Surrey County Hospital
Title
Surgicric 2: A comparative bench study with two established emergency cricothyrotomy techniques in a porcine model
Amount
£9,750
Scientific Abstract
"Can't intubate, can't ventilate" (CICV) is a life-threatening emergency occurring in approximately 1:50,000 general anaesthetics. Despite this rarity, it is imperative that appropriate emergency tracheal access equipment is available, in order that we can be optimally prepared for such an eventuality. Several cricothyroidotomy devices are available, but there is little consensus as to which is quickest and safest.
We plan to conduct a bench study comparing 3 cricothyroidotomy techniques (surgical cricothyroidotomy, Melker Seldinger Cricothyrotomy, and the new VBM Surgicric2) on a porcine airway. The pig larynx and trachea has been used in previous studies, and found to provide a realistic anatomical representation of the human airway.
Having excluded the requirement for Research Ethics Approval, (Appendix F) anaesthetists (n=25) will be recruited. They will receive a standardised 5 minute demonstration of each technique, and permitted a single practice insertion into a manikin. They will perform cricothyroidotomy on a fresh pig larynx with each method in randomised order. Primary outcomes measured will be success rate, and duration of the insertion attempt (opening of pack to first successful 'ventilation'). Secondary outcomes include immediate complications, and user preference.
Please see the NIAA's position statement on the use of animals in medical research.
Principal Applicants
Dr Rob Sanders & Dr Alex Bottle
Imperial College London
Title
Predicting perioperative risk in patients with Acute Coronary Syndromes
Amount
£51,222
Scientific Abstract
Based on hospital episode statistics (HES) administrative data, we have recently shown that major orthopaedic surgery conducted within the first year following an Acute Coronary Syndrome (ACS) increases the odds of perioperative mortality. While our findings are biologically plausible and are consistent with an increased mortality from ACS itself for at least a year, we consider these findings to need further validation. Indeed there were a limited number of patients with a prior ACS in our orthopaedic cohort. Furthermore, we did not identify the same effect in a smaller cohort of patients undergoing aortic abdominal aneurysm surgery that we suspect may be due to reduced statistical power. Hence it appears prudent to study a larger cohort of non-cardiac surgical cases to validate our findings and extend their generalizability to other surgical populations. We propose to address these limitations by inclusion of HES-linked data from the Myocardial Ischaemia National Audit Project (MINAP) within a larger cohort of patients undergoing elective noncardiac surgery. To minimize confounding we will evaluate other ACS-related factors in the MINAP dataset, including whether different approaches to revascularisation differentially affect subsequent perioperative risk. Our endpoints will be mortality, postoperative ACS, prolonged length of stay, and emergency readmission rates.
