Better outcomes for critically ill patients the focus of new research centre

Professor Carol Hodgson will lead a new Centre for Research Excellence (CRE) that will rapidly generate and translate new knowledge for patients who require invasive life support in intensive care settings. The NHMRC announced funding for the CRE to Transform Outcomes of Critically Ill Patients in ICU (CRE-ICU) this week.

An estimated 50% of Australians will be admitted to the intensive care unit (ICU) during their lifetime and many will require invasive life support, such as mechanical ventilation. Management of critically ill patients is complex and costly, with an annual healthcare bill of more than $1.5 billion.

In Australia, the mortality burden of patients on mechanical ventilation is much greater than the annual road toll, and survivors commonly experience poor long-term recovery, with new disability reported in half of them at six months after their admission to ICU.

In addition, the use of more invasive devices to support patients who are failing conventional life support, such as extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (VADs), has more than tripled in five years in Australia, and globally.

Professor Carol HodgsonProfessor Hodgson is the Head of the School’s Division of Clinical Trials and Cohort Studies, and serves as Deputy Director of the Australian and New Zealand Intensive Care Research Centre. A physiotherapist by initial training, she has a well-established track record of investigating long-term functional outcomes in ICU patients.

She says, “one of the most exciting aspects for me is that by building this CRE around existing registries and electronic data systems, we’re effectively turning ICUs into low-cost ‘living’ learning systems.

“We have some wonderfully experienced and talented researchers from a broad range of clinical and research disciplines, who together sit on executive and scientific leadership groups of international societies and networks across 58 countries. This is a great opportunity to harness that expertise and drive important change.”

The CRE-ICU aims to improve patient outcomes and decrease associated healthcare costs through a series of clinical trials, the establishment of national coordination of care, and laboratory-based research.

The research team will leverage data gathered via clinical registries and electronic medical records, a method proven repeatedly to generate affordable, high-quality results. They’ll generate findings on new interventions to aid survival and recovery, changing clinical practice in the process. Some of the questions that could be addressed through the CRE include the impact of dose of oxygen therapy during invasive life support on death, the impact of pain management on delirium and cognitive function, and the impact of early rehabilitation in ICU on long-term functional recovery. The team will also build up the existing Patient Reported Outcome Measures (PROMs) registry, to better capture patient experiences after critical care delivery.

The coordination of care component will focus on complex life-saving interventions across the spectrum of services that support critical care, including ambulances, emergency departments, retrievals, intensive care units and discharge planning. ECMO will be a major focus, as previous research has revealed a concerning lack of standardisation around training and usage of this expensive, life-saving technology.

Biological sample collection will facilitate laboratory-based studies exploring the biological basis of critical illness so that we can better predict patient outcomes and test treatments in patients with specific biological indicators. An existing biobank at The Prince Charles Hospital will house the samples, whilst the BLENDER trial, embedded within the national ECMO registry (The EXCEL Registry) already managed by Professor Hodgson, will provide access to patients and their relevant health data.

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