ProMISe. A multi-centre, randomised controlled trial of the clinical and cost-effectiveness of early, goal-directed, protocolised resuscitation for emerging septic shock. ICNARC study. PI-Maha Zuleika. Published in the NEJM.
An international multicentre clinical trial to investigate the efficacy of removing nitrous oxide (N2O) from the anaesthetic gas mixture in patients with coronary artery disease undergoing major surgery. PI – MD. Published in the Lancet.
DREAMS. A Phase III, double blind multicentre randomised controlled trial with the primary objective of determining if pre-operative dexamethasone reduces post-operative nausea and vomiting in patients undergoing elective colorectal resections. PI – JKB.
Calories. A phase III, open, multi-centre, randomised controlled trial comparing the clinical and cost-effectiveness of early nutritional support in critically ill patients via the parenteral versus the enteral route. ICNARC study. PI – BCB. Published in the NEJM.
PROWESS-SHOCK – RCT of activated protein C (xigris) vs. Placebo in septic shock. Commercial study sponsored by Lilly. This study led to an abrupt change in practice – in that xigris was withdrawn from the market due to lack of efficacy. Published NEJM 2012.
OPTIMISE – An open, multi-centre, randomised controlled trial of stroke volume guided fluid therapy and low dose dopexamine infusion compared to usual care in patients undergoing major abdominal
surgery involving the gastrointestinal tract. PI – JKB No statistically significant improvement in primary or secondary outcomes in the intervention group. Published in JAMA.
SPOT(light), observational study to evaluate the impact of duration of illness on severity and outcome
TRACMAN. A UK multi-centre RCT of the effect of early vs. late tracheostomy placement on survival in patients receiving mechanical ventilation. Despite completing recruitment in 2008, only reported 2013.
Published in JAMA and led to a change in practice long before 2013 – we now wait longer before making the decision to perform a tracheostomy.
EuSOS. An international observational study of standards of care and clinical outcomes for patients undergoing non-cardiac surgery.
Published in the Lancet 2012. Revealing study that demonstrated unanticipated variations in mortality between countries. To be followed up by ISOS.
Local investigator-initiated studies
- Emergency Laparotomy Pathway Quality Improvement Project (ELPQuIC). Grant obtained from the Health Foundation. Multi-centre site instigated and co-ordinated by investigators from RSCH. PI – Nial Quiney. Published in the British Journal of Surgery.
- Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Trial assessing the merits of an enhanced recovery programme on hepatic resections. Collaboration between research fellows, consultant surgeons and anaesthetists and the University of Surrey. Presented at International conferences and published in British Journal of Surgery (2013).
- RCT of intra-operative analgesia in laparoscopic colo-rectal surgery: spinal, epidural analgesia or intravenous morphine followed by postoperative patient-controlled analgesia (PCA). In addition to standard monitoring, oesophageal Doppler monitoring of the stroke volume allowed directed intravenous fluid therapy. Those with lower oxygen delivery had higher incidence of anastomotic leakage. Led to high-profile publications in Colorectal diseases (2012) and British Journal of Surgery (2011).
- Enhanced recovery and the stress response in open liver resection surgery. Manuscripts in preparation.