探花直播 of Cambridge - intensive care

Cambridge leads national drug trial to prevent deaths after COVID-19 patients leave hospital

cjb250 — Thu, 25 Mar 2021 00:17:28 +0000

探花直播clinical trial - named HEAL-COVID - also aims to cut the number of patients being readmitted to hospital with complications as a result of having COVID.

Data from the Office for National Statistics suggests that 29% of patients who are hospitalised due to COVID-19 are readmitted within six months, and more than 12% die within the same period.

HEAL-COVID stands for Helping to Alleviate the Longer-term consequences of COVID-19 and is funded by the National Institute for Health Research (NIHR) and the NIHR Cambridge Biomedical Research Centre.聽It will test a number of safe, existing drugs on patients across the UK in order to find effective treatments.聽聽

Study lead Dr Charlotte Summers, from the 探花直播 of Cambridge and Addenbrooke's Hospital, said: "Having survived the trauma of being hospitalised with COVID-19, far too many patients find themselves back in hospital with new or long-term complications.

"Unfortunately, many go on to die in the months after being discharged. This trial is the first of its kind to look at what drugs we could use to reduce the devastating impact on patients."

探花直播trial is being led by Cambridge 探花直播 Hospitals NHS Foundation Trust and 探花直播 of Cambridge, in collaboration with Liverpool Clinical Trials Centre at the 探花直播 of Liverpool, and Aparito Limited.聽

HEAL-COVID will enrol patients when they are discharged from hospital, following their first admission for COVID-19.聽 They will be randomised and given one of two drugs 鈥� apixaban and atorvastatin - and their progress tracked. It's hoped a third drug will be introduced to the trial on the recommendation of the UK COVID Therapeutic Advisory Panel in the coming weeks.

Prof Carrol Gamble, Director of the Liverpool Clinical Trials Centre, said: 鈥淭his is an exciting opportunity to help people in the post-acute phase of COVID-19. 探花直播trial is designed to allow us to remove or add-in treatment options in response to patient outcomes. Every effort has been made to design the trial to minimise burden on NHS staff and patients and represents a true team approach to science.鈥�

NHS medical director, Professor Stephen Powis, said: 鈥� 探花直播NHS led the world in research identifying dexamethasone as the first treatment in the world for COVID-19 and this latest trial could help discover new treatments for the after-effects of COVID, helping to rapidly get world-leading therapies to our patients.

鈥淟ong COVID can have a significant impact on someone鈥檚 quality of life, which is exactly why in addition to funding research into the condition, the NHS has invested millions into opening dozens of dedicated clinics to help people get back to good health."

Lord Bethell, Minister for Innovation, said:聽鈥� 探花直播UK is a world-leader in developing life-saving treatments in response to the pandemic and this clinical trial is further evidence of this. It is vital we continue our search for the best treatments for COVID-19, particularly to prevent people developing long-term complications after becoming ill.

鈥淐linical trials platforms like HEAL are showing how innovative designs can mean we can reach just the right candidates, quickly and emphatically. I am massively grateful to the incredible scientists and clinicians at Cambridge 探花直播 who are driving forward this life-saving work, which will play a critical role in putting this pandemic behind us.鈥�

Adapted from a press release by聽Cambridge聽探花直播 Hospitals NHS Foundation Trust

A UK-wide study is being launched to reduce the number of people who die in the months following a stay in hospital with COVID-19.

Having survived the trauma of being hospitalised with COVID-19, far too many patients find themselves back in hospital with new or long term complications

Charlotte Summers

Fusion Medical Animation

Visualisation of the SARS-CoV-2 virus

探花直播text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright 漏探花直播 of Cambridge and licensors/contributors as identified.聽 All rights reserved. We make our image and video content available in a number of ways 鈥� as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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DNA test can quickly identify pneumonia in patients with severe COVID-19, aiding faster treatment

sc604 — Fri, 15 Jan 2021 06:00:00 +0000

For patients with the most severe forms of COVID-19, mechanical ventilation is often the only way to keep them alive, as doctors use anti-inflammatory therapies to treat their inflamed lungs. However, these patients are susceptible to further infections from bacteria and fungi that they may acquire while in hospital 鈥� so called 鈥榲entilator-associated pneumonia鈥�.

Now, a team of scientists and doctors at the 探花直播 of Cambridge and Cambridge 探花直播 Hospitals NHS Foundation Trust, led by Professor Gordon Dougan, Dr Vilas Navapurkar and Dr Andrew Conway Morris, have developed a simple DNA test to quickly identify these infections and target antibiotic treatment as needed.

探花直播test, developed at Addenbrooke鈥檚 hospital in collaboration with Public Health England, gives doctors the information they need to start treatment within hours rather than days, fine-tuning treatment as required and reducing the inappropriate use of antibiotics. This approach, based on higher throughput DNA testing, is being rolled out at Cambridge 探花直播 Hospitals and offers a route towards better treatments for infection more generally. 探花直播results are reported in the journal Critical Care.

Patients who need mechanical ventilation are at significant risk of developing secondary pneumonia while they are in intensive care. These infections are often caused by antibiotic-resistant bacteria, and are hard to diagnose and need targeted treatment.

鈥淓arly on in the pandemic we noticed that COVID-19 patients appeared to be particularly at risk of developing secondary pneumonia, and started using a rapid diagnostic test that we had developed for just such a situation,鈥� said co-author Dr Andrew Conway Morris from Cambridge鈥檚 Department of Medicine and an intensive care consultant. 鈥淯sing this test, we found that patients with COVID-19 were twice as likely to develop secondary pneumonia as other patients in the same intensive care unit.鈥�

COVID-19 patients are thought to be at increased risk of infection for several reasons. Due to the amount of lung damage, these severe COVID-19 cases tend to spend more time on a ventilator than patients without COVID-19. In addition, many of these patients also have a poorly-regulated immune system, where the immune cells damage the organs, but also have impaired anti-microbial functions, increasing the risk of infection.

Normally, confirming a pneumonia diagnosis is challenging, as bacterial samples from patients need to be cultured and grown in a lab, which is time-consuming. 探花直播Cambridge test takes an alternative approach by detecting the DNA of different pathogens, which allows for faster and more accurate testing.

探花直播test uses multiple polymerase chain reaction (PCR) which detects the DNA of the bacteria and can be done in around four hours, meaning there is no need to wait for the bacteria to grow. 鈥淥ften, patients have already started to receive antobiotics before the bacteria have had time to grow in the lab,鈥� said Morris. 鈥淭his means that results from cultures are often negative, whereas PCR doesn鈥檛 need viable bacteria to detect 鈥� making this a more accurate test.鈥�

探花直播test 鈥� which was developed with Dr Martin Curran, a specialist in PCR diagnostics from Public Health England鈥檚 Cambridge laboratory 鈥� runs multiple PCR reactions in parallel, and can simultaneously pick up 52 different pathogens, which often infect the lungs of patients in intensive care. At the same time, it can also test for antibiotic resistance.

鈥淲e found that although patients with COVID-19 were more likely to develop secondary pneumonia, the bacteria that caused these infections were similar to those in ICU patients without COVID-19,鈥� said lead author Mailis Maes, also from the Department of Medicine. 鈥淭his means that standard antibiotic protocols can be applied to COVID-19 patients.鈥�

This is one of the first times that this technology has been used in routine clinical practice and has now been approved by the hospital. 探花直播researchers anticipate that similar approaches would benefit patients if used more broadly.

This study was funded by the National Institute for Health Research Cambridge Biomedical Research Centre.

聽

Reference:
Mailis Maes et al. 鈥�Ventilator-associated pneumonia in critically ill patients with COVID-19.鈥� Critical Care (2021). DOI: 10.1186/s13054-021-03460-5

Researchers have developed a DNA test to quickly identify secondary infections in COVID-19 patients, who have double the risk of developing pneumonia while on ventilation than non-COVID-19 patients.

Using this test, we found that patients with COVID-19 were twice as likely to develop secondary pneumonia as other patients in the same intensive care unit

Andrew Conway Morris

Official U.S. Navy Page

Lt. Cmdr. Michael Heimes checks on a patient connected to a ventilator at Baton Rouge General Mid City campus

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Intensive care units in England could run out of beds within two weeks, study finds

cjb250 — Tue, 24 Mar 2020 13:32:31 +0000

Since emerging in November 2019, there have been over 267,000 confirmed cases of COVID-19 coronavirus and over 11,200 deaths (WHO figures 22 March). While COVID-19 generally causes mild symptoms, some patients may develop severe lung inflammation. This may be severe enough to require intensive care for advanced, invasive mechanical ventilation (鈥榣ife support鈥�).

Mechanical ventilation is a specialised procedure that can only be provided on an intensive care unit. 探花直播number of intensive care beds is limited and the equipment and specialist staffing required makes it difficult to create more ICU beds easily/quickly. In Northern Italy, which has been particularly severely affected, the large volumes of patients has overwhelmed ICU capacity.

鈥淚f mechanical ventilation cannot be provided to patients who need it, they will die,鈥� says Dr Ari Ercole from the Division of Anaesthesia at the 探花直播 of Cambridge. 鈥淚CU capacity is a crucial concern as additional capacity takes time to create both in terms of staffing and equipment.鈥�

Dr Ercole and colleagues from Cambridge鈥檚 Division of Anaesthesia and Department of Computer Science and Technology have built a real-time computer model to try and make the earliest possible predictions of ICU demand in England. Their aim is to give an early warning of when or whether capacity will become critical and give as much advanced notice as possible to help build capacity.

Because of the urgent implications of the model鈥檚 results, the team has made its study available online early. 探花直播research has not been peer-reviewed. All source code has been made freely-available online.

探花直播team used COVID-19 diagnoses from England as reported by Public Health England and matched to NHS commissioning regions as its source data to obtain information on daily cases. They have assumed that the daily incidence of COVID-19 can be modelled as an exponential growth, in line with what has been observed in Italy. 聽探花直播most up-to-date information suggests the median length of time spent in an ICU is eight days.

探花直播Cambridge model predicts that ICU demand in England could rise to levels which are impossible to supply with the current beds available very quickly 鈥� as early as within two weeks in some regions and with London at particular risk.

鈥淚f our assumptions are correct, ICU capacity may be complete overwhelmed very quickly in England,鈥� added Dr Ercole, who is also a Fellow in Clinical Medicine at Magdalene College. 鈥淎 large increase in ICU capacity is required extremely urgently if we are to be able to treat patients with life-threatening COVID-19 in the near future.鈥�

探花直播model makes a number of assumptions about the outbreak which may limit its accuracy, but is based on the best available data at the earliest time.

探花直播team used data published by Public Health England. While the researchers acknowledge this data does not recognise all cases within the wider population, it is likely to include the vast majority of severe cases, on which the models specifically focus. Changes over time in World Health Organization case definitions and in surveillance strategies may also overestimate ICU admission rates as milder cases were not identified initially and would artificially inflate the forecast numbers.

They have forecast the percentage of聽COVID-19 bed requirements in isolation. In reality, all ICUs will need to continue to provide 鈥榖usiness as usual鈥� care for other types of patients. Since UK bed occupancy is typically greater than 80% and may frequently exceed 100%, the researchers say it is clearly not the case that all open beds can simply be re-allocated for COVID-19 patients.

They have also assumed that all adult critical care beds can be used for level 3 or mechanically ventilated ICU patients, which may not be possible; some specialist ICUs may not be able to reconfigure at all.

Listen to Dr Ercole on the Naked Scientists podcast.

Reference
Deasy, J et al. Forecasting Ultra-early Intensive Care Strain from COVID-19 in England.聽DOI:聽10.1101/2020.03.19.20039057

How you can support Cambridge's COVID-19 research effort

Donate to support COVID-19 research at Cambridge

Intensive care unit (ICU) occupancy is likely to increase dramatically over the next few weeks, suggests research published by a team at the 探花直播 of Cambridge. Their work suggests that if the current exponential growth of COVID-19 infections continues, then within two weeks, five out of seven commissioning regions in England will have more critically ill COVID-19 patients than can be accommodated with ICU beds normally available.聽

ICU capacity is a crucial concern as additional capacity takes time to create both in terms of staffing and equipment

Ari Ercole

Calleamanecer (WikiCommons)

Clinicians in Intensive Care Unit

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Test can identify patients in intensive care at greatest risk of life-threatening infections

cjb250 — Wed, 13 Jun 2018 09:37:58 +0000

Infections in intensive care units (ICU) tend to be caused by organisms, such as multi-resistant gram-negative bacteria found in the gut, that are resistant to frontline antibiotics. Treating such infections means relying on broad spectrum antibiotics, which run the risk of breeding further drug-resistance, or antibiotics that have toxic side-effects.

Estimates of the proportion of patients in ICU who will develop a secondary infection range from one in three to one in two; around a half of these will be pneumonia. However, some people are more susceptible than others to such infections 鈥� evidence suggests that the key may lie in malfunction of the immune system.

In a study published in the journal Intensive Care Medicine, a team of researchers working across four sites in Edinburgh, Sunderland and London, has identified markers on three immune cells that correlate with an increased risk of secondary infection. 探花直播team was led by researchers at the Universities of Cambridge and Edinburgh and biotech company BD Bioscience.

鈥淭hese markers help us create a 鈥榬isk profile鈥� for an individual,鈥� explains Dr Andrew Conway Morris from the Department of Medicine at the 探花直播 of Cambridge. 鈥淭his tells us who is at greatest risk of developing a secondary infection.

鈥淚n the long term, this will help us target therapies at those most at risk, but it will be immediately useful in helping identify individuals to take part in clinical trials of new treatments.鈥�

Clinical trials for interventions to prevent secondary infections have met with mixed success, in part because it has been difficult to identify and recruit those patients who are most susceptible, say the researchers. Using this new test should help fine tune the selection of clinical trial participants and improve the trials鈥� chances of success.聽

探花直播markers identified are found on the surface of key immune cells: neutrophils (frontline immune cells that attack invading pathogens), T-cells (part of our adaptive immune system that seek and destroy previously-encountered pathogens), and monocytes (a type of white blood cell).

探花直播researchers tested the correlation of the presence of these markers with susceptibility to a number of bacterial and fungal infections. An individual who tests positive for all three markers would be at two to three times greater risk of secondary infection compared with someone who tests negative for the markers.

探花直播markers do not indicate which secondary infection an individual might get, but rather that they are more susceptible in general.

鈥淎s intensive care specialists, our priority is to prevent patients developing secondary infections and, if they do, to ensure they get the best treatment,鈥� says Professor Tim Walsh from the 探花直播 of Edinburgh, senior author on the study.

探花直播Immune Failure in Critical Therapy (INFECT)聽Study聽examined data from 138 individuals in ICUs and replicated findings from a pilot study in 2013.

A key part of enabling this study was to standardise how the research could be carried out across multiple sites, say the researchers. They used an imaging technique known as flow cytometry, which involves labelling components of the cells with fluorescent markers and then shining a laser on them such that they give off light at different wavelengths. This has previously been difficult to standardise, but the researchers successfully developed a protocol for use, ensuring they could recruit patients from the four study sites.

探花直播study was funded by Innovate UK, BD Bioscience and the National Institute of Academic Anaesthesia.

Reference
Conway Morris, A et al. Cell surface signatures of immune dysfunction risk stratify critically ill patients: INFECT Study. Intensive Care Medicine; June 2018; DOI: 10.1007/s00134-018-5247-0

Patients in intensive care units are at significant risk of potentially life-threatening secondary infections, including from antibiotic-resistant bacteria such as MRSA and C. difficile. Now, a new test could identify those at greatest risk 鈥� and speed up the development of new therapies to help at-risk patients.

In the long term, this will help us target therapies at those most at risk, but it will be immediately useful in helping identify individuals to take part in clinical trials of new treatments

Andrew Conway Morris

MilitaryHealth

Intensive Care Unit

Researcher Profile: Dr Andrew Conway Morris

聽Dr Andrew Conway Morris is an intensive care specialist at Addenbrooke鈥檚 Hospital, part of Cambridge 探花直播 Hospitals. It was the hospital鈥檚 location on the Cambridge Biomedical Campus that attracted him back to the city where he had been born and raised.

鈥淚 moved to Cambridge in order to take advantage of the fantastic opportunities to work with some of the world鈥檚 leading scientists, as well as develop collaborations with the growing biotech and pharmaceutical cluster centred around Addenbrooke鈥檚 Hospital,鈥� he says. 聽

Conway Morris undertook his undergraduate medical education in Glasgow before moving to Edinburgh to train in Anaesthesia and Intensive Care Medicine. His PhD in Edinburgh was on dysfunction of immune cells known as neutrophils in critically ill patients and looking at the development of new diagnostic tests for secondary pneumonia. 聽

He is now a Wellcome-funded Senior Research Associate in the John Farman Intensive Care Unit at Addenbrooke鈥檚, where he is trying to find new ways to prevent and treat infections in hospitalised and critically-ill patients.

鈥淚 carry out my work using a combination of human cell models and animal models of pneumonia and aim to develop new therapies for infection that do not rely on antibiotics,鈥� he says. 鈥淚 also have a clinical project evaluating a new molecular diagnostic test for pneumonia, which aims to deliver more rapid and accurate tests for infection.鈥�

Outside of work, it is his children that keep him occupied. 鈥淚 have two boys who occupy most of my free time -聽both are football-mad - and I help run a local youth football team,鈥� he adds.

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