Intensive Care Research Unit

Cabrini Research Annual Report 2020-21 Intensive Care Research Unit

ASSOCIATE PROFESSOR VINEET SARODE

PUBLICATIONS 12

PRESENTATIONS 7 CLINICAL TRIALS 5

The Cabrini Intensive Care Unit (ICU) admits approximately 1570 patients per year following procedures such as cardiothoracic and abdominal surgery as well as medical admissions requiring multi organ support. The average length of stay in our unit is 48 hours.

Cabrini Research Annual Report 2020-21 Intensive Care Research Unit

Research in the ICU is about questioning current practices and determining how we can get the best outcomes for our patients based on the evidence found. It is increasingly trending towards examining patient outcomes post ICU discharge by following up patients for extended time periods to determine quality of life and disability as well as the standard outcome measures such as morbidity and mortality. Through this extended follow up of patients, we hope to ascertain the long-term impacts an ICU admission can have on both patients and their families – emotionally, physically, financially and socially. This would ultimately lead to standard practices and procedures possibly being changed or modified to ensure beneficial long-term outcomes for our patients.

The COVID-19 pandemic has presented challenges to all healthcare workers and Cabrini's ICU is no exception. It is through research that we can learn more about this virus and the immediate impact it has on patients and communities as well as the medium to long-term impacts, giving us more knowledge in uncertain times.

INTUBE study The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) was the largest ever trial of intubations in the critically unwell. It included over 3000 patients from almost 200 hospitals in 29 countries across five continents. Associate Professor David Brewster was the national coordinator for Australia and New Zealand and a co-author of the paper. This paper was the first true multinational study to demonstrate the significant morbidity and mortality associated with intubations in this patient group, as well as modifiable factors such as the choice of both operator and equipment.

Vincenzo Russotto, Sheila N Myatra, John G. Laffey, Elena Tassistro, Laura Antolini, Philippe Bauer, Jean Baptiste Lascarrou, Konstanty Szułdrzyński, Luigi Camporota, Paolo Pelosi, Massimiliano Sorbello, Andy Higgs, Robert Greif, Christian Putensen, Christina Agvald-Öhman, Athanasios Chalkias, Kristaps Bokums, David J Brewster, Roberto Fumagalli, Antonio Pesenti, Giuseppe Foti and Giacomo Bellani (for INTUBE Study Investigators). (2021) Intubationrelated morbidity, mortality and practice in critically ill patients from 29 countries. JAMA. 325(12):1164–1172. doi:10.1001/jama.2021.1727.

A/Prof David Brewster has delivered a number of presentations across the year. Most notably he was the keynote speaker at the Difficult Airway Society (DAS) ASM (London 2020), speaking on “Defining aerosol generating procedures” and a member on the expert panel discussion “Airway management during COVID-19”. Locally, he was the plenary speaker and member on the expert panel discussion at the Australian and New Zealand College of Anaesthetists (ANZCA) ASM (Melbourne 2021), speaking on the “Airway national guidelines during COVID-19”.

Associate Professor David Brewster and Shannon Simpson.

Aerosol transmission of COVID-19 is of particular concern because it can remain suspended in the air and is easily produced by actions such as coughing, sneezing, shouting and singing. This puts frontline healthcare workers at greatest risk. The consensus statement on Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group was planned on 11 March 2020, when an urgent need for guidance in Australia and New Zealand for both clinical practice and staff preparation for the COVID-19 pandemic was identified.

Led by A/Prof Brewster, the Safe Airway Society board assembled 14 experts from Australia and New Zealand to prepare the statement. The consensus statement recommended safe, simple, familiar, reliable and robust practices that should be adopted for all episodes of airway management for patients with COVID-19.

These crucial national guidelines were immediately widely endorsed by all relevant specialty colleges and airway societies in Australia and New Zealand. It was used by almost all hospitals to guide clinicians in the airway management of COVID-19 patients and help with simulation training from early in 2020 to keep staff in ICU, theatre and emergency departments safe. The consensus statement was published in the Medical Journal of Australia in June 2020 and had over 330 citations in its first year.

Brewster DJ, Chrimes N, Do TB, et al. (2020) Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Aust. 212(10):472-481. doi:10.5694/mja2.50598.

STAFF

Associate Professor Vineet Sarode – Director Intensive Care Unit Associate Professor David Brewster – Deputy Director Intensive Care Unit, Head of ICU Research Dr Deirdre Murphy – Intensive Care Physician Dr Steve Philpot – Intensive Care Physician Professor Warwick Butt – Intensive Care Physician Shannon Simpson – ICU Research Coordinator

B MED SCI (MONASH)

Kelly Hotchin (2020) Calvin Lu (2021)

Right: Associate Professor David Brewster (left) and Associate Professor Vineet Sarode.