There are currently no drug treatments that have been shown to be effective in the treatment of Covid 19. The national agenda is therefore to recruit all Covid 19 patients into a research trial as some drugs may be effective in treatment.
The Recovery trial and Remap Cap trial are adaptive platform studies, which means that treatments given are continuously evaluated for effectiveness, so some treatments may be noted as effective during recruitment and therefore drug treatment of Covid 19 may be recommended during the trial. Whilst there are many studies in the pipeline, these are being prioritised by CMO and currently only 4 top priority. In critical care in JCUH we are actively recruiting to 3 studies, although we may also have patients from the ward based Recovery trial coming to critical care on interventional treatment. Which arms we choose will depend on many factors, including national shortages of drugs such as B Interferon.
We will also see patients who have already been recruited from the Recovery Trial ( PI David Chadwick)
There are further level 1 priority studies in the trust which should not involve critical care, e.g. Priest is looking at triage in ED and UKOSS is investigating Pandemic COVID-19 in Pregnancy.
It is imperative that we support these studies. We currently have no treatment for Covid19 and the UK is in an almost unique position with a national infrastructure to rapidly respond and find treatments that work. It is possible that treatments may emerge during the trials and be recommended.
We may ask Critical Care consultants to give professional consultee consent if relatives cannot be contacted and the patient is unconscious. Retrospective consent will be undertaken by the research team. Patients may potentially be in 3 or 4 studies. Our research nurse is trying to minimise nursing workload by asking for samples only at a time when the nurses are already taking samples, e.g. in the morning blood run. He has created premade packs and will package these for the path lab himself together with a simple document outlining which samples are required.
Thank you all,
Prof. Stephen Bonner
HEMOglobin Transfusion Threshold in Traumatic Brain Injury OptimizatioN: The HEMOTION Trial Protocol
BiomArker-guided Duration of Antibiotic treatment in hospitalised PaTients with suspected Sepsis: the ADAPT-Sepsis Trial
Antifungal stewardship opportunities with rapid tests for fungal infection in critically ill patients. The purpose of this project is to assess the performance of three rapid tests for fungal infection. The accuracy of these tests will be compared and the optimal test (or combination) identified. The emphasis will be on their ability to rule-out infection.
Suspiction of Sepsis - Validation Study
A multi-centre validation of the ability of Suspicion Of Sepsis (SOS) diagnosis codes to identify bacterial infections diagnosed during hospital inpatient spells: a review of medical records.
The OPTIC-ICP study: Optic Nerve Sheath Ultrasound to track changes in Intra Cranial Pressure.
Genetics of Susceptibility and Mortality in Critical Care
Epidemiology and determinants of outcomes of Hospital Acquired Blood Stream Infections in the Intensive Care. A multinational cohort study by the ESICM Trials Group.
Treatment of invasively ventilated adults with Early Activity and Mobilisation (TEAM) trial.
A cluster randomised, crossover, registry-embedded clinical trial of proton pump inhibitors vs. histamine-2 receptor blockers for ulcer prophylaxis therapy in the Intensive Care Unit
WorldwidE AssessmeNt of Separation of pAtients From ventilatory assistancE (WEAN SAFE STUDY)