Intensive care research at Murdoch

• Traditionally, medical research is focused on different treatment options for specific conditions and less on what type of supportive care is the best for our patients.
• Many treatment options for diseases are well examined in the general population but intensive care patients are sicker and more vulnerable. Small differences in their care can make large differences in their outcome.
• Public awareness of the role of intensive care is low.

• Participating in national and international clinical studies assessing best management of critically ill patients.
• Contributing to national and international observational studies including the Australian and New Zealand Adult Intensive Care research database.
• Consumer perspectives on intensive care as a patient or relative.
• Patient outcomes beyond the intensive care admission.

GAINS

Muscle growth and anabolism in intensive care survivors.

This study assesses whether nandrolone compared to placebo improves muscle strength and physical functioning at hospital discharge in patients with critical illness weakness.

BALANCE PLUS

A Platform Trial for Gram Negative Bloodstream Infections.

This platform study compares the effect of a range of different interventions to improve outcomes of adult hospitalised patients with a gram negative bacteraemia.

BONE ZONE

Bone Loss Prevention with Zoledronic Acid or Denosumab in Critically ill adults.

This study assesses the effects of denosumab or zoledronic acid compared with placebo on annual change in bone mineral density in women and men aged > 50 and >70 years respectively that require more than two days of intensive care treatment.

ESODICE

Efficacy & Safety of Drainage of Intensive Care Pleural Effusion.

This study compares drainage versus expectant management in patients with pleural effusions to determine the safety and efficacy in the intensive care setting.

REMAP-CAP

Randomised, Embedded, Multifactorial Adaptive Platform trial for Community –Acquired Pneumonia.

This platform study compares the effect of a range of different interventions to improve outcomes of adult patients admitted to the ICU with severe community acquired pneumonia. This study also enrols patients with COVID. Numerous publications have arisen from this platform trial.

SPRINT-SARI

Short Period Incidence Study of Severe Acute Respiratory Infection.

This study was set up before COVID-19 to observe critically ill patients afflicted by new pandemics to better understand clinical epidemiology and microbiology profiles of severe acute respiratory infections. This ongoing study has been instrumental in improving our understanding around COVID-19.

BALANCE

Bacteraemia Antibiotic Length Actually Needed for Clinical Effectiveness: Randomised Controlled Trial

This study compared whether a longer (14d) or a shorter (7d) antibiotic duration is better for survival of hospitalised patients with bloodstream infections. This study demonstrated that a shorter antibiotic duration was not inferior to a longer duration in terms of morbidity and mortality.

CHESTY

Chest infection prevalence following surgery. International multicentre observational trial.

This study assessed the incidence of post-operative pulmonary complications following major abdominal surgery. The study is concluded and manuscripts are are in preparation. Subanalysis are planed.

Intensive Care Unit Consumer Research Survey

This study assessed the beliefs and attitudes regarding the health outcomes of patients after admission to ICU and their willingness to participate in clinical trials. This study highlighted that survived patients focus on disability requiring care and inability to return home. Future studies should focus more on functional outcome.

PLUS Study

Plasmalyte vs Normal Saline for fluid resuscitation.

This study compared Plasma-Lyte 148 to Normal Saline on 90-day mortality in critically ill patients who require fluid resuscitation. This study did not demonstrate any outcome differences between the two fluids.

PROMEDIC Study

Prophylactic Melatonin for the Prevention of Delirium in Intensive Care. A randomised blinded placebo controlled trial of melatonin in Intensive Care patients for the prevention of Delirium.

This study compared melatonin to placebo to prevent delirium in critically ill patients. This study did not demonstrate melatonin ti reduce confusion or improve sleep in critically ill patients.

EUROBACT

International multicentre observational study of critically ill patients with Hospital-Acquired Blood Stream Infection.

This observational study aims to understand the prevalence and epidemiology of Hospital Acquired Blood Stream Infections and the potential for improved medical management. Numerous publications have resulted from this study.

The ANZICS Clinical Trial Group Point Prevalence Program

This yearly one day snap shot observation throughout Australian intensive care units provide invaluable data on the current disease burden of our patients across Australia.

This program allows the generation of a comprehensive database that is the foundation of future studies in critically ill patients.

Gajdos L, Buetti N, Tabah A, et al. EUROBACT-2 Study Group, ESICM, ESCMID ESGCIP and the OUTCOMEREA Network. Shortening antibiotic therapy duration for hospital-acquired bloodstream infections in critically ill patients: a causal inference model from the international EUROBACT-2 database. Intensive Care Medicine 2025. Online ahead of print.

Regli A, Litton E, Palermo A, Hammond N, Knowles S, von Ungern-Sternberg B. Airborne personal protective equipment availability and preparedness in Australian and New Zealand intensive care units: A point prevalence survey. Australian Critical Care 2025. 38:1-6.

Anstey M, Litton E, Habibi M, Van der Lee L, Palmer R, Tran N, Mammana B, Scheepers S, Palermo A, Fiorilla X, Mevavala B, Regli A, Jacques A, Wibrow B. Muscle growth and anabolism in intensive care survivors (GAINS 2.0): Protocol for a multi-centre randomised; placebo controlled clinical trial of nandrolone in deconditioned adults recovering from critical illness. PLoS One 2025. 20:e0315170.

The BALANCE Investigators. Antibiotic treatment for 7 versus 14 days in patients with bloodstream infections. New England Journal of Medicine 2025. 392:1065-1078.

EUROBACT-2 Study Group. The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections. Intensive Care Medicine 2024. 50:873-889.

Barnes E, Zhao P, Udy A, Nguyen N et al. SPRINT‐SARI Australia Investigators. Outcomes of pregnant and post-partum patients admitted to the intensive care unit with COVID-19 in Australia: An analysis of SPRINT-SARI Australia. Australian and New Zealand Journal of Obstetrics and Gynaecology 2024 Online ahead of print.

Margalit I, Yahav D, et al. EUROBACT-2 Study Group, ESICM, ESCMID, ESGCIP, ESGIE, and the OUTCOMEREA Network. Presentation, management, and outcomes of older compared to younger adults with hospital-acquired bloodstream infections in the intensive care unit: a multicenter cohort study. Infection 2024. 52:2435-43.

Aboobacker R, Goldsmith C, Demasi N, Wibrow B, Parangi P, Regli A, Anstey M, Susan Pellicano S, Palermo AM, Van Der Laan S, Litton E. Health concerns of intensive care survivors and research participation willingness: A multicentre survey. Critical Care and Resuscitation 2024. 26:95-99.

Corley A, Royle R, Marsh N, Larsen EN, Playford GE, McGrail MR, Runnegar N, Ware RS, Gavin NC, Alexandrou E, Murgo M, Gowardman JR, Regli A, Rickard CM. Risk factors for central venous access device failure in hospitalised adults: a multivariable analysis of 1,892 catheters. Journal of Hospital Medicine 2024. 19:905-917.

Schults JA, Young ER, Marsh N, Larsen E, Corley A, Ware RS, Murgo M, Alexandrou E, McGrail M, Gowardman J, Charles KR, Regli A, Yasuda H, Rickard CM on behalf of the RSVP Study Investigators. Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial. Journal of Intensive Care 2024. 12:12.

Fysh E, Mevavala BV, Wigston C, Hince D, Sirisinghe I, Regli A, Litton E, Wibrow B. Efficacy and safety outcomes of drainage of intensive care pleural effusions: Study protocol for the ESODICE randomized controlled trial. Medicine Case Reports and Study Protocols. 2023. 4:e00301.

Russotto V, Lascarrou JB, et al. INTUBE Study Investigators. Efficacy and adverse events profile of videolaryngoscopy in critically ill patients: subanalysis of the INTUBE study. British Journal of Anaesthesia 2023. 131:607-616.

REMAP-CAP Investigators. Long-term (180-Day) Outcomes in Critically Ill Patients With COVID-19 in the REMAP-CAP Randomized Clinical Trial. Journal of the American Medical Association 2023. 329: 39-51.

WEAN SAFE Investigators. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study. Lancet Respiratory Medicine. 2023. 11:465-476.

Wibrow B, Martinez E, Myers E, Chapman A, Litton E, Ho KM, Regli A, Hawkins D, Ford A, van Haaren FMP, Wyer S, McCaffrey J, Rashid A, Kelty E, Murray K, Anstey M. Prophylactic Melatonin for Delirium in Intensive Care (Pro-MEDIC): a randomised controlled trial. Intensive Care Medicine. 2022 48:414-25.

Finfer S, Micallef S, Hammond N, et al. PLUS Study Investigators. Balanced Multi Electrolyte Solution versus Saline in Critically Ill Adults. New England Journal of Medicine 2022. 386:815-26.

Rickard CM, Marsh NM, Larsen EN, McGrail MR, Graves N, Runnegar N, Webster J, Corley A, McMillan D, Gowardman JR, Long DA, Fraser JF, Gill FJ, Young J, Murgo M, Alexandrou E, Choudhury MA, Chan RJ, Gavin NC, Daud A, Palermo A, Regli A, Playford EG. Effect of infusion set replacement intervals on catheter-related bloodstream infections (RSVP): a randomised, controlled, equivalence (central venous access device)-non-inferiority (peripheral arterial catheter) trial. Lancet 2021. 397:1447-1458.

Litton E, Anstey M, Broadhurst D, Chapman A, Currie A, Ferrier J, Gummer J, Higgins A, Lim J, Manning L, Myers E, Orr K, Palermo AM, Paparini A, Pellicano S, Raby E, Rammohan A, Regli A, Richter B, Salman S, Strunk T, Waterson S, Weight D, Wibrow B, Wood F. Early and sustained Lactobacillus plantarum probiotic therapy in critical illness: the randomised, placebo-controlled, restoration of gut microflora in critical illness trial (ROCIT). Intensive Care Medicine 2021. 47:307-315.

Burrell AJC, Serpa Neto A, Trapani T et al. SPRINT-SARI Australia Investigators. Rapid Translation of COVID-19 Preprint Data into Critical Care Practice. American Journal of Respiratory Critical Care Medicine 2021. 203:368-371.

Russotto V, Myatra SN, Laffey JG, et al. INTUBE Investigators. Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries. Journal of the American Medical Association 2021. 325:1164-1172.