Intensive care research at Subiaco

The Intensive Care Research Group are involved in a range of projects including:

• supporting junior medical officers (JMOs) and medical students with audits
• single and multi-site research initiated at St John of God Subiaco Hospital
• large, investigator-initiated studies originating in Australia and internationally

Key research areas for intensive care medicine are cardiothoracic surgery, patient experiences and outcomes, embedding research in Clinical Quality Registries, and the treatment of community acquired pneumonia and COVID-19 related pneumonia.

In addition to contributing to national and international clinical trials, members of the Intensive Care Research Group have developed and published multiple studies conceived to address the specific needs of patients admitted to one of the busiest private intensive care units (ICUs) in Australia.

The focus has been on particular areas of interest and expertise including the use of clinical quality registry data to investigate the processes and outcomes associated with bariatric surgery, delivering the highest quality care to patients undergoing cardiothoracic surgery, support of the next of kin of patients admitted to the ICU, investigating the effect of probiotic therapy on nosocomial infection and other outcomes in critical illness, and the importance of sleep in recovery from critical illness.

The Intensive Care Research Group is also involved in REMAP-CAP, led by Prof Steve Webb as the principal investigator. This is an international adaptive randomised controlled trial of treatments for community-acquired pneumonia that also includes patients with COVID-19. The trial is supported by multiple international funding bodies including the European Union, National Institutes of Health Research in the United Kingdom, Canadian Institute for Health Research, Health Research Council of New Zealand, and the National Health Medical and Research Council in Australia, as well a $2m grant from the Minderoo Foundation.

REMAP-CAP has identified multiple effective therapies for patients with severe COVID-19, as well as identifying that several promising therapies were unfortunately not effective.

Consultant Intensivists
Prof Steve Webb (Director of Clinical Trials St John of God Healthcare Subiaco and Consultant Intensivist)A/Prof Kwok Ho
A/Prof Ed Litton (Research Fellow and Consultant Intensivist)
Dr John Lewis (Head of Department ICU and Consultant Intensivist)

Research Officers
Janet Ferrier RN
Lesley Kemp RN

Ed Litton, Thirty years of ANZICS CORE: A clinical quality success story. https://doi.org/10.1016/j.ccrj.2023.04.009

Ed Litton, Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study. https://doi.org/10.1016/s2213-2600(22)00449-0

Steve Webb, Collaborator Ed Litton, Dexmedetomidine and Propofol Sedation in Critically Ill Patients and Dose associated 90-Day Mortality: A Secondary Cohort Analysis of a Randomized Controlled Trial (SPICE III). https://doi.org/10.1164/rccm.202206-1208oc

Bailey RL, Ramanan M, Litton E, Yan Kai NS, Coyer FM, Garrouste-Orgeas M, Tabah A; Welcome ICU contributors. Staff perceptions of family access and visitation policies in Australian and New Zealand intensive care units: The WELCOME-ICU survey. Aust Crit Care. 2022 Jul;35(4):383-390. https://doi.org/10.1016/j.aucc.2021.06.014

Gardiner E, Baumgart A, Tong A, Elliott JH, Azevedo LC, Bersten A, Cervantes L, Chew DP, Cho Y, Crowe S, Douglas IS, …..Viecelli AK, Webb S, Williamson PR, Woc-Colburn L, Zhang J, Craig JC. Perspectives of patients, family members, health professionals and the public on the impact of COVID-19 on mental health. J Ment Health. 2022 Aug;31(4):524-533. http://doi.org/10.1080/09638237.2021.2022637

Begum H, Neto AS, Alliegro P, Broadley T, …. B, Reynolds C, Webb SA, Udy AA, Burrell A. People in intensive care with COVID-19: demographic and clinical features during the first, second, and third pandemic waves in Australia. Med J Aust. 2022 Oct 3;217(7):352-360. https://doi.org/10.5694/mja2.51590

Buetti N, Tabah A, ….. Paiva JA, Hayashi Y, Ramanan M, Conway Morris A, Barbier F, Timsit JF; Eurobact 2 study group. Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: a descriptive analysis of the Eurobact II study. Crit Care. 2022 Oct 18;26(1):319. https://pubmed.ncbi.nlm.nih.gov/36258239/

Wunsch H, Pilcher DV, Litton E, Anstey M, Garland A, Gershengorn HB. Variation in Bed-to-Physician Ratios During Weekday Daytime Hours in ICUs in Australia and New Zealand. Crit Care Med. 2022 Dec 1;50(12):1737- 1747. https://doi.org/10.1097/CCM.0000000000005623

Writing Committee for the REMAP-CAP Investigators; Higgins AM, Berry LR, Lorenzi E, Murthy S, McQuilten Z, Mouncey PR, Al-Beidh F, Annane D, Arabi YM, Beane A, van Bentum-Puijk W, …. Gordon AC, Webb SA, Lawler PR. Long-term (180-Day) Outcomes in Critically Ill Patients With COVID-19 in the REMAP-CAP Randomized Clinical Trial. JAMA. 2023 Jan 3;329(1):39-51. https://doi.org/10.1001/jama.2022.23257

Tabah A, Buetti N, Staiquly Q, Ruckly S, Akova M, Aslan AT, Leone M, Conway Morris A, Bassetti M, Arvaniti K, … Timsit JF; EUROBACT-2 Study Group, ESICM, ESCMID ESGCIP and the OUTCOMEREA Network. Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study. Intensive Care Med. 2023 Feb;49(2):178-190. https://doi.org/10.1007/s00134-022-06944-2

Secombe PJ, Brown A, Bailey MJ, Huckson S, Chavan S, Litton E, Pilcher D. Twelve-month mortality outcomes for Indigenous and non-Indigenous people admitted to intensive care units in Australia: a registry-based data linkage study. Med J Aust. 2023 Feb 6;218(2):77-83. https://doi.org/10.5694/mja2.51763

Goligher EC, Lawler PR, Jensen TP, Talisa V, Berry LR, Lorenzi E, McVerry BJ, Chang CH, Leifer E, Bradbury C, Berger J, Hunt BJ, Castellucci LA, Kornblith LZ, Gordon AC, McArthur C, Webb S, Hochman J, Neal MD, Zarychanski R, Berry S, Angus DC; REMAP-CAP, ATTACC, and ACTIV-4a Investigators. Heterogeneous Treatment Effects of Therapeutic-Dose Heparin in Patients Hospitalized for COVID-19. JAMA. 2023 Apr 4;329(13):1066-1077 https://doi.org/10.1001/jama.2023.3651

Writing Committee for the REMAP-CAP Investigators. Effect of Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Initiation on Organ Support–Free Days in Patients Hospitalized With COVID-19: A Randomized Clinical Trial. JAMA. 2023;329(14):1183–1196. https://doi.org/10.1001/jama.2023.4480

Taylor CB, Thompson KJ, Hodgson C, Liew C, Litton E, McGain F, Nichol A, Rauniyar R, Ridley E, Higgins A. Economic evaluations for intensive care unit randomised clinical trials in Australia and New Zealand: Practical recommendations for researchers. Aust Crit Care. 2023 May;36(3):431-437 https://doi.org/10.1016/j.aucc.2022.02.002

Anstey, M. H., Trent, L., Bhonagiri, D., Hammond, N. E., Knowles, S., McGain, F., ... & Brailsford, J. (2023). How much do we throw away in the intensive care unit? An observational point prevalence study of Australian and New Zealand ICUs. Critical Care and Resuscitation, 25(2), 78-83 https://doi.org/10.1016/j.ccrj.2023.05.004

Anstey MH, Maxwell N, Rickard CM, Hammond NE, Knowles S, McGain F; George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group, Steering Committee members; Coordinating centre List of investigators; Site List of investigators. How often are infusion sets for central venous catheters changed in Australian and New Zealand Intensive Care Units? A point prevalence survey. Aust Crit Care. 2024 May;37(3):495-498 https://doi.org/10.1016/j.aucc.2023.05.004

Bradbury, C. A., Lawler, P. R., McVerry, B. J., & Zarychanski, R. (2023). Continuation of therapeutic dose heparin for critically ill patients with COVID-19. Intensive care medicine, 49(7), 873-875 https://doi.org/10.1007/s00134-023-07095-8

Griffee, M. J., Bozza, P. T., Reyes, L. F., Eddington, D. P., Rosenberger, D., Merson, L., ... & Bitton, J. (2023). Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low-and middle-income countries in an international registry. Research and practice in thrombosis and haemostasis, 7(5), 102142 https://doi.org/10.1016/j.rpth.2023.102142

Ross, P., Serpa-Neto, A., Tan, S. C., Watterson, J., Ilic, D., Hodgson, C. L., ... & Pilcher, D. (2023). The relationship between nursing skill mix and severity of illness of patients admitted in Australian and New Zealand intensive care units. Australian Critical Care, 36(5), 813-820 https://doi.org/10.1016/j.aucc.2022.11.012

Russotto, V., Lascarrou, J. B., Tassistro, E., Parotto, M., Antolini, L., Bauer, P., ... & INTUBE Study Investigators. (2023). Efficacy and adverse events profile of videolaryngoscopy in critically ill patients: subanalysis of the INTUBE study. British journal of anaesthesia, 131(3), 607-616 https://doi.org/10.1016/j.bja.2023.04.022

Moran, J.L., Duke, G.J., Santamaria, J.D. et al. Modelling of intensive care unit (ICU) length of stay as a quality measure: a problematic exercise. BMC Med Res Methodol 23, 207 (2023) https://doi.org/10.1186/s12874-023-02028-x

Secombe, P., Brown, A., Bailey, M., Litton, E., & Pilcher, D. (2020). Characteristics and outcomes of patients admitted to regional and rural intensive care units in Australia. Critical Care and Resuscitation, 22(4), 335-343 https://doi.org/10.51893/2020.4.OA6 

Burrell, A. J., Neto, A. S., Broadley, T., Trapani, T., Begum, H., Campbell, L. T., ... & SPRINT SARI Australia Investigators. (2021). Comparison of baseline characteristics, treatment and celinical outcomes of critically ill COVID-19 patients admitted in the first and second waves in Australia. Critical Care and Resuscitation, 23(3), 308-319 https://doi.org/10.51893/2021.3.OA8

REMAP-CAP Investigators; Hills T.E, Lorenzi E, Berry L.R, Shyamsundar M, Al-Beidh F, Annane D, Arabi Y, Aryal D, Au C, Beane A, Bhimani Z, Bonten M,, Bradbury C.A, Brunkhorst .FM, Burrell A, Buxton M, Calfee C.S, Cecconi M, Cheng A.C, Cove M.E, Detry M.A, .... Angus D.C, Berry .SM, Derde, L.P.G, Webb S.A, Gordon A.C, McAuley D.F.N Engl J Med. 2023 Dec 21;389(25):2341-2354. https://doi.org/10.1056/nejmoa2309995

The LOVIT-COVID Investigators, on behalf of the Canadian Critical Care Trials Group, and the REMAP-CAP Investigators. Intravenous Vitamin C for Patients Hospitalized With COVID-19: Two Harmonized Randomized Clinical Trials. JAMA. 2023;330(18):1745–1759. https://doi.org/10.1001/jama.2023.21407

Pilcher, D. V., Hensman, T., Bihari, S., Bailey, M., McClure, J., Nicholls, M., ... & Litton, E. (2023). Measuring the impact of ICU strain on mortality, after-hours discharge, discharge delay, interhospital transfer, and readmission in Australia with the activity index. Critical care medicine, 51(12), 1623-1637. https://doi.org/10.1097/ccm.0000000000005985

Camirand-Lemyre, F., Merson, L., Vijayaraghavan, B. K. T., Burrell, A. J., Citarella, B. W., Domingue, M. P., ... & Bidin, F. N. (2023). Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19. JAMA Network Open, 6(12), e2346502-e2346502 https://doi.org/10.1001/jamanetworkopen.2023.46502

Litton, E., French, C., Herschtal, A., Stanworth, S., Pellicano, S., Palermo, A. M., ... & Shah, A. (2023). Iron and erythropoietin to heal and recover after intensive care (ITHRIVE): A pilot randomised clinical trial. Critical Care and Resuscitation, 25(4), 201-206 https://doi.org/10.1016/j.ccrj.2023.10.007

Salluh, J. I., Quintairos, A., Dongelmans, D. A., Aryal, D., Bagshaw, S., Beane, A., ... & Pilcher, D. (2024). National ICU registries as enablers of clinical research and quality improvement. Critical Care Medicine, 52(1), 125-135. https://doi.org/10.1097/ccm.0000000000006050

McLarty, J., Litton, E., Beane, A., Aryal, D., Bailey, M., Bendel, S., ... & Salluh, J. (2024). Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study. thorax, 79(2), 120-127. https://pubmed.ncbi.nlm.nih.gov/37225417/

Maiden, M. J., Horton, M., Power, P., Knowles, S., & Hammond, N. E. (2024). Critically ill patients having time outdoors: prevalence and resources in Australia and New Zealand. Intensive Care Medicine, 50(3), 475-477. https://doi.org/10.1007/s00134-024-07355-1

PRACTICAL, PANTHER, TRAITS, INCEPT, and REMAP-CAP investigators. (2024). The rise of adaptive platform trials in critical care. American Journal of Respiratory and Critical Care Medicine, 209(5), 491-496. https://doi.org/10.1164/rccm.202401-0101CP

Evans, T., & Litton, E. (2024). " The human gut microbiome in critical illness: Disruptions, consequences, and therapeutic frontiers". Journal of critical care, 82, 154768. https://doi.org/10.1016/j.jcrc.2024.154768

Buetti, N., Tabah, A., Setti, N., Ruckly, S., Barbier, F., Akova, M., ... & Timsit, J. F. (2024). The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections. Intensive care medicine, 1-17. https://doi.org/10.1007/s00134-024-07348-0