Intensive Care

Is the mechanism of action of hypertonic saline and/or carbocisteine in the treatment of patients with acute respiratory failure due to an increase in mucus hydration?

Addressing one of the top priorities: NIHR research in progress

Many patients in the intensive care unit (ICU) need a breathing machine (ventilator) to help them to breathe. However, one problem that can occur from being on a ventilator, is difficulty clearing secretions (sputum) from the lungs. In some cases, medications called mucoactives may be prescribed. Around one-third of patients in UK ICUs receive a mucoactive at any time. The most common two are called 'carbocisteine' and 'hypertonic saline'. However, we do not know if these medications really help patients with secretions that are difficult to clear. There is a current clinical trial (the MARCH trial) to see whether using one, or both, of these mucoactives helps with clearing thick secretions, and if as a result, patients spend less time on the ventilator. It will also find out if they can improve other important outcomes during the ICU stay. However, although these medications have been used for many years, little is known about the biological way in which they might work to help clear thick secretions. We call this the 'mechanism of action'. The team would therefore like to carry out an additional study, as part of the MARCH trial, to investigate the mechanism of action of carbocisteine and hypertonic saline.

Getting it right: the continuing support and service needs of ICU survivors

Addressing priority 2: In 2015 the Intensive Care Foundation gave a £50,000 ‘JLA Award’ to Dr Brenda O’Neill and Dr Bronagh Blackwood of Queen’s University Belfast, who led a UK-wide collaborative project proposal aiming to improve the assessment of ICU survivor’s support needs across the continuum of care.

Mucoactive drugs for acute respiratory failure: A 2x2 factorial, randomised, controlled, allocation concealed, open-label, Phase 3, pragmatic, clinical and cost effectiveness trial with internal pilot

Addressing one of the top priorities: NIHR research in progress

Many patients in intensive care (ICU) need help to breathe from a breathing machine (ventilator). However, one problem that can occur as a result of being on a ventilator, is difficulty clearing secretions (mucus) from the lungs. This may result in developing a lung infection (called ventilator-associated pneumonia). To reduce the problem of thick secretions, the air coming from the ventilator can have moisture added to it (humidification). Other treatments can include using a suction tube to remove secretions via the breathing tube. Physiotherapists may also use techniques to help clear thick secretions. In some cases medications called mucoactive drugs may be prescribed. This research team conducted a survey of UK ICUs and found that about one-third of patients on a ventilator will be receiving a mucoactive drug. However, we do not know if these mucoactive drugs really help patients with thick secretions or not. In this trial, the team wants to find out if using one, or both, of these mucoactive drugs helps with clearing thick secretions, and if as a result, this means patients spend less time on the ventilator. They also want to know how safe they are, and if they can improve other important outcomes during the ICU stay.

Evaluating the clinical and cost-effectiveness of a conservative approach to oxygen therapy for invasively ventilated adults in intensive care (UK-ROX)

Addressing one of the top priorities: NIHR research in progress

This project addresses the priority "What is the best way of preventing damage to the lungs of patients receiving respiratory support (ventilation)?". It aims to find out whether keeping oxygen saturations at lower levels (conservative oxygen therapy) is better than the higher level that is currently being used in the NHS to treat patients in ICU needing help from a ventilator.