A new multi-million pound EU-funded research project could help NHS staff provide life-saving treatment to some of the country’s most ill patients.
The new European study, led by Imperial College London and Royal Brompton Hospital, will investigate how to increase the chance of survival for patients on life support systems.
Specifically, the trial will assess critically ill patients in the U.K., France and Austria, who require a ventilator.
The team will be funded by the EU Horizon 2020 programme, and will also comprise doctors and scientists from Aalborg University, Denmark, CHU Clermont-Ferrand in France, and The Medical University of Vienna.
Ventilators help very ill patients breathe, and involve a tube being placed in the windpipe via the mouth or throat.
Around four in five patients in NHS intensive care units are on ventilators – and around a quarter of these patients suffer from a condition called acute respiratory distress syndrome (ARDS), explains Dr Brijesh Patel, clinical senior lecturer at Imperial College London and chief investigator of the new study: “Acute respiratory distress syndrome can occur when a patient has had a severe illness or trauma, such as flu, pneumonia, sepsis or a serious accident. The lungs struggle to cope and start to fill with fluid from the body as they become ‘leaky’ – essentially causing a patient to ‘drown’. This is a very serious situation, and as it worsens requires emergency treatment with the patient being placed on a ventilator.”
The ventilator helps the patient breathe and saves their life, explains Dr Patel, who is also an intensive care consultant at Royal Brompton Hospital, but in some cases can also cause further injury to the lungs.
“Although the ventilator is essential to keeping a patient alive, sometimes the pressure with which it forces air into the lungs is too much, and they overinflate. This damages the delicate, already injured, cells in the airspaces, and further increases the amount of fluid and inflammation within the lungs. In some cases this proves too much for a patient’s body to cope with – and sadly can lead to multiple organ failure and death.”
At the moment, doctors use various approaches to help reduce the lung damage from ventilators. These include lowering the pressure of the ventilator, lying the patient on their front, or attaching the patient to a machine that provides oxygen directly into their blood, called extracorporeal membrane oxygenation.
However, even with these treatments, ARDS can often prove fatal.
To help boost a patient’s chance of survival, the team in the new trial will use a type of ‘black box’ which helps tailor ventilator pressure to each individual patient’s lungs – and avoids them becoming over-inflated.
The technology, called the Beacon Caresystem, attaches to a standard ventilator and uses an AI computer algorithm to advise the clinicians how best to set the ventilator pressure to each individual patient.
The system enables breath-by-breath analysis, and adjusts the pressure for each individual breath the patient takes. It continually assesses the health of a patient’s lungs – and can alert medical staff immediately if a patient starts to deteriorate.
The technology, invented by scientists at the University of Aalborg and now made by Danish company Mermaid Care, has previously been trialled on ventilated patients without severe ARDS. The system can also be adapted to stream data in real-time to doctors across the UK, explains Dr Patel, enabling medical teams around the country to monitor patients.
“Royal Brompton Hospital is one of five specialist respiratory failure centres in the country, and because of this treats patients with lung failure from across all of South West England and Wales. This technology could, for example, allow our London team to analyse real-time lung health – breath-by-breath – of a patient in an intensive care unit in Bristol.”
He adds this research study will also help doctors understand more about ARDS – and why it is so deadly.
“Although ARDS is often fatal, up until now scientists understood very little about why it happens and how to treat it. But we desperately need this new information – flu is one of the commonest causes of ARDS, and flu cases are currently nearly ten times higher than normal in Australia. The Australian flu season is usually a reliable predictor of our upcoming flu season, and indicates we may see much higher cases this winter.
This new study is the first step to creating a clearer picture of ARDS – and how to save more patients who suffer from it.”