Research - ICU at The Queen Elizabeth Hospital

The research activities of The Queen Elizabeth Hospital (TQEH) Intensive Care Unit (ICU) are world recognized and published in leading journals. Research conducted includes a combination of investigator-initiated studies conducted under the auspices of the Australian and New Zealand Intensive Care Society-Clinical Trials Group (ANZICS-CTG), local investigator-initiated studies and commercially-sponsored clinical trials.

Our research is aimed at improving patient outcomes, answering pragmatic, relevant clinical questions that are of importance to the clinicians who provide patient care and also delivering more efficient and effective treatments that will not only benefit critically ill patients but also decrease costs, preserve resources and increase access to scarce critical care beds.

RESEARCH — Landmark studies

• ARISE Investigators and the ANZICS Clinical Trials Group. Goal-directed resuscitation for patients with early septic shock. N Engl J Med 2014;371:1496-506
• PRISM Investigators. Early goal-directed therapy for septic shock - a patient-level meta-analysis. N Engl J Med 2017;376:2223-2234
• TARGET Investigators and the ANZICS Clinical Trials Group. Energy-dense versus routine enteral nutrition in the critically ill. N Engl J Med 2018;379:1823-1834
• Deane AM, Little L, Bellomo R, Chapman MJ, Davies AR, Ferrie S, Horowitz M, Hurford S, Lange K, Litton E, Mackle D, O’Connor S, Parker J, Peake SL Presneill JJ, Ridley EJ, Singh V, van Haren F, Williams P, Young P, Iwashyna TJ. Outcomes Six-Months After 100% or 70% of Enteral Calorie Requirements During Critical Illness (TARGET): A Randomized Controlled Trial. Am J Respir Crit Care Med 2020;201:814-822

Publications (past 5 years)

Nutrition

• Chapple LS, Weinel L, Ridley EJ, Jones D, Chapman MJ, Peake SL. Clinical Sequelae From Overfeeding in Enterally Fed Critically Ill Adults: Where Is the Evidence? JPEN J Parenter Enteral Nutr. 2019 Nov 17. doi: 10.1002/jpen.1740. [Epub ahead of print] Review. PMID: 31736105
• Davies ML, Chapple L-AS, Chapman MJ, Moran JL, Peake SL: Protein delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis. Crit Care Resusc 2017;19:117-127
• Davies ML, Chapple LS, Chapman MJ, Moran JL, Peake SL. Protein delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis. Critl Care Resusc 2017;19:117-127
• Deane AM, Peake SL, Chapman MJ. The disconnect between nutrition guidelines and evidence: how much protein should I prescribe to this critically ill patient? Crit Care Resusc 2018;20:3-4
• Lambell K, Peake S, Ridley E. Nutrition management of obese critically ill patients: More research is urgently needed. Clin Nutr. 2019;38;1957
• Parikh HG, Miller A, Chapman M, Moran JL, Peake SL: Calorie delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis. Crit Care Resusc 2016;18:17-24
• Reid DB, Chapple LS, O'Connor SN, Bellomo R, Buhr H, Chapman MJ, Davies AR, Eastwood GM, Ferrie S, Lange K, McIntyre J, Needham DM, Peake SL, Rai S, Ridley EJ, Rodgers H, Deane AM. The effect of augmenting early nutritional energy delivery on quality of life and employment status one year after ICU admission. Anaesth Intensive Care 2016;44(3):406-12
• Ridley E, Lambell K, Peake S, Chapman M.  Cover story: Nutrition - Obesity and Nutrition in Critical Illness. ICU Management and practice 3. August 2019
• Ridley EJ, Peake SL, Jarvis M, Deane AM, Lang K, Davies AR, Chapman M, Heyland D. Nutrition Therapy in Australia and New Zealand Intensive Care Units: An international Comparison Study. J Parenter Enteral Nutr 2018;42:1349-1357
• Ridley EJ, Peake SL, Jarvis M, Deane AM, Lange K, Davies AR, Chapman M, Heyland D. NutritionTherapy in Australia and New Zealand Intensive Care Units: An International Comparison Study. J Parenter Enteral Nutr 2018;42:1349-1357  
• The Target Investigators On Behalf Of The Australian And New Zealand Intensive Care Society Clinical Trials Group. Statistical Analysis Plan For The Augmented Versus Routine Approach To Giving Energy Trial (Target). Crit Care Resusc 2018: 20:15-21
• The TARGET Investigators, for the ANZICS Clinical Trials Group. Peake SL co-first author. Energy- Dense versus Routine Enteral Nutrition in the Critically Ill. New Engl J Med 2018; 379:1823-1834
• Young PJ, Bellomo R, Chapman MJ, Deane AM, Peake SL. What should we target after TARGET? Crit Care Resusc 2018:20:252-253

Sepsis

• Chan P, Peake S, Bellomo R, Jones D. Improving the Recognition of, and Response to In-Hospital Sepsis. Curr Infect Dis Reports 2016;18:20
• Cudini D, Smith K, Bernard S, Stephenson M, Andrew E, Cameron P, Lum M, Udy A on behalf of the ARISE Investigators. Can pre-hospital administration reduce time to initial antibiotic therapy in septic patients? Emerg Med Australas 2019;31:669-672
• Delaney A, Finnis M, Bellomo R, Udy A, Jones D, Keijzers G, MacDonald S, Peake S. Initiation of vasopressor infusions via peripheral versus central access in patients with early septic shock: A retrospective cohort study. Emerg Med Australas 2020:;32:210-219
• Gotmaker R, Peake SL, Forbes A, Bellomo R for the ARISE investigators. Mortality is greater in septic patients with hyperlactatemia than with refractory hypotension. Shock 2017;48:294-300
• Higgins AM, Bellomo R, Cooper DJ, Delaney A, Nichol AD, Williams PJ on behalf of the Australasian Resuscitation in Sepsis Evaluation (ARISE) Investigators and the ANZICS Clinical Trials Group. Quality of Life and 1-Year Survival in Patients With Early Septic Shock: Long-Term Follow-Up of the Australasian Resuscitation in Sepsis Evaluation Trial. Crit Care Med 2019;47:765-773
• Keijzers G, Macdonald S, Udy A, Arendts G, Bailey M, Bellomo R, Blecher G, Burcham J, Delaney A, Coggins A, Fatovich D, Fraser J, Harley A, Jones P, Kinnear F, May K, Peake S, Taylor D, Williams J, Williams P. The Australasian Resuscitation In Sepsis Evaluation: FLUid or Vasopressors In Emergency Department Sepsis, a multi-centre observational study (ARISE FLUIDS observational study): rationale, methods and analysis plan. Emerg Med Australas 2019;31:90-96
• Luethi N, Bailey M, Higgins A, Howe B, Peake S, Delaney A, Bellomo R; ARISE investigators. Gender differences in mortality and quality of life after septic shock: A post-hoc analysis of the ARISE study. J Crit Care. 2019;55:177-183 .
• Maiden M, Finnis M, Peake S, McRae S, Delaney A, Bailey M, Bellomo R.  Authors’ response to “the relationship between the decrease in haemoglobin concentration and the volume of fluids administered during resuscitation from septic shock may not be so weak. Crit Care 2018; 22:234
• Maiden MJ, Finnis ME, Peake SL, McRae S, Delaney A, Bailey M, Bellomo R. Haemoglobin concentration and volume of intravenous fluids in septic shock in the ARISE trial. Crit Care 2018;22:118
• Moran J, Solomon P: Procalcitonin as a Biomarker for Infection and Sepsis: Yet Again. Pulmonary Crit Care Med 2017;2
• Moran JL, Santamaria J: Reconsidering lactate as a sepsis risk biomarker. PLOS ONE 2017;12:e0185320
• Peake SL, Delaney A, Bailey M, Bellomo R on behalf of the ARISE Investigators. Potential impact of the 2016 consensus definitions of sepsis and septic shock on future sepsis research. Annals Emerg Med 2017;70:553-561
• PRISM Investigators, Rowan KM, Angus DC, Bailey M, Barnato AE, Bellomo R, Canter RR, Coats TJ, Delaney A, Gimbel E, Grieve RD, Harrison DA, Higgins AM, Howe B, Huang DT, Kellum JA, Mouncey  PR, Music E, Peake SL, Pike F, Reade MC, Sadique MZ, Singer M, Yealy DM. Early goal-directed therapy for septic shock - a patient-level meta-analysis. N Engl J Med 2017;376:2223-2234
• Reddi B, Finnis M , Udy A, Maiden M, Delaney A, Bellomo R, Peake S; ARISE Study Management Committee and the Australian and New Zealand Intensive Care Society Clinical Trials Group. The relationship between the change in central venous pressure and intravenous fluid volume, in patients presenting to the emergency department with septic shock. Intensive Care Med 2018;44:1591-1592
• Udy A, Finnis M, Jones D, Delaney A, Macdonald S, Bellomo R, Peake S for the ARISE  Investigators. Incidence, patient characteristics, mode of drug delivery and outcomes of septic shock patients treated with vasopressors in the ARISE Trial. Shock 2019;52:400-407
• Venkatesh B, Finfer S, Cohen J, Rajbhandari D, Arabi Y, Bellomo R, Billot L, Correa M, Glass P, Harward M, Joyce C. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med 2018;378:797-808

Deteriorating patients

• Deane AM, Hodgson CL, Young P, Little L, Singh V, Poole A, Young M, Mackle D, Lange K, Williams P, Peake SL, Chapman MJ, Iwashyna TJ. The rapid and accurate categorisation of critically ill patients (RACE) to identify outcomes of interest for longitudinal studies: a feasibility study. Anaesth Intensive Care 2017;45:476-484
• Malycha J, Bonnici T, Clifton DA, Ludbrook G, Young JD, Watkinson PJ. Patient centred variables with univariate associations with unplanned ICU admission: a systematic review. BMC medical informatics and decision making. 2019;19:98
• Malycha J, Bonnici T, Sebekova K, Petrinic T, Young D, Watkinson P. Variables associated with unplanned general adult ICU admission in hospitalised patients: protocol for a systematic review. Systematic reviews. 2017 Dec 1;6(1):67.
• Malycha J, Farajidavar N, Pimentel MA, Redfern O, Clifton DA, Tarassenko L, Meredith P, Prytherch D, Ludbrook G, Young JD, Watkinson PJ. The effect of fractional inspired oxygen concentration on early warning score performance: a database analysis. Resuscitation 2019 Jun 1;139:192-9.
• Malycha J, Redfern OC, Ludbrook G, Young D, Watkinson PJ. Testing a digital system that ranks the risk of unplanned intensive care unit admission in all ward patients: protocol for a prospective observational cohort study. BMJ open. 2019 Sep 1;9(9):e032429.
• Pimentel MA, Redfern OC, Gerry S, Collins GS, Malycha J, Prytherch D, Schmidt PE, Smith GB, Watkinson PJ. A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: a multi-centre database study. Resuscitation. 2019 Jan 1;134:147-56.
• Santamaria J, Moran J, Reid D: Increasing the Number of Medical Emergency Calls Does Not Improve Hospital Mortality. Crit Care Med 2018;45:1063-1069
• Smith GB, Redfern OC, Pimentel MA, Gerry S, Collins GS, Malycha J, Prytherch D, Schmidt PE, Watkinson, PJ. The National Early Warning Score 2 (NEWS2). Clin Mede 2019;3: 260-3
• Subbe CP, Bannard-Smith J, Bunch J, Champunot R, DeVita MA, Durham L, Edelson DP, Gonzalez I, Hancock C, Haniffa R, Hartin J. Quality metrics for the evaluation of Rapid Response Systems: Proceedings from the third international consensus conference on Rapid Response Systems. Resuscitation 2019;1;141:1-2

Pharmacology

• Abraham J, Sinnollareddy MG, Roberts MS, Williams P, Peake SL, Lipman J, Roberts JA. Plasma and interstitial fluid population pharmacokinetics of vancomycin in critically ill patients with sepsis. Int J Antimicrob Agents 2019;53:137-42
• Kelly SJ, Moran JL, Williams PJ, Burns K, Rowland A, Miners JO, Peake SL: Haemodynamic effects of parenteral vs. enteral paracetamol in critically ill patients: a randomised controlled trial. Anaesthesia 2016;71:1153-1162
• Myburgh J, Paterson DL, Peake S, Rajbhandari D, Rhodes A, Roberts JA, Shirwadkar C, Starr T, Taylor C, Billot L, Dulhunty JM. A protocol for a Phase 3 multicentre randomised controlled trial of continuous versus intermittent beta-lactam antibiotic infusion in critically ill patients with sepsis: the BLING III trial. Crit Care Resusc 2019;21:63-68              
• Roberts JA, Choi GY, Joynt GM, Paul SK, Deans R, Peake S, Cole L, Stephens D,  Bellomo R, Turnidge J, Wallis SC, Roberts MS, Roberts DM, Lassig-Smith M, Starr T, Lipman J. SaMpling Antibiotics in Renal Replacement Therapy (SMARRT): an observational pharmacokinetic study in critically ill patients. BMC Infect Dis 2016;16:103
• Sime FB, Hahn U, Warner MS, Tiong IS, Roberts MS, Lipman J, Peake S, Roberts JA. Using population pharmacokinetic modelling and Monte Carlo simulations to determine whether standard doses of piperacillin in piperacillin/tazobactam regimens are adequate for the management of febrile neutropenia. Antimicrob Agents Chemother 2017;61:1-13
• Sinnollareddy M, Roberts M, Lipman J, Lassig-Smith M, Starr T, Robertson T, Peake S, Roberts J. In vivo microdialysis to determine subcutaneous interstitial fluid penetration and pharmacokinetics of fluconazole in intensive care unit patients with sepsis. Antimicrob Agents and Chemother 2016;60:827-32
• Sinnollareddy M, Roberts M, Lipman J, Peake S, Roberts J. Pharmacokinetics of piperacillin in critically ill patients with acute kidney injury receiving sustained low-efficiency diafiltration. J Antimicrob Chemother 2018;73;1647-1650  
• Roberts JA, Joynt G, Bellomo R et al. The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: Data from the multinational SMARRT Study. Clin Infect Dis 2020: Mar 9;ciaa224.doi: 10.1093/cid/ciaa224. Online ahead of print.

Statistics

• Moran JL, Graham PL: Risk related therapy in meta-analyses of critical care interventions: Bayesian meta-regression analysis. J Crit Care 2019;53:114-119
• Moran J, Solomon PJ: Volatility in High-Frequency Intensive Care Mortality Time Series: Application of Univariate and Multivariate GARCH Models. Open J Applied Sci 2017;7:385-411

Analgaesia

• Kadam VR, Ludbrook G, Van Wijk R, Hewett P, Moran JL, Thiruvenkatarajan V, Williams PJ: Comparison of ultrasound guided Trans-muscular Quadratus Lumborum (TQL) block catheter technique with surgical pre-peritoneal catheter (PPC) for use in the delivery of local anaesthetic to provide post-operative analgesia in abdominal surgery - a randomised controlled trial. Anaesthesia 2019;74:1381-1388
• Kadam VR, Van Wijk RM, Moran JL, Ganesh S, Kumar A, Sethi R, Williams P: Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trial. J Pain Res 2017;10:1705-1712

Miscellaneous

• Warrilow S, Austin D, Cheung W, Elian C, Holley A, Horgamn B, Jansen M, Joynt G, Lister P, Moodie S, Nichol A, Nicholls M, Peake S, Skowronski G, Streat S, White B, Willmott L. ANZICS Guiding principles for complex decision making during the COVID0-19 pandemic. Crit Care Resusc 2020: Epub ahead of print
• Abraham J, Sinha R, Robinson K, Scotland V, Cardone D. Aetiology of preoperative anaemia in patients undergoing elective cardiac surgery - the challenge of pillar one of Patient Blood Management. Anaesth Intensive care 2017;45:46-51.
• Annane D, Ouanes-Besbes L, de Backer D, DU B, Gordon AC, Hernández G, Olsen KM, Osborn TM, Peake S, Russell JA, Cavazzoni SZ. A global perspective on vasoactive agents in shock. Intensive Care Med 2018;44:833-846
• Bihari S, Prakash S, Peake SL, Bailey MJ, Pilcher D, and Bersten A. ICU mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia. Respirology 2017;22:1165-1170
• Chen AX, Moran JL, Libianto R, Baqar S, O’Callaghan C, MacIsaac RJ, Jerums G, Ekinci EI: Effect of angiotensin II receptor blocker and salt supplementation on short-term blood pressure variability in type 2 diabetes. J Hum Hypertens 2019;34:143-150
• Cooper DJ, McQuilten ZK, Nichol A, Ady B, Aubron C, Bailey M, Bellomo R, Gantner D, Irving DO, Kaukonen KM, McArthur C, Murray L, Pettilä V, French C; TRANSFUSE Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults. N Engl J Med 2017;377:1858-67
• Jastrzebski N, Duncan K, Yeo N, Wilson S, Kocher M, Poole A, Reddi B, Moodie M. Feasibility of delivering bereavement follow-up for relatives of patients who have died in a tertiary intensive care unit. Australian Critical Care 2019; 32: S14.
• Libianto R, Moran J, O'Callaghan C, Baqar S, Chen AX, Baker ST, Clarke M, MacIsaac RJ, Jerums G, Ekinci EI: Relationship between urinary sodium-to-potassium ratio and ambulatory blood pressure in patients with diabetes mellitus. Clin Exp Pharmacol Physiol 2018;45:94-97
• Malycha J, Murphy D, Barker G, Ludbrook G, Young JD, Watkinson PJ. Using real-time location devices (RTLD) to quantify off-unit adult intensive care registrar workload: a 1-year tertiary NHS hospital prospective observational study. J Clin Monit Comput 2019;Sep 5:1-5
• McFall A, Peake SL, Williams PJ. Weight and height documentation: Does ICU measure up? Aust Crit Care 2018;32:314-18
• Moran J, Solomon P: New initiatives in Critical Care: distinguishing hype from hope. Crit Care Resusc 2016;18:141-147
• Moran JL, Solomon P: The search for biomarkers in the critically ill: a cautionary tale. Crit Care Resusc 2018;20:85-93
• Peake S, Delaney A, French C. Evolution not revolution: the future of randomized controlled trial in intensive care research. Med J Aust 2019 Oct;211L:303-305
• Peake SL, Maiden M. Overview of shock. In: Oh’s Intensive Care Manual, 8th Edition. A Bersten (Ed). Invited Chapter.
• Pimentel MA, Smith GB, Redfern OC, Gerry S, Collins GS, Malycha J, Prytherch D, Schmidt PE, Watkinson PJ. Reply to: NEWS2 needs to be tested in prospective trials involving patients with confirmed hypercapnia. Resuscitation 2019;1:139:371-372
• Reddi B, Finnis M, Peake S. Difficulties in knowing which critical care trial data warrant change in practice. Med J Aust. 2019;211:306-307
• Santamaria JD, Duke GJ, Pilcher DV, Cooper DJ, Moran J, Bellomo R, Discharge obo, Group RES: Readmissions to Intensive Care: A Prospective Multicentre Study in Australia and New Zealand. Crit Care Med 2017;45:290-297
• Tian DH, Smyth C, Keijzers G, Macdonald SP, Peake S, Udy A, Delaney A. Safety of peripheral administration of vasopressor medications: A systematic review. Emerg Med Australas 201932:220-227
• Venkatesh B, Mehta S, Angus D, Finfer S, Machado F, Marshall J, Mitchell I, Peake S, Zimmerman J. Women in Intensive Care(WIN) study: A preliminary assessment of international data on female representation in the ICU physician workforce, leadership and academic positions. Crit Care 2018;22:21
• Yeo N, Reddi B, Kocher M, Wilson S, Jastrzebski N, Duncan K, Moodie S. Collaboration between the intensive care unit and the organ donation agency to achieve routine consideration of organ donation and comprehensive bereavement follow-up: an improvement project in a quaternary Australian hospital. In press: Australian Health Review.
• Yeo N, Terrett L, Gupta AK. Contemporary management of aneurysmal subarachnoid hemorrhage. A literature review. J Neuroanaesthesiol Crit Care 2019; 6: 131-139.

Trials being actively recruited by TQEH ICU

TQEH ICU is actively recruiting in the following trials:

A phase III randomised controlled trial of continuous beta-lactam infusion compared with intermittent beta-lactam dosing in critically ill patients (BLING III)

• This is an ANZICS-CTG-endorsed, 7000 patient, prospective, multicentre randomised trial  conducted in 100 sites worldwide evaluating the effect of continuous versus intermittent beta-lactam infusion on 90-day mortality in critically ill patients with sepsis. (Professor Peake is on the Management Committee)

A crossover, cluster randomised controlled trial of Selective Decontamination of the Digestive Tract in Intensive Care Unit patients (SuDDICU)

• SuDDICU is an ANZICS-CTG-endorsed cluster crossover randomised trial evaluating the effect of selective decontamination of the digestive tract versus standard care on hospital mortality in patients receiving invasive ventilation. Secondary outcomes include an ecological assessment and a long-term health economic analysis.

Randomized, Embedded, Multifactorial Adaptive Platform trial for Community-Acquired Pneumonia (REMAP-CAP)

• REMAP-CAP is an ANZICS-CTG-endorsed, international, adaptive, platform trial conducted in patients admitted to the ICU with community acquired pneumonia. Multiple interventions are being evaluated, including antimicrobial, prolonged azithromycin and steroid domains. REMAP-CAP has recently being updated to also include a COVID-19 specific domain evaluating antiviral and immunomodulatory therapies (Professor Peake is on the Management Committee).

Reduction of oxygen after cardiac arrest (EXACT)

• A Phase 3 multi-centre, randomised, controlled trial to determine whether reducing oxygen administration to target an oxygen saturation of 90-94%, compared to 98-100%, as soon as possible following successful resuscitation from out-of-hospital cardiac arrest improves outcome at hospital discharge.

The Intensive Care Unit Randomised Trial Comparing Two Approaches to OXygen therapy: Translating Research into Practice Study (ICU-ROX TRIPS)

• ICU-ROX TRIPS is evaluating the change in attitudes and practices, with respect to oxygen management, of staff in ICUs which participated in ICU-ROX compared with staff from ICUs which do not participate in ICU-ROX.

Enteral protein delivery in Australia and New Zealand critically ill adults (TARGET II)

• A prospective, observational study to assess the dose of enteral protein delivered to critically ill adults as standard practice across ICUs in Australia and New Zealand is being conducted as part of the planning for TARGET PROTEIN, a Phase III multicentre randomised trial evaluating augmented protein delivery versus usual care in mechanically ventilated proteinsPhD Scholars

Dr James Malycha

• Using electronic patients records to predict clinical deterioration on the hospital ward

Dr Nikki Yeo

• Optimising end of life care in the critically ill

More information

For information on current research trials at TQEH please view the ANZICS web page.