Critical care specialty profile
Why you should deliver critical care research in the UK
Critical care in the UK, in partnership with the NIHR Clinical Research Network, has a strong track record of planning and delivering world-leading clinical research within traditionally hard to reach patient populations. Excellence in nationally coordinated clinical research capabilities, combined with access to large patient populations, allows critical care clinical studies performed in the UK to be efficient, effective and safely delivered to time and target.
The NIHR Clinical Research Network provides researchers with the practical support they need to make research happen in the NHS and the wider health and social care environment. As well as providing highly trained research delivery staff, the NIHR brings together communities of clinical research practice and delivery to provide a well-resourced national Clinical Research Network. Critical Care is one of 30 communities and is made up of leading clinical academics, research-interested clinicians and healthcare practitioners coordinated at national, regional and local levels. The Critical Care Specialty Group ensures critical care studies deliver to time and target providing the best evidence to support best patient care.
We can provide:
A multi-disciplinary faculty of researchers, clinicians, nurses and associated professionals within NHS critical care provide leadership for the specialty working in partnership with the UK’s internationally leading higher education sector.
The Critical Care Specialty Group has expertise and experience in all areas of critical care clinical research including: laboratory and experimental medicine; clinical trials testing safety and efficacy; large scale multi-centre pragmatic effectiveness trials and health policy implementation.
The UK provides internationally leading expertise in efficient trial design and health economic evaluations relevant to technologies assessment. Researchers in NHS centres form experienced multi-disciplinary teams able to engage patients, families and institutions in the benefits of research participation and prioritisation, preventing fragmentation and facilitating rapid assessment, recruitment and follow up.
Access to participants
The National Intensive Care Case Mix Programme database includes 220 intensive care units (ICUs) and facilitates rapid screening of suitable units and patients, in addition to ensuring high quality data capture. The next generation system currently being implemented will facilitate bespoke research data collection for an individual patient, combined and integrated with population level data.
Over a quarter of a million adult critical care episodes are recorded by the NHS each year, including well established sub-specialty pathways for specific cohorts (for example surgical, cardiac, trauma, haematology), with linkage to longitudinal datasets for long term follow-up.
The Clinical Research Network supported the recruitment of over 41,000 participants to 93 studies in 2018/19.
Research within critical care practice, where participants frequently lack the capacity to consent, is challenging. The UK’s nationally coordinated ethical approval processes permit rapid adoption in local centres, who are expert in the recruitment of such patients.
Co-enrolment agreements are encouraged and supported between clinical trials. A national framework to assist clinical trial teams to explore opportunities for patient co-enrolment has been successfully implemented throughout UK critical care research practice.
Each clinical study is monitored and performance managed in direct partnership with the Critical Care Specialty Group: a system which has led to the delivery of numerous high quality UK-led clinical research studies with global impact.
- 88 per cent of critical care non-commercial studies achieved or surpassed their recruitment target during their planned recruitment period
- 83 per cent of trusts with intensive care units recruited into studies on the NIHR CRN Portfolio
UK critical care research is multi-disciplinary; frequently partnering with universities and industry. Well established collaborations with the professional bodies that regulate and lead critical care practice means research findings are rapidly adopted.
International collaboration enables research of global importance, for example, serious infectious diseases and the spread of antimicrobial resistance, which do not respect international borders. International engagement mechanisms include active partnership with the International Forum for Acute Care Trialists (InFACT): an international network of national clinical trial networks.
BREATHE (protocolised trial of invasive and non-invasive weaning off ventilation)
The BREATHE study was a pragmatic, randomised, controlled, open, multi-centre, effectiveness trial of 1,060 participants in 48 UK ICUs. The aim of the study was to determine if the use of Non-Invasive Ventilation (NIV) as an intermediate step in the protocolised weaning of patients off invasive ventilation is of clinical benefit and cost effective. That this intervention could be delivered successfully across such a large, complex cohort of participants who require multi-discipinary management demonstrates the tangible benefits of undertaking trials within the high risk area of critical care within a supportive and well-designed network.
The results of the trial have been presented at a leading international scientific meeting (European Society of Intensive Care Medicine) and the primary manuscript published in the Journal of the American Medical Association.
The NIHR were able to work collaboratively with the research team to increase recruitment via site expansion, training and on the ground clinical research network support.
Delivering public-private partnerships for innovation in rapid sepsis diagnostics
NHS clinical trials of new diagnostic technologies mean the specialty group is at the centre of the UK’s innovation agency’s initiative to reduce deaths and illnesses caused by sepsis globally. Innovate UK in partnership with the Department of Health, the Ministry of Defence, the Home Office, the Engineering and Physical Sciences Research Council and the Medical Research Council, developed grants with matched funding from UK technology companies, injecting £15m into the health technology arena. The initiative has helped UK-based companies work collaboratively with universities, research organisations and NHS hospitals.
The emerging projects will help improve patient care and create opportunities for UK companies in the diagnostic devices global market.