The NIHR is the nation's largest funder of health and care research and provides the people, facilities and technology that enable research to thrive. We work in partnership with the NHS, universities, local government, other research funders (including industry and charities), patients and the public to improve the health and wealth of the nation.
The NIHR Clinical Research Network (CRN) supported 104 studies on critical care, 35 of which were new studies, and recruited 41,045 patients to studies last year (2018/19).
How research is conducted in the Intensive Care Unit
Find out how we conduct clinical research in NHS intensive care units, and what this means for patients.
This animation was co-produced with researchers and clinicians, former ICU patients and relatives, and ICUSteps. It has been developed based on findings from the Perspectives Study (Perspectives on enhancing consent and recruitment in intensive care units) at the University of Liverpool.
Investigating the role of adrenaline in cardiac arrest
The application of adrenaline is one of the last things tried in attempts to treat cardiac arrest. It increases blood flow to the heart and increases the chance of restoring a heartbeat. However some studies suggest it also reduces blood flow in very small blood vessels in the brain, which may worsen brain damage.
PARAMEDIC 2 aimed to determine if adrenaline is beneficial or harmful as a treatment for out of hospital cardiac arrest.
The trial was funded by the NIHR Health Technology Assessment Programme and supported by the NIHR Clinical Research Network Critical Care National Specialty Group.
The results found that the use of adrenaline in cardiac arrests results in less than 1% more people leaving hospital alive - but almost doubles the risk of severe brain damage for survivors of cardiac arrest.
Patients in shock suffer a lack of oxygen throughout the body, causing many of their organs to deteriorate and eventually even stop working. Without any direct way of measuring how much oxygen is being used, it can make it difficult for doctors to judge which treatments are likely to be most beneficial.
The new technology combines laser spectroscopy and precise flow measurement of breath in a single medical device which fits into a standard ventilation tube. Results from testing of the device in healthy volunteers, and patients receiving anaesthetics, indicate the precision as being better than anything previously achieved.
Overwhelming infection, also called sepsis, is a major problem for the health community. It is the leading cause for admission to an intensive care unit in the UK, accounting for about 30 percent of all admissions. Despite advances in treatment around 40 per cent of such patients do not survive – more than breast and bowel cancer combined.
The LEvOsimendan for the Prevention of Acute oRgan Dysfunction in Sepsis (LeoPARDS) trial was carefully designed to try and identify whether using levosimendan, a new type of drug, in patients with sepsis could produce important benefits by reducing multiple organ failure, which will then hopefully lead to better survival rates.
You can find out more about critical care studies in your area through the Be Part of Research website.
The NIHR provides researchers with the practical support they need to make clinical studies happen in the NHS. This support covers every stage of research, from set up to delivery.
We provide world-class health service infrastructure - research support staff such as clinical research nurses, and research support services such as pharmacy, pathology and radiology - to support organisations seeking to conduct clinical research in the NHS in England. Some of this research is funded by the NIHR, but most of it is funded by NHS non-commercial partners and industry.
The Critical Care Specialty supports a national portfolio of high quality research studies relating to the care of critically ill patients. The research relates primarily to intensive care, high dependency care and acute medical care.
We support researchers to deliver high quality studies to time and target in the NHS. We do this by engaging with the existing research community and developing the research infrastructure locally.
The portfolio of the Critical Care Specialty includes:
Interventions to improve outcomes from Acute Respiratory Distress Syndrome (ARDS) and sepsis
Understanding the long term implications of critical illness and how to improve recovery
The mechanisms and management of brain injury
Developing risk models to guide intensive care treatments for common conditions or complications
Minimising risk and morbidity associated with major surgery
International Critical Care Trials
Many critical care trials led from other countries and funded by overseas charities or government organisations are also able to apply for inclusion in the NIHR Clinical Research Network (CRN) Portfolio. The Critical Care Specialty alongside the UK Critical Care Research Group (UKCCRG) have developed an International Trials Endorsement Policy for the UK. This policy outlines the review process by which international critical care studies, if deemed eligible, are able to access support from the CRN as well as the UKCCRG. The UKCCRG includes representation from all of the main professional bodies relevant to UK critical care research. Read more about our policy.
Experimental medicine in Critical Care
This area of Emerging technology and Innovation aims to support the setup and delivery of Experimental medicine in Critical care studies within the NHS. Following on from the recommendations from the 2018 workshop, we intend to focus on the following areas:
Develop new and stronger partnerships with industry and cross-sector partners
Working with key stakeholders, to support the setup and delivery of studies in the NHS
Draft an Experimental Medicine in Critical care strategy to increase the capacity and capability across the UK, including recommendations for:
The research workforce
Improving the efficiency of existing infrastructure
Development of trial design and methods
Improve NHS and Industry/Biobank engagement
The NIHR CRN Experimental Medicine subgroup will play a coordinating role in progressing these recommendations, which will require UK system-wide responses.
National Critical Care Specialty Group
Each of our 15 Local Clinical Research Networks has at least one nominated local Clinical Specialty Research Lead for Critical Care research. These clinicians lead research groups to promote and support Critical Care research within the NHS Trusts in their area.
At a national level the local leads come together to manage the national Critical Care clinical research portfolio. This involves regularly reviewing the progress of studies, identifying barriers to recruitment, and coming up with solutions and strategies to help overcome those barriers. Our National Specialty Group of clinical experts offer advice and support to commercial and non-commercial customers looking to conduct research in the NHS.
The NIHR Clinical Research Network (CRN) Critical Care Specialty Group oversees the NIHR CRN Portfolio of critical care research, and supports the successful delivery of these studies within the NHS. The Clinical Leads meet nationally three or four times each year, which provides a forum for information sharing, discussion and the planning of activities to support study delivery (for both commercial and non-commercial studies). In addition to clinicians from across the UK the National Specialty Group also includes representatives from key allied stakeholders, such as intensive care nursing, pharmacy and physiotherapy organisations and the Intensive Care National Audit and Research Centre (ICNARC).
The Intensive Care Society (ICS) is the representative body in the UK for all intensive care professionals and patients dedicated to providing the highest quality critical care. It provides multiple functions for the intensive care community, including the production of standards and guidelines, education and training programmes, and the flagship State of the Art Annual National Meeting. The ICS represents the intensive care profession in a wide range of organisations from Royal Colleges to other bodies and societies with an allied stake or interest, and the President also sits on the board of the Faculty of Intensive Care Medicine. The Intensive Care Society’s Patients and Relative Committee (CritPAL) can also advise on study design and are another respected stakeholder. This group can be contacted via the Intensive Care Society (ICS).
Intensive Care Foundation
The Intensive Care Foundation (ICF) is an integral part of the ICS, with a specific aim to facilitate and support the highest quality collaborative intensive care research and innovation within the UK. Its Board is responsible for fundraising, facilitating and coordinating UK intensive care research through its Directors of Research. The Foundation’s activities include a biannual research prioritisation exercise, recently collaborating with the James Lind Alliance. It also sponsors the annual Gold Medal Research Award at the State of the Art meeting, New Investigator Awards and an annual Travel Fellowship. The Foundation endeavours to deliver the best evidence base to improve quality of care, patient safety and outcomes for intensive care patients.
Faculty of Intensive Care Medicine
The Faculty of Intensive Care Medicine (FICM) is the professional body responsible for the training, assessment, practice and continuing professional development of Intensive Care Medicine consultants in the UK. The FICM supports research in critical care in the UK in a number of ways, for example it determines the national curriculum for training in Intensive Care medicine including a framework for core research training and the potential for progression to advanced academic scholarship. The FICM supports regional Deaneries and Universities in enabling access to high quality careers advice and support for ICM trainees wishing to pursue careers in clinical academic medicine. The NIHR Clinical Research Network works in partnership with the FICM to recognise the outstanding contribution of NHS consultants and trainees who are active in research through a yearly award scheme.
UK Critical Care Leadership Forum
The UK Critical Care Leadership Forum (CCLF) is a voluntary collaboration of more than 20 national professional organisations with a remit for critical care, including physicians, nurses, allied health professionals, and researchers. The CCLF also provides an essential bridge between professional groups and the commissioning arm of NHS England. Hosted by the FICM, the aim of the CCLF is to improve patient care through integrating the energies and skills of its participating organisations, to which it is subservient, not superior. Its authority derives from the senior representation of each participant. The CCLF’s workstreams include professional standards, workforce, training and education in intensive care nursing, case mix programmes, and research.
The NIHR provides the support and facilities the NHS needs for first-class research by funding a range of infrastructure.
NIHR Biomedical Research Centres
NIHR Biomedical Research Centres (BRCs), partnerships between England’s leading NHS organisations and universities, conduct translational research to transform scientific breakthroughs into life-saving treatments. The following BRC undertakes critical care research:
The NIHR Health Informatics Collaborative (HIC) has been set up to deliver high quality data in five key therapeutic areas, including intensive care, and make NHS clinical data more readily available to researchers, industry and the NHS community.
Work with our infrastructure
All of the NIHR facilities and centres are opening to working with the public, charities, industry and other partners. If you are interested in collaborating with the NIHR please contact the NIHR Office for Clinical Research infrastructure: firstname.lastname@example.org
Our experts in the NIHR Clinical Research Network National Specialty Group can advise on delivering your critical care study across health and care settings
Professor Paul Dark is the the NIHR Clinical Research Network National Specialty Lead for critical care.
Professor Dark studied undergraduate physics and then medicine. Graduating from The Manchester Medical School in 1989, he went on to study clinical academic surgery, emergency medicine and critical care at the Universities of Glasgow and Manchester in the UK, and at the Catholic University of Leuven, Belgium. He was a MRC Clinical Training Fellow, completing a PhD supervised by Professor Rod Little at the MRC Trauma Unit in 2002, where he developed non-invasive technologies to transduce and study dynamic cardio-respiratory responses to tissue injury and haemorrhage.
Appointed by the University of Manchester in 2003, he developed his clinical academic practice in Intensive Care Medicine as Honorary NHS Consultant at Salford Royal NHS Foundation Trust. He provides leadership for a programme of work funded by the National Institute of Health Research (NIHR) developing and assessing the diagnostic utility of emerging molecular technologies in the setting of sterile tissue injury and severe infection - focused on matrices in blood and breath. Funded by Innovate UK, he has also led a programme of work developing novel technologies aimed at rapid point-of-care infection/sepsis diagnosis and he has advised NICE at a number of diagnostic technology appraisals.
Professor Dark is Academic Lead for Greater Manchester’s Major Trauma Centre and holds a senior academic leadership position in the Faculty of Medical and Human Sciences at the University of Manchester, overseeing innovations in medical science education within a research intensive Russell Group University.