Near Infra Red Light has fascinating properties in that it can pass through biological tissue and be used to identify hemoglobin, and how much oxygen is attached to the haemoglobin within tissues. This technology at the moment is used frequently to monitor the levels of oxygen in the blood via a finger probe giving an indication of lung function.

Although the technology is currently available to monitor brain oxygen levels using infra red light (or near infra red light) it has up until now not been considered sufficiently accurate to be used in traumatic brain injury. We are developing a refined and improved method of non-invasively monitoring the brain using these techniques. With your help we aim to develop a system that is sufficiently accurate that it can be used in brain trauma, in some cases replacing invasive probes, and hopefully this system can be used in many different areas of care outside of the intensive care unit. All of these will provide a real benefit to individuals who suffer brain injury in the future.

A common problem in about 40% of patients having bowel surgery is that their bowel takes longer than normal to start working again. In most patients the bowel will start working after surgery in 3- 4 days, but in some it takes a week or more. We call this “delayed recovery of gut function”.  This delayed recovery causes nausea, vomiting, complete constipation, tummy pain and tummy swelling (distension). As a result, patients cannot eat or drink until gut function returns, their recovery is slower and they have to stay longer in hospital. There is no immediate cure, and although it gets better on its own in most cases, it can take from 3-7 days to do so. During this time patients have to have a continuous intravenous drip and often insertion of a nasogastric tube to empty the stomach to reduce vomiting (most patients find this very unpleasant).

 One of the common drugs used in hospitals is the local anaesthetic: Lidocaine. This is used to “freeze” parts of the body, for example for minor skin operations or dental procedures. Recently Lidocaine has been used intravenously (through the vein) as part of a general anaesthetic. It reduces pain and inflammation caused by surgery, and seems to help other aspects of recovery that may be important for return of gut function, for example reducing nausea and vomiting, and shortening the time from surgery to first bowel movement. However, previous studies were small and the true benefit of Intravenous (IV) Lidocaine is uncertain. We hope to find out if giving IV Lidocaine improves recovery of gut function after colorectal surgery for NHS patients.

Beta-lactam antibiotics are a group of antibiotics commonly used to treat infection in patients who are seriously ill. Currently, beta-lactam antibiotics are most commonly given to patients as intermittent infusions (given at regular intervals) throughout 24 hours. However, giving the beta-lactam antibiotic as a continuous infusion may mean that antibiotic concentrations in the blood remain more consistent and may be more effective at killing bacteria. Previous studies in humans have not been large enough to show if there is any benefit to the patient by giving beta-lactam antibiotics this way. The purpose of this research is to explore whether beta-lactam antibiotics, commonly used in the treatment of sepsis (a life threatening complication of infection), work better when they are administered by 24 hour continuous infusion as opposed to multiple intermittent infusions each day. This study is part of an international multicentre clinical trial involving 7000 participants to answer this important clinical question. These sort of antibiotics are a vital part of our treatment for people with severe infections so it is important we know how to use them in the most effective way. All of the antibiotics used in this study (i.e. piperacillin-tazobactam and meropenem) are registered drugs currently used in the treatment of sepsis. In this trial we are investigating the delivery method for these drugs.

Hip fractures are one of the commonest osteoporotic fractures in the UK and are the single greatest healthcare burden in this country. They cause considerable ill-health and death for many people. As a consequence of the importance of this injury, the NHS has set up the National Hip Fracture Database to help determine how well the NHS treats patients with a hip fracture and to try to improve this service. This study aims to record important additional patient-centred outcomes of treatment. Using this information, we aim to be able to test new treatments that may in the future improve our treatment of patients with a hip fracture.

Cardiac arrest is a common and catastrophic event with substantial human and financial costs. It is well established that cardiac arrest leads to brain injury. However, what is not widely appreciated is that, after circulation has been restored, cerebral (brain) hypoperfusion (inadequate blood supply) continues. Ongoing cerebral vasoconstriction (blood vessel constriction) and cerebral hypoxia (inadequate oxygen) has been demonstrated using imaging and metabolic technologies including positron emission tomography, ultrasound, jugular bulb oxygen saturation and cerebral oximetry. A likely mechanism responsible for sustained early cerebral hypoperfusion relates to impaired cerebrovascular autoregulation which is the ability of the brain to maintain its own perfusion. Impaired cerebral auto-regulation may make even a normal arterial carbon dioxide tension (PaCO₂) (the major physiological regulator of cerebral blood flow) insufficient to achieve and maintain adequate cerebral perfusion and, consequently, cerebral oxygenation. PaCO₂ is the major determinant of cerebral blood flow and an increased PaCO₂ (hypercapnia) markedly increases cerebral blood flow. Arterial carbon dioxide is modifiable and, as such, is a potential therapeutic target. The TAME Cardiac Arrest Trial is a phase III, multi-centre, randomised controlled trial in resuscitated cardiac arrest patients. This trial will determine whether targeted therapeutic mild hypercapnia (TTMH) applied during the first 24 hours of mechanical ventilation in the intensive care unit improves neurological outcome at 6 months compared to standard care (targeted normocapnia (TN). Supported by compelling preliminary data, significant improvements in patient outcomes are achievable with this simple and cost-free therapy. Recruiting 1,700 patients, for multiple sites in many countries, this will be one of the largest trial ever conducted involving resuscitated cardiac arrest patients admitted to ICU. If the TAME Cardiac Arrest Trial confirms that TTMH is effective, its findings will improve the lives of many patients, transform clinical practice and yield major economic gains worldwide.