Intensive Care Unit Research Staff
Research is an integral part of the department’s culture as it underpins the aim to provide high quality evidence based intensive care. The last decade has seen substantial progress in critical care related research generated from the Department of Intensive Care.
The establishment of a NATIONAL data base has provided an invaluable tool for research activities.This database has been in existence in various forms since 1990 when the decisions was made by ANZICS to collect national information about ICU resource allocation, patient demographics and patient outcome. The national database known as AORTIC (Australian Outcomes Research Tool for Intensive Care) stores raw data and undertakes calculations to provide the Acute Physiology, Age, & Chronic Health Evaluation (APACHE III) score for each patient. Metropolitan and Regional Intensive Care Units generate routine reports from their own in house databases and submit these electronically on a regular basis to the national database run by ANZICS.
Research interests are varied and include sedation, renal replacement therapy, nutrition and sepsis.
The department has been a member of the ANZICS Clinical Trials Group (CTG) for 6 years and has colloborated on numerous multicentre trials.
Links with industry have provided grants for futher trials that are currently underway.
Colloboration with Fisher Paykel has created oppurtunities for evaluating methods of oxygen delivery and theses data have lead to international presentations and publications in peer reviewed journals.
Assoc Prof Botha is a member of The Sedation and Analgesia Advisory Board in Intensive Care (SAABIC) and ongoing multi centre reseach in ICU delirium and Sedation are planned with this group.
Intensive Care Unit Research Staff
Director of Intensive Care
Associate Professor John Botha
Intensivists
Associate Professor Ian Carney, Dr Kavi Haji, Dr Ravindranath Tiruvoipati, Dr Sachin Gupta, Dr Mainak Majumdar, Nurse Unit Manager Ms Sue Reaper
Nurse Unit Managers
Ms Claire Allen-Terry / Sue Reaper (Maternity Leave)
Research Coordinators
Ms Jodi Vuat, Ms Sharon Allsop
Data Manager
Ms Laurel Walker
Collaborations
- ANZICS CTG – RENAL, Early PN, Enteric, STATINS, ARISE, CHEST, DARE
- Canadian CTG – PROTECT
- The George Institute – RENAL
- SAABIC- Sedation in Intensive Care
- Fisher Paykel –Oxygen Therapy
- European Society for Intensive Care Medicine (ESICM) EPIC II
- European Critical Care Research Network – AKI EPI
- Parexel International/Eli Lilly – PROWESS SHOCK
- The Alfred Hospital – Staircase Maneuvers in Acute Lung Collapse
- The Austin Hospital – A randomised controlled study of two different anticoagulation regimens on filter life during Continuous Venovenous Haemofiltration (CVVH)
- International Mechanical Ventilation Study
Current Research Projects
HIT trial
This trial will evaluate the role of hyperthermia in the treatment of critically ill patients with sepsis
REFEEDING TRIAL
This trial will evaluate the efficacy of restricting feeding in patients with refeeding syndrome
NEPHROPROTECITVE TRIAL
This NHMRC study is a prospective study to investigate if an amino acid infusion protects the kidney from acute kidney injury during an ICU admission
Post RENAL study
This study is evaluating the renal status of patients who survived an episode of acute renal failure in the ICU
CHEST (Crystalloid versus Hydroxyethyl Starch Trial)
A multicentre randomised controlled trial of fluid resuscitation with starch (6% hydroxyethyl starch 130/0.4) compared to saline (0.9% sodium chloride) in intensive care patients on mortality.
EARLY PARENTERAL NUTRITION STUDY
The purpose of this study is to determine the benefits of starting parenteral nutrition earlier than would normally be started under standard care, and whether it improves survival measured at 60 days after commencement of treatment.
ARISE
This multi centre will evaluate the effect of Goal Directed Therapy on septic patients admitted to the Emergency Department.
Completed Research Studies.
SPICE
This observational was a multi centre evaluating sedation practice and the incidence of ICU delirium
STATINS in Sepsis
This multi centre study evaluated the effect of statin drugs on inflammatory mediators and patient outcomes in patients with sepsis
INFINITE 2009
A prospective study, observing the patient population admitted to Intensive Care with H1N1 and Influenza A.
TAME (Time and Money Evaluation) Study.
An Audit of the Time and Financial Costs involved in the Review Process of Multi-Centre Clinical Trials in Australia and New Zealand.
The DARE (Discharge and Readmission Evaluation) Study
In this study Frankston Hospital Intensive Care was one of many units participating in a study which evaluated the impact of ICU discharge and re admission on patient outcomes
PROTECT
The objective of the trial evaluated the effect of Low Molecular Weight Heparin (LMWH) vs. Unfractionated Heparin (UFH) on the primary outcome of proximal leg DVT diagnosed by compression ultrasound, and the secondary outcomes of PE and confirmed bleeding
RENAL
Multicentre, Unblinded, Randomized, Controlled Trial to assess the effect of Augmented vs. Normal Continuous Renal Replacement Therapy (CRRT) on 90 day all cause mortality of Intensive Care Unit Patients with Acute Renal Failure.(ARF)
POINT PREVALENCE PROGRAM 2009
The aim of this CTG point prevalence program was to provide the structure for individual researchers to conduct basic observational Point Prevalence Program Studies to inform future research, while minimizing the workload on participating ICU’s by combining studies using a common and standardized Case Report Form, on predictable dates. This year Frankston Hospital participated in collecting data which evaluates the implementation of “processes of care” practices.
SEMI-RECUMBENT POSITIONING IN VENTILATED PATIENTS
A multi-centre observational study to determine the use of semi-recumbent positioning and the degree of backrest elevation in patients receiving mechanical ventilation in Australia and New Zealand ICU’s.
ENTERIC STUDY
The primary objective of the study was to establish whether early jejunal feeding (using a frictional nasojejenal tube) increased the amount of enteral nutrition delivered during ICU admission in mechanically ventilated medical-surgical critically ill patients with reduced gastric motility when compared to standard feeding (commencing through a naso-gastric tube).
AKI-EPI
Acute kidney Injury-Epidemiologic Prospective Investigation. Evaluation of the epidemiology and early management of AKI according to the RIFLE classification in ICU patients.
ASAP
Audit of Severe Acute Pancreatitis Feeding Practices
CRITICAL CARE NUTRITION
Improving the Practice of Nutrition Therapy in the critically ill: International Nutrition Survey 2008
BLOOD USE IN ICU
A Prospective Observational Study of Blood Product Transfusion Practices in Australian Intensive Care Units
EPIC II
The extended study of Prevalence of Infection in Intensive Care
A COMPARISON OF HIGH FLOW NASAL OXYGEN TO HIGH FLOW FACE MASK OXYGEN.
A randomized crossover study comparing high flow face mask oxygen to high flow nasal prong oxygen delivery in recently actuated patients.
RICH.
A randomized trial evaluating the efficacy of Cold Hartman’s solution in out of hospital cardiac arrest outcome
RICH PILOT STUDY
(Rapid Infusion of Cold Hartman’s) solution in out of Hospital Cardiac Arrest. (Pilot Study 2005)
DEVELOPING AND EVALUATING EVIDENCE BASED GUIDELINES FOR FEEDING IN THE INTENSIVE CARE UNIT.A CLUSTER RANDOMISED TRIAL.
ANZICS CTG feeding investigators group. This trial was a multi centre cluster randomized trial evaluating the impact of applying evidence based nutritional guidelines on mortality in the intensive care unit. Principal site Investigator for Frankston Hospital 2005
BEST (Beginning and Ending Supportive Therapy) for the kidney study –
A multi-centre trial co-ordinated by Professor Bellomo from the Austin & Repatriation Hospital.
Research Grants:
2010-2012 Doig GS, Bellomo R, Davies AR, Simpson F, Reade M, Pollock C, Chesher D, Harrigan P, Devarajan, P, Botha J and Sweetman EA. Nephro-protective effects of L-amino acids in critically ill patients: A multi-centre randomized controlled trial. National Health & Medical Research Council Project Grant $829,300
Publications
Research Articles under Consideration for Publication
Ravi Tiruvoipati, Belchi Chiezey, David Lewis, Kevin Ong, Elmer Villanueva, Kavi Haji, John Botha. Evidence of reduced mortality with stress hyperglycemia in critically ill patients with sepsis. JCRC-D-11-00127
R Tiruvoipati, J Botha, GJ Peek. Effectiveness of ECMO when conventional ventilation fails: valuable option or vague remedy? JCRC-D-11-00055R1
R Tiruvoipati, N Sultana, D Lewis, Prognostic value of troponin I in critically ill patients with severe sepsis. Emergency Medicine Australia.
Kavi Haji, Ravindranath Tiruvoipati, Darsim Haji. Two case reports of colchicine overdose: An uncommon presentation and a classic but initially misdiagnosed. Journal of Emergency Medicine
In Press
Effect of intensity of smoking-history on mortality of seriously ill patients: a multi-centre observational study Kwok m Ho et al Intensive Care Medicine
Prone ventilation for severe hypoxic respiratory failure: Lacking evidence but probably not efficacy. R Tiruvoipati, J Botha. British Journal of Intensive care
2010
Critical Care Services and 2009 H1N1 in Australia and New Zealand. The ANZICS influenza investigators NEJM 2009; Oct 8; 61
Rapid Infusion of Cold Hartmann’s (RICH) Investigators. Induction of Therapeutic Hypothermia by Paramedics After Resuscitation From Out-of-Hospital Ventricular Fibrillation Cardiac Arrest A Randomized Controlled Trial.
Circulation. 2010 Aug 2; 122:737-42. PMID: 20679551
Peek GJ, Elbourne D, Mugford M, Tiruvoipati R, Wilson A, Allen E, Clemens F, Firmin R, Hardy P, Hibbert C, Jones N, Killer H, Thalanany M, and Truesdale A. Randomised controlled trial and parallel economic evaluation of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR). Health Technol Assess. 2010 Jul; 14(35):1-46
Impact of length of stay in emergency department on the outcome in patients with severe sepsis. Kavi Haji, Darsim Haji, Ravindranath Tiruvoipati, Michael Bailey, Van Le Blanc, John A. Botha
Crit Care and Shock (2010) 13: 132-137
Hypothermia predicts Mortality in elderly patients with Sepsis
Tiruvoipati R, Ong K, Gangopadhyay H, Arora S, Carney I, Botha J. BMC Geriatr. 2010 Sep 27; 10(1):70
Clinical application, the use of dexmedotomidine in intensive care sedation.
Yahya Shehabi, John A. Botha, David Ernest, Ross C. Freebairn, Michael Reade, Brigit L. Roberts, Ian Seppelt, Leonie Weisbrodt
Crit Care & Shock (2010) 13:18-21
2009
The RENAL Replacement Therapy Study Investigators . Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients. NEJM October 22, 2009 vol. 361 no. 17
The ANZIC Influenza Investigators. Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand. NEJM October 8, 2009 Vol 361
Death and End of life management in a Metropolitan Intensive Care Unit.
Bloomer M, Tiruvoipati Ravindranath, Tsiripillis M, , Botha J Australian Critical Care 2009
A Comparison of High Flow Nasal Oxygen with Face Mask Oxygen in Extubated Patients.
Tiruvoipati R, Lewis D, Botha J. Journal of Critical care 2009
Screening and Study Enrolment in the Randomised and Evaluation of Normal Vs Augmented level (RENAL) Replacement Therapy Trial Blood Purif 2009; 27;199-205
The cost of intensive care access block: a retrospective two-year study across metropolitan Melbourne.
Graeme J Duke, Michael D Buist, David Pilcher, Carlos D Scheinkestel, John D Santamaria, Geoff A Gutteridge, Peter J Cranswick, David Ernest, Craig French, John A Botha.
MJA 2009;190:375-378
2008
Design and Challenges of the Randomised Evaluation of Normal versus Augmented Level Replacement Therapy (RENAL) Trial: High-Dose versus Standard Dose Hemofiltration in Acute Renal Failure
Blood Purif 2008; 26: 407-416
Renal replacement therapy for acute kidney injury in Australian and New Zealand intensive Care Units: a practice survey
Critical Care and Resuscitation. Volume 10.Number 3 Sept 2008
Effect of Evidence –Base Feeding Guidelines on Mortality of Critically Ill Patients
A cluster Randomised Controlled Trial.
JAMA Dec 17.2008 Vol 300 no 23
Shehabi Y, Botha J, Boyle M, Ernest D, Freebairn R, Jenkins I, Roberts B, Seppelt I.
Sedation and Delirium in the ICU:An Australian Perspective. Anaesthesia and Intensive Care Vol 36 No 4 July 2008
Predictors of outcome of ruptured aortic aneurysms in a metropolitan hospital.
Botha JA, Tiruvoipati R, Last GC, Somjen G, Chue WL.
Anaesth Intensive Care. 2008 Jul;36(4):560-4.
Fatal thrombosis with activated factor VII in a paediatric patient on extracorporeal membrane oxygenation.
Chalwin RP, Tiruvoipati R, Peek GJ.
Eur J Cardiothorac Surg. 2008 Sep;34(3):685-6.
Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK: conventional ventilation or ECMO for Severe Adult Respiratory Failure (CESAR).
Thalanany MM, Mugford M, Hibbert C, Cooper NJ, Truesdale A, Robinson S, Tiruvoipati R, Elbourne DR, Peek GJ, Clemens F, Hardy P, Wilson A; CESAR Trial Group.
BMC Health Serv Res. 2008 Apr 30;8:94.
Efficacy of prone ventilation in adult patients with acute respiratory failure: a meta-analysis.
Tiruvoipati R, Bangash M, Manktelow B, Peek GJ.
J Crit Care. 2008 Mar;23(1):101-10.
PMID: 18359427
Kavi Haji, Van Le Blanc, Darsim Haji, John Botha
The effect of prolonged Emergency Department length of stay on inpatient length of stay and in-hospital mortality in severe sepsis and septic shock
Critical Care 2008, 12(Suppl 2):P418
Tiruvoipati Ravindranath, Ong K, Walker L Arora S, Carney I , Botha John Sepsis in Elderly Patients –Are there early predictors of mortality ?
Anaesth Intensive Care. Volume: 35 Issue: 6 Page numbers: 1011-1012
Tiruvoipati Ravindranath, Ong K, Walker L, Gangopadhyay, H, Botha J, Carney I. Predictors of Intensive Care Unit Mortality in Patients with Sepsis.
Anaesth Intensive Care. Volume: 35 Issue: 6 Page numbers: 1011-1011
2006
Nagappan R, Botha J, Copland J, Carney I, Vij J :Oxford Mini Vaporiser for Halothane in Ventilated Asthmatics Critical Care 2006, 10(Suppl 1):P62
2005
BEST Kidney Investigators. Acute Renal Failure in Critically Ill Patients JAMA 2005 August; 294
B.E.S.T. Kidney Investigators
External validation of severity scoring systems for acute renal failure using a multinational database. Critical Care Medicine. 33(9):1961-1967, September 2005.
Botha J , Mudholkar P, Le Blanc V: The Effect of Changing from Pressure Support to Volume Control Ventilation on Renal Function .Crit Care and Resusc.2005 Dec;7(4) 303-9.
Botha J, Le Blanc V: The State of Sedation in the Nation, results of a national survey. Crit Care and Resusc.2005 Jun; 7(2):92-96.
Naka T, Moritoki E, Bellomo R, Cole L, French C, Botha J, Wan L, Fealy N, Baldwin I: Commercial low citrate anticoagulation haemofiltration in the high risk patient with frequent filter clotting .Anaesthesia and Intensive Care 2005 Oct; 33(5) 601-608.
2004
BEST Kidney Investigators. Diuretics and Mortality in acute renal failure. Crit Care Med.2004 Aug; 32(8):1669-77.
Botha J, Mudholkar P: The effect of a Sedation scale on ventilation hours, sedative, analgesic and inotropic use in an intensive care unit. Crit Care and Resusc.2004 Dec; 6(4): 253-7.
Kumar Ajith, Botha J: Metabolic Stridor –A Case Report .Crit Care and Resusc.2004 Dec; 6(4):277-9.
2003
Botha J A Sedation in the Intensive Care unit: Automate or Vacillate .Editorial. Critical Care and Resuscitation Sept 2003.
Letters to the Editor:
Crit Care and Resusc. Dec 2003 In Response to a letter by Dr G Shaw.
2001
Tolan P, O’Loughlin D, Botha JA: Can seizures and rhabdomyolysis be a potentially serious complication of hyponatremia due to polydipsia? Aust NZJ Psychiatry. 2001 June; 35(3):386.
Invited Lectures
Majumdar M
Is retrieval an appropriate mode of delivering critical care to the remote/rural patient?
ANZICS 2010 Melbourne
Tiruvoipati, R
Why I use ECMO
ANZICS 2010 Melbourne
Presentations and abstracts
Molloy JHM, Pratt NM, Reaper S, Botha J, Tobias T
The First 12 months of the critical care liaison service
ANZICS 2010 Melbourne
Pratt NM, Molloy JHM, Botha J, Tobias T, White S, Simms K.
A ten year check up for a rapid response system – revitalizing our medical emergency team
ANZICS 2010 Melbourne
Tiruvoipati R, Chiezey B, Lewis D, Ong K, Villanueva E, Haji K, Botha J
Evidence of reduced mortality with stress hyperglycaemia in critically ill patients with sepsis
ANZICS 2010 Melbourne
D Lewis, Chiezey B, Tiruvoipati R
Elderly patients are more prone for hypoglycaemia while in intensive care.
ANZICS 2010 Melbourne
Reaper, S NUM ICU, Allen-Terry C, Clinkaberry A, Conroy S, Kohlman D, Leatch L & Macey A.
H1N1 Influenza A: The Complexities and Care Required for a Bariatric Patient in Intensive Care8th Annual ACCCN Victoria
Symposium on Critical Care
Kavi Haji, Van Le Blanc, Darsim Haji, John Botha
The effect of prolonged Emergency Department length of stay on inpatient length of stay and in-hospital mortality in severe sepsis and septic shock.
International Intensive Care and Emergency Symposium Brussels March 2007
Shehabi Y, Botha J Boyle M, Ernest D, Freebairn R, Jenkins I, Roberts B, , Seppelt I.
Sedation and Delirium in the ICU:An Australian Perspective
Anzics Oct 2007 Rotorua
Botha J, Tiruvoipati R, Tsiripillis M, Bloomer M, Walker L, Hanna D.
End of Life Decisions in the ICU: A single centre study.
ANZICS Oct 2007 Rotorua.
Lewis D, Tiruvoipati R, Botha J.
A Comparison of High Flow Nasal Oxygen with Face Mask Oxygen in Extubated Patients.
ANZICS Oct 2007 Rotorua
Botha J, Cameron D , Broughton S , Carney I, Trevaskis K, Taylor P
Implementation of an infection control plan decreases blood stream infection (BSI) rate and MRSA acquisition in an ICU.
ANZICS Oct 2007 Rotorua.
Ravindranath Tiruvoipati, Kevin Ong, Laurel Walker, Himangsu Gangopadhyay, Ian Carney, John Botha
Predictors of Intensive Care Unit Mortality in patients with Sepsis
ANZICS Oct 2007 Rotorua
Ravindranath Tiruvoipati, Kevin Ong, Laurel Walker, Subhash Arora, John Botha, Ian Carney
Sepsis in Elderly Patients – are there early predictors of Mortality?
ANZICS Oct 2007 Rotorua
Subhash Arora, John Botha, Ravindranath Tiruvoipati
Wolff Parkinson White Syndrome can present as sudden cardiac arrest.
ANZICS Oct 2007 Rotorua
International Intensive Care and Emergency Symposium Brussels March 2006-06-13
Nagappan R, Botha J, Copland J, Carney I, Vij J :Oxford Mini Vaporiser for Halothane in Ventilated Asthmatics
ANZICS Adelaide Oct 2005
Myoclonus does not always predict poor prognosis in Anoxic Brain Injury
R Nagappan, J Botha, I Carney, E Butler, T Day
ANZICS meeting Cairns Sept 2003-10-07
The Outcome of Ruptured Aortic Abdominal Aneurysms admitted to a Metropolitan Hospital
J Botha Priestley, I Carney.R Nagappan.S Marshall, K Heckmann
Anzics Cairns Sept 2003
Vasopressin; A therapeutic option in Massive Pulmonary Embolism
J Botha, D Mitra
RACP meeting Hobart May 2003
Hypoxic Brain Injury.R Nagappan, J Botha Carney
ANZICS CTG Meeting Noosa 2003
Dexmedotomidine for Sedation Y Shehabi, J Botha
The State of Sedation in the Nation: results of an Australian Survey
J Botha Le Blanc ANZICS Perth 2002
Ventilation of patients with Obstructive Pulmonary Disease: Intensive Care Outcome
J Botha Mudholkar,V Le Blanc, G Braun ANZICS Perth 2002
An Audit of Glucose Control in a Multidisciplinary Intensive Care Unit
J Botha Mathieson, I Carney, V Le Blanc
The definition of Acute Renal Failure: Results of an International Survey
J Mulder J Botha ANZICS Perth 2002
Eight World Congress of Intensive Care – Sydney, Australia – October 2001
Renal function during changes from volume control to pressure support ventilation – J Botha, P Mudholkar, N Vasic, R Udin – Intensive Care Unit, Frankston Hospital, Frankston, Victoria
Eight World Congress of Intensive Care – Sydney, Australia – October 2001
The effect of a sedation scale on ventilation hours and sedative use – J Botha, P Mudholkar, D Langton, J Pugh, D Kohlman, B Gardner, E Robinson, Intensive Care Unit, Frankston Hospital, Frankston, Victoria.
Research Awards
Nursing Research Prize Winners: Peninsula Health Research Day
2007: David Lewis: “A Comparison of High Flow Nasal Oxygen to High Flow Face Mask Oxygen in Extubated Patients”
2010: David Lewis: “Impact of glycaemic control on survival in critical care patients with sepsis”
Registrar Research Prize Winners: Peninsula Health Research Day
2008 Dr Ravi Tiruvoipati : Sepsis in Elderly patients Are there early predictors of mortality?
