Extracorporeal Therapies and Mechanical Ventilation
Assoc Prof Tiruvoipati has a long standing interest in ECMO and has published extensively in this area. The Frankston Hospital Intensive Care Group is the first in Australia to use the Haemolung device for extracorporeal removal of CO2.The relevance of C02 in the Critically Ill is also the subject of Dr Tiruvoipati’s PhD.
The unit has undertaken previous work on the effect of ventilation on renal function and is currently undertaking a large randomized trial comparing pressure support to Proportional Assist Ventilation (PAV+) in critically ill patients. The department has published on the use of high flow nasal prongs in the critically ill and has extensive experience in its use. The work of Dr Haji continues in evaluating diaphragmatic function in mechanically ventilated patients.
The Department has successfully delivered the Beyond BASIC Mechanical Ventilation course and members of the Department were on the Faculty for the Beyond BASIC course at the World Congress of Intensive Care in Durban 2013. Professor Botha is on the Faculty for the Master of Peri Operative Medicine offered through Monash University and Assoc Professor Carney has presented at regional educational meetings on the provision of ECMO in regional settings.
The Intensive Care Unit at Frankston hospital has participated in a number of multicentre nutrition trials including the Early PN trial, international nutrition surveys, the ENTERIC trial, and the Refeeding Trial, which that have guided clinical practices.
The international nutrition surveys aim to compare current nutrition practices in ICUs within and across different countries and are an ongoing quality improvement and benchmarking activity. Frankston Hospital ICU has participated in 3 of the 4 surveys, and the results have assisted in identifying areas for further research and investigation around our feeding and nutrition care practices. The observational data collected globally as part of the international nutrition surveys has indicated that adequate nutrition plays a role in reducing mortality and increasing ventilator-free days.
The Early Nasojejunal Tube to meet Energy Requirements in Intensive Care (ENTERIC) study compared early nasojejunal nutrition delivered via a spontaneously migrating frictional nasojejunal tube, to continued nasogastric nutrition in mechanically ventilated adults who had elevated gastric residual volumes within 72 hrs of intensive care unit admission. This study showed that in patients with mildly elevated gastric residual volumes and already receiving enteral nutrition, early nasojejunal nutrition did not increase energy delivery and did not appear to reduce the frequency of pneumonia.
The Department’s interest in nutrition has led to significant collaboration in attempts to find evidence based strategies to improve nutritional outcomes of the critically ill
Echocardiography and Critical Care Ultrasound
The unit has a strong interest and expertise in this area. Most members of this small and cohesive group are holding or training in qualifications including the DDU and, the Diploma in Peri-Operative and Critical Care Echocardiography. Dr Haji is PhD candidate of the University of Melbourne for her work on the role of routine focused transthoracic echocardiography and respiratory ultrasound in the assessment of critically ill patients as extended clinical examination.
Dr Haji is a regular facilitator of the HART scan course and there is an active teaching program in the department. Echocardiography and ultrasound are routinely used in clinical practice and the ICU has a dedicated senior echo sonographer Ms Lynda Hopkins who educates and ensures quality of and technique
Acute Kidney Injury and Renal Replacement Therapy
The unit has collaborated with various groups including the CTG and has contributed to knowledge of renal injury and renal replacement therapy. These include epidemiological studies, High Volume Renal Replacement, Citrate therapy and post-discharge renal outcomes. Prof Botha obtained an NHMRC grant and was on the management committee of the Nephroprotect study. This study evaluated the effects of supplemental amino acids on renal function in the critically ill.
Sedative Practice and Delirium
The Intensive Care Department has a long standing interest in sedative practice and has published on epidemiological studies of Australasian Sedative practice and the impact of sedation scales on patient outcomes. The unit has an interest in novel agents such as dexmedetomidine and have published on its use. Sedative research has led to the introduction of standardised sedation scales and screening for delirium using the CAM-ICU tool. Assoc Prof Tiruvoipati has been awarded an ANZICS grant to evaluate the effect of delayed discharge from the ICU on the incidence of delirium. Our Research co-ordinator Mr Cameron Green has an MSc from the University of Edinburgh for his work on delirium.
Organ and Tissue Donation and End of Life Care
Advances in health care and general wellbeing mean that Australians live longer and can remain relatively independent despite multiple co-morbidities.
The vast majority of deaths in a critical care environment are from cessation or limitation of invasive therapies for refractory or end stage organ dysfunction. Also, Frankston ICU staff are directly involved in identifying and initiating end of life care across all areas of the hospital through the Critical Care Liaison service. Working through various hospital forums with input from senior nurses, Palliative Care and other stakeholders, the End of Life Care group aims to establish standards of care for end of life management and ensure patients receive consistent high quality evidence based end of life care across all hospital settings. The Organ and Tissue Donation team are also strong advocates of routinely including organ, tissue and eye donation in conversations on end of life issues. Education and awareness strategies have led to successful Donation after Cardiac Death at Frankston
Members of the group have collaborated with the organizations legal counsel and published on Futility of Care in Australasia.