Acute and Critical Care

The Acute and critical care research team work closely with the HRB Clinical Research Facility and Irish Critical Care Trials Group and is focused on the development and testing of therapies for the acutely severely ill patient. Specific research areas include acute respiratory failure (Laffey/Scully), acute kidney injury (B. McNicholas) and sepsis (Laffey/McNicholas). We focus on the critically ill patient from throughout their hospital journey from the emergency department to the hospital ward, the ICU complex and through to their recovery process.

The spectrum of research studies ranges from early phase investigator initiated studies, to large scale prospective observational studies to participation in large scale phase 3 clinical trials. In the last 5 years, research team members have played leading roles in the HARP-2 study (NEJM 2014; JL CI for Ireland), PROBESE (JAMA 2019; JL Country PI), and the LUNG-SAFE study (JAMA 2016; JL Joint-CI). The group has also participated in several international multi-centre studies, including TRANSFUSE (NEJM 2017; JL Site PI), REMAP-CAP (JAMA 2020) and SOLIDARITY (NEJM 2020). Recently completed (unpublished) studies include INTUBE (J Laffey Country PI), and the WEAN SAFE Study (ERJ 2019; JL Joint-CI).

The research team is currently participating in several international multi-centre studies. TAME is a study of therapeutic hypercapnia following cardiac arrest (NCT03114033) which is initiated in the Emergency Department. TEAM (NCT03133377) is a study of early exercise and mobilization in the critically ill. REMAP-CAP (NCT02735707) is a platform designed study of multiple domain interventions for patients with community acquired pneumonia, again initiated at ward level and continued in the critical care area.

With the advent of the COVID-19 pandemic, the research team has spearheaded local efforts and combined with international collaborations to find therapies for patients with COVID-19 Severe Respiratory Failure. Studies in progress include REMAP-CAP, the platform designed study in patients with community acquired pneumonia which has been repurposed for COVID patients. This study has been repurposed to enable us to offer novel emerging therapies to these patients. We are participating in the SOLIDARITY Trial, which is the WHO initiated platform designed study of multiple domain interventions (remdesivir, anti-cytokine therapies) for patients on the wards and in the ICU with proven COVID-19.

We also have three NUI Galway investigator-initiated clinical studies in progress. APPROVE-CARE Trial is an NUI Galway initiated (CI: B. McNicholas) testing the potential for awake prone positioning (i.e., turning awake patients on to their front) to reduce the need for ventilatory support and improve outcomes in severe COVID-induced respiratory failure. CHARTER-Ireland is a Galway initiated COVID-19 phase 1b/2a clinical Trial (Joint CI’s: D. Cosgrave, J Laffey) testing the efficacy inhaled heparin for COVID-19 respiratory failure. This is a CURAM SFI co-funded project with Aerogen as Industry partner. Our COVID-19 biobank (lead B McNicholas) is a truly collaborative effort, enabled by our clinical colleagues in Infections Diseases, Respiratory Medicine and Laboratory medicine, and investigators at the Lambe Institute.

This research is led by Professor John Laffey, Dr Michael Scully, Dr Bairbre McNicolas and Dr David Cosgrave.