Biography

Areas of specialism

Critical care medicine; Respiratory medicine; Perioperative medicine

My qualifications

2011
PhD
Imperial College
1999
Bachelor Medicine (BM)
University of Southampton

Research

Research interests

Research projects

Supervision

Postgraduate research supervision

My publications

Publications

Creagh-Brown B, De Silva A, Pubudu A, Ferrando-Vivas P, Harrison DA (2016) Relationship Between Peak Lactate and Patient Outcome Following High-Risk Gastrointestinal Surgery: Influence of the Nature of Their Surgery: Elective Versus Emergency, Critical Care Medicine 44 (5) pp. 918-925 Lippincott, Williams & Wilkins
Objectives: The association between hyperlactatemia and adverse outcome in patients admitted to ICUs following gastrointestinal surgery has not been reported. To explore the hypothesis that in a large cohort of gastrointestinal surgical patients, the peak serum lactate (in the first 24 hr) observed in patients admitted to ICU following surgery is associated with unadjusted and severity-adjusted acute hospital mortality and that the strength of association is greater in patients admitted following ?emergency? surgery than in patients admitted following ?elective? surgery.

Design: A retrospective cohort study of all patients who had gastrointestinal surgery and were admitted directly to the ICU between 2008 and 2012.

Setting: Two hundred forty-nine hospitals in the United Kingdom.

Patients: One hundred twenty-one thousand nine hundred ninety patients.

Interventions: None.

Measurements and Main Results: Peak blood lactate in the first 24 hours of admission to critical care, acute hospital mortality, length of stay, and other variables routinely collected within the U.K. Intensive Care National Audit and Research Centre Case Mix Programme database. Elevated blood lactate was associated with increased risk of death and prolonged duration of stay, and the relationship was maintained once adjusted for confounding variables. The positive association between mortality and levels of blood lactate continued down into the ?normal range,? without evidence of a plateau. There was no difference in the extent to which hyperlactatemia was related to mortality between patients admitted following elective and emergency surgery.

Conclusions: These findings have implications for our understanding of the role of lactate in critically ill patients.

Davidson AC, Banham S, Elliott M, Kennedy D, Gelder C, Glossop A, Church AC, Creagh-Brown B, Dodd JW, Felton T, Foex B, Mansfield L, McDonnell L, Parker R, Patterson CM, Sovani M, Thomas L (2016) BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults, THORAX 71 pp. 1-35 BMJ PUBLISHING GROUP
Vandevala T, Pavey L, Chelidoni O, Chang N, Creagh-Brown B, Cox AC (2017) Psychological rumination and recovery from work in Intensive Care Professionals: Associations with stress, burnout, depression, and health, Journal of Intensive Care 5 (16) BioMed Central
Background The work demands of critical care can be a major cause of stress in intensive care unit (ICU) professionals and lead to poor health outcomes. In the process of recovery from work, psychological rumination is considered to be an important mediating variable in the relationship between work demands and health outcomes. This study aimed to extend our knowledge of the process by which ICU stressors and differing rumination styles are associated with burnout, depression and risk of psychiatric morbidity among ICU professionals. Methods Ninety-six healthcare professionals (58 doctors and 38 nurses) who work in ICUs in the UK completed a questionnaire on ICU-related stressors, burnout, work-related rumination, depression and risk of psychiatric morbidity. Results Significant associations between ICU stressors, affective rumination, burnout, depression and risk of psychiatric morbidity were found. Longer working hours were also related to increased ICU stressors. Affective rumination (but not problem-solving pondering or distraction detachment) mediated the relationship between ICU stressors, burnout, depression and risk of psychiatric morbidity, such that increased ICU stressors, and greater affective rumination, were associated with greater burnout, depression and risk of psychiatric morbidity. No moderating effects were observed. Conclusions Longer working hours were associated with increased ICU stressors, and increased ICU stressors conferred greater burnout, depression and risk of psychiatric morbidity via increased affective rumination. The importance of screening healthcare practitioners within intensive care for depression, burnout and psychiatric morbidity has been highlighted. Future research should evaluate psychological interventions which target rumination style and could be made available to those at highest risk. The efficacy and cost effectiveness of delivering these interventions should also be considered.
Rayner L, Mcgovern Andrew Peter, Creagh-Brown Ben, Woodmansey C, de Lusignan Simon (2018) Type 2 Diabetes And Asthma: Systematic Review, Current Diabetes Reviews 14 Bentham Science Publishers
Background and Objective: Obesity is an important contributor to the risk of both asthma and Type 2 Diabetes (T2DM). However, it has been suggested that T2DM and asthma are also independently associated. The aim of this systematic review was to synthesize the evidence for an independent relationship between T2DM and asthma. Methods: MEDLINE and EMBASE were searched for studies reporting the relationship between asthma and T2DM in adults. Given a potential bidirectional relationship, articles relating to T2DM as a risk factor for asthma, and asthma as a risk factor for T2DM were examined separately. Results: Eight studies were identified for inclusion in the review (n=2,934,399 participants). Four studies examined incident diabetes in those with asthma. The pooled (random effects model) adjusted hazard ratio for incident T2DM in asthma was 1.37 (95%CI 1.12-1.69; p
Tyson Emma, Creagh-Brown Ben (2018) Postoperative care, Medicine (United Kingdom) 46 (12) pp. 750-753 Elsevier
Optimal postoperative care involves a multidisciplinary team of healthcare professionals and a patient-centred approach to avoid postoperative complications and enable a rapid return to normal function. During the last decade, enhanced recovery after surgery programmes have been implemented worldwide to reduce complications and length of stay ? challenging traditional models of perioperative care. Some aspects of perioperative care have consensus guidelines without significant controversy, whereas others, such as perioperative fluid therapy, remain contentious.
Abbott T.E.F., Fowler A.J., Pelosi P., Gama de Abreu M., Møller A.M., Canet J., Creagh-Brown B., Mythen M., Gin T., Lalu M.M., Futier E., Grocott M.P., Schultz M.J., Pearse R.M., Myles P., Gan T.J., Kurz A., Peyton P., Sessler D., Tramèr M., Cyna A., De Oliveira G.S., Wu C., Jensen M., Kehlet H., Botti M., Boney O., Haller G., Cook T., Fleisher L., Neuman M., Story D., Gruen R., Bampoe S., Evered L., Scott D., Silbert B., van Dijk D., Kalkman C., Chan M., Grocott H., Eckenhoff R., Rasmussen L., Eriksson L., Beattie S., Wijeysundera D., Landoni G., Leslie K., Biccard B., Howell S., Nagele P., Richards T., Lamy A., Gabreu M., Klein A., Corcoran T., Jamie Cooper D., Dieleman S., Diouf E., McIlroy D., Bellomo R., Shaw A., Prowle J., Karkouti K., Billings J., Mazer D., Jayarajah M., Murphy M., Bartoszko J., Sneyd R., Morris S., George R., Moonesinghe R., Shulman M., Lane-Fall M., Nilsson U., Stevenson N., van Klei W., Cabrini L., Miller T., Pace N., Jackson S., Buggy D., Short T., Riedel B., Gottumukkala V., Alkhaffaf B., Johnson M. (2018) A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications, British Journal of Anaesthesia 120 (5) pp. 1066-1079 Elsevier

Background

There is a need for robust, clearly defined, patient-relevant outcome measures for use in randomised trials in perioperative medicine. Our objective was to establish standard outcome measures for postoperative pulmonary complications research.

Methods

A systematic literature search was conducted using MEDLINE, Web of Science, SciELO, and the Korean Journal Database. Definitions were extracted from included manuscripts. We then conducted a three-stage Delphi consensus process to select the optimal outcome measures in terms of methodological quality and overall suitability for perioperative trials.

Results

From 2358 records, the full texts of 81 manuscripts were retrieved, of which 45 met the inclusion criteria. We identified three main categories of outcome measure specific to perioperative pulmonary outcomes: (i) composite outcome measures of multiple pulmonary outcomes (27 definitions); (ii) pneumonia (12 definitions); and (iii) respiratory failure (six definitions). These were rated by the group according to suitability for routine use. The majority of definitions were given a low score, and many were imprecise, difficult to apply consistently, or both, in large patient populations. A small number of highly rated definitions were identified as appropriate for widespread use. The group then recommended four outcome measures for future use, including one new definition.

Conclusions

A large number of postoperative pulmonary outcome measures have been used, but most are poorly defined. Our four recommended outcome measures include a new definition of postoperative pulmonary complications, incorporating an assessment of severity. These definitions will meet the needs of most clinical effectiveness trials of treatments to improve postoperative pulmonary outcomes.

Lambden Simon, Creagh-Brown Ben C., Hunt Julie, Summers Charlotte, Forni Lui G. (2018) Definitions and pathophysiology of vasoplegic shock, Critical Care 22 174 pp. 1-8 BioMed Central Ltd.
Vasoplegia is the syndrome of pathological low systemic vascular resistance, the dominant clinical feature of which is reduced blood pressure in the presence of a normal or raised cardiac output. The vasoplegic syndrome is encountered in many clinical scenarios, including septic shock, post-cardiac bypass and after surgery, burns and trauma, but despite this, uniform clinical definitions are lacking, which renders translational research in this area challenging. We discuss the role of vasoplegia in these contexts and the criteria that are used to describe it are discussed. Intrinsic processes which may drive vasoplegia, such as nitric oxide, prostanoids, endothelin-1, hydrogen sulphide and reactive oxygen species production, are reviewed and potential for therapeutic intervention explored. Extrinsic drivers, including those mediated by glucocorticoid, catecholamine and vasopressin responsiveness of the blood vessels, are also discussed. The optimum balance between maintaining adequate systemic vascular resistance against the potentially deleterious effects of treatment with catecholamines is as yet unclear, but development of novel vasoactive agents may facilitate greater understanding of the role of the differing pathways in the development of vasoplegia. In turn, this may provide insights into the best way to care for patients with this common, multifactorial condition. © 2018 The Author(s).
Mifsud Bonnici D., Sanctuary T., Creagh-Brown B. (2014) Erratum: Observational cohort study of outcome of patients referred to a regional weaning centre (Thorax (2013) 63:3 (A68)), Thorax 69 (3) pp. 279-279 BMJ Publishing Group

The results section of this abstract should read:

Results A total of 369 patients were referred over the 6 year period. Of these, 194 (52.6%) were admitted. The largest outcome group was total liberation from all forms of MV (45%). The remainder were shown to (1) require nocturnal non-invasive ventilation (NIV) (21%); (2) require nocturnal and intermittent daytime NIV (1%); (3) require long-term tracheostomy ventilation (19%); and (4) died in hospital (15%). Post-surgical and COPD patients had the highest rate of total liberation from mechanical ventilation at 60% and 54%, respectively. The median time from admission to tracheostomy decannulation was 18 days (9?33). NMD-CWD patients had the lowest hospital mortality (7%), whereas COPD patients had the highest hospital mortality (29%). The overall survival at 12 and 24 months was 55% and 47%, respectively. 25% of the COPD patients were alive and 59% of the NMD-CWD patients were alive at 24 months (Figure 1).

Davidson A.C., Banham S., Elliott M., Kennedy D., Gelder C., Glossop A., Church A.C., Creagh-Brown Ben, Dodd J.W., Felton T., Foëx B., Mansfield L., McDonnell L., Parker R., Patterson C.M., Sovani M., Thomas L. (2016) BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults, Thorax 71 pp. ii1-ii35 BMJ Publishing Group
Vandevala Tushna, Pavey Louisa, Chelidoni Olga, Chang Nai-Feng, Creagh-Brown Ben, Cox Anna (2017) Psychological rumination and recovery from work in intensive care professionals: Associations with stress, burnout, depression and health, Journal of Intensive Care 5 (1) BMC

Background

The work demands of critical care can be a major cause of stress in intensive care unit (ICU) professionals and lead to poor health outcomes. In the process of recovery from work, psychological rumination is considered to be an important mediating variable in the relationship between work demands and health outcomes. This study aimed to extend our knowledge of the process by which ICU stressors and differing rumination styles are associated with burnout, depression and risk of psychiatric morbidity among ICU professionals.

Methods

Ninety-six healthcare professionals (58 doctors and 38 nurses) who work in ICUs in the UK completed a questionnaire on ICU-related stressors, burnout, work-related rumination, depression and risk of psychiatric morbidity.

Results

Significant associations between ICU stressors, affective rumination, burnout, depression and risk of psychiatric morbidity were found. Longer working hours were also related to increased ICU stressors. Affective rumination (but not problem-solving pondering or distraction detachment) mediated the relationship between ICU stressors, burnout, depression and risk of psychiatric morbidity, such that increased ICU stressors, and greater affective rumination, were associated with greater burnout, depression and risk of psychiatric morbidity. No moderating effects were observed.

Conclusions

Longer working hours were associated with increased ICU stressors, and increased ICU stressors conferred greater burnout, depression and risk of psychiatric morbidity via increased affective rumination. The importance of screening healthcare practitioners within intensive care for depression, burnout and psychiatric morbidity has been highlighted. Future research should evaluate psychological interventions which target rumination style and could be made available to those at highest risk. The efficacy and cost effectiveness of delivering these interventions should also be considered.

Seaton Alister, Hodgson Luke E, Creagh-Brown Ben, Pakavakis Adrian, Wyncoll Duncan LA, Doyle James F (2017) The use of veno-venous extracorporeal membrane oxygenation following thrombolysis for massive pulmonary embolism, Journal of the Intensive Care Society 18 (4) pp. 342-347 SAGE Publications Inc.
A 59-year-old man was diagnosed with a massive pulmonary embolism. Despite thrombolysis there were two episodes of cardiac arrest and following recovery of spontaneous circulation profound cardiorespiratory failure ensued. An extracorporeal membrane oxygenation retrieval team initiated veno-venous extracorporeal membrane oxygenation on site to facilitate transfer to the extracorporeal membrane oxygenation centre. An excellent outcome is reported in the short term. This represents one of the few published cases of veno-venous extracorporeal membrane oxygenation for a massive pulmonary embolism following thrombolysis.
Rayner Louise, Mcgovern Andrew, Creagh-Brown Ben, Woodmansey Chris, de Lusignan Simon (2019) Type 2 Diabetes and Asthma: Systematic Review of the Bidirectional Relationship, Current diabetes reviews 15 (2) pp. 118-126 Bentham Science Publishers

Background and Objective: Obesity is an important contributor to the risk of both asthma and Type 2 Diabetes (T2DM). However, it has been suggested that T2DM and asthma are also independently associated. The aim of this systematic review was to synthesize the evidence for an independent relationship between T2DM and asthma.

Methods: MEDLINE and EMBASE were searched for studies reporting the relationship between asthma and T2DM in adults. Given a potential bidirectional relationship, articles relating to T2DM as a risk factor for asthma, and asthma as a risk factor for T2DM were examined separately.

Results: Eight studies were identified for inclusion in the review (n=2,934,399 participants). Four studies examined incident diabetes in those with asthma. The pooled (random effects model) adjusted hazard ratio for incident T2DM in asthma was 1.37 (95%CI 1.12-1.69; p Â0.001) after controlling for BMI.

Four studies reported prevalence or incidence rates of asthma in people with T2DM; higher rates of asthma in those with T2DM were reported in all four studies. Meta-analysis of results was not possible due to methodological heterogeneity.

The quality of included studies was good, but due to small numbers, publication bias cannot be excluded.

Conclusion: The published literature suggests a bidirectional independent relationship between T2DM and asthma, although we cannot exclude publication bias.

Rayner L.H., Mcgovern A.P., Sherlock J., Gatenby P., Correa A., Creagh-Brown B., de Lusignan S. (2018) Type 2 diabetes: A protective factor for COPD?, Primary Care Diabetes 12 (5) pp. 438-444 Elsevier Ltd

Background

Chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2DM) are common comorbidities. COPD is a known risk factor for incident T2DM, however few studies have examined the relationship in reverse. The primary aim of this study was to compare the incidence of COPD in people with and without T2DM.

Materials and methods

We conducted a retrospective case-control study using a long-established English general practice network database (n = 894,646). We matched 29,217 cases of T2DM with controls, adjusting for age, gender, smoking status, BMI and social deprivation, to achieve 1:1 propensity matching and compared the rate of incident COPD over eight years of follow-up. We performed a secondary analysis to investigate the effect of insulin, metformin and sulphonylureas on COPD incidence.

Results

People with T2DM had a reduced risk of COPD compared to matched controls over the follow-up period (HR 0.89, 95%CI 0.79?0.93). 48.5% of those with T2DM were ex-smokers compared with 27.3% of those without T2DM. Active smoking rates were 20.4% and 23.7% respectively. Insulin, metformin and sulphonylureas were not associated with incident COPD.

Conclusions

People with T2DM are less likely to be diagnosed with COPD than matched controls. This may be due to positive lifestyle changes, such as smoking cessation in those with T2DM.

Gattenby Piers, Sultan Javed, Gregory Sarah, Creagh-Brown Ben (2016) Commentary on the study of the efficacy of lung expansion techniques on alterations in postoperative pulmonary complications, Chest 149 (2) pp. 606-607 Elsevier
Bonnici Denise Mifsud, Sanctuary Thomas, Warren Alex, Murphy Patrick B, Steier Jorge, Marino Philip, Pattani Hina, Creagh-Brown Ben C, Hart Nicholas (2016) Prospective observational cohort study of patients with weaning failure admitted to a specialist weaning, rehabilitation and home mechanical ventilation centre, BMJ Open 6 (3) e010025 BMJ Publishing Group

Objectives According to National Health Service England (NHSE) specialist respiratory commissioning specification for complex home ventilation, patients with weaning failure should be referred to a specialist centre. However, there are limited data reporting the clinical outcomes from such centres.

Setting Prospective observational cohort study of patients admitted to a UK specialist weaning, rehabilitation and home mechanical ventilation centre between February 2005 and July 2013.

Participants 262 patients admitted with a median age of 64.2?years (IQR 52.6?73.2?years). 59.9% were male.

Results 39.7% of patients had neuromuscular and/or chest wall disease, 21% were postsurgical, 19.5% had chronic obstructive pulmonary disease (COPD), 5.3% had obesity-related respiratory failure and 14.5% had other diagnoses. 64.1% of patients were successfully weaned, with 38.2% weaned fully from ventilation, 24% weaned to nocturnal non-invasive ventilation (NIV), 1.9% weaned to nocturnal NIV with intermittent NIV during the daytime. 21.4% of patients were discharged on long-term tracheostomy ventilation. The obesity-related respiratory failure group were most likely to wean (relative risk (RR) for weaning success=1.48, 95% CI 1.35 to 1.77; pÂ0.001), but otherwise weaning success rates did not significantly vary by diagnostic group. The median time-to-wean was 19?days (IQR 9?33) and the median duration of stay was 31?days (IQR 16?50), with no difference observed between the groups. Weaning centre mortality was 14.5%, highest in the COPD group (RR=2.15, 95% CI 1.19 to 3.91, p=0.012) and lowest in the neuromuscular and/or chest wall disease group (RR=0.34, 95% CI 0.16 to 0.75, p=0.007). Of all patients discharged alive, survival was 71.7% at 6?months and 61.8% at 12?months postdischarge.

Conclusions Following NHSE guidance, patients with weaning delay and failure should be considered for transfer to a specialist centre where available, which can demonstrate favourable short-term and long-term clinical outcomes.

Creagh-Brown Ben C., De Silva A. Pubudu, Ferrando-Vivas Paloma, Harrison David A. (2016) Relationship between peak lactate and patient outcome following high-risk gastrointestinal surgery: Influence of the nature of their surgery: Elective versus emergency, Critical Care Medicine 44 (5) pp. 918-925 Lippincott Williams and Wilkins

Objectives:

The association between hyperlactatemia and adverse outcome in patients admitted to ICUs following gastrointestinal surgery has not been reported. To explore the hypothesis that in a large cohort of gastrointestinal surgical patients, the peak serum lactate (in the first 24 hr) observed in patients admitted to ICU following surgery is associated with unadjusted and severity-adjusted acute hospital mortality and that the strength of association is greater in patients admitted following ?emergency? surgery than in patients admitted following ?elective? surgery.

Design:

A retrospective cohort study of all patients who had gastrointestinal surgery and were admitted directly to the ICU between 2008 and 2012.

Setting:

Two hundred forty-nine hospitals in the United Kingdom.

Patients:

One hundred twenty-one thousand nine hundred ninety patients.

Interventions:

None.

Measurements and Main Results:

Peak blood lactate in the first 24 hours of admission to critical care, acute hospital mortality, length of stay, and other variables routinely collected within the U.K. Intensive Care National Audit and Research Centre Case Mix Programme database. Elevated blood lactate was associated with increased risk of death and prolonged duration of stay, and the relationship was maintained once adjusted for confounding variables. The positive association between mortality and levels of blood lactate continued down into the ?normal range,? without evidence of a plateau. There was no difference in the extent to which hyperlactatemia was related to mortality between patients admitted following elective and emergency surgery.

Conclusions:

These findings have implications for our understanding of the role of lactate in critically ill patients.

Buggy D.J., Freeman J., Johnson M.Z., Leslie K., Riedel B., Sessler D.I., Kurz A., Gottumukkala V., Short T., Pace N., Myles P.M., Gan T.J., Peyton P., Tramèr M., Cyna A., De Oliveira G.S., Wu C., Jensen M., Kehlet H., Botti M., Boney O., Haller G., Grocott M., Cook T., Fleisher L., Neuman M., Story D., Gruen R., Bampoe S., Evered L., Scott D., Silbert B., van Dijk D., Kalkman C., Chan M., Grocott H., Eckenhoff R., Rasmussen L., Eriksson L., Beattie S., Wijeysundera D., Landoni G., Biccard B., Howell S., Nagele P., Richards T., Lamy A., Lalu M., Pearse R., Mythen M., Canet J., Moller A., Gin T., Schultz M., Pelosi P., Gabreu M., Futier E., Creagh-Brown B., Abbott T., Klein A., Corcoran T., Jamie Cooper D., Dieleman S., Diouf E., McIlroy D., Bellomo R., Shaw A., Prowle J., Karkouti K., Billings J., Mazer D., Jayarajah M., Murphy M., Bartoszko J., Sneyd R., Morris S., George R., Moonesinghe R., Shulman M., Lane-Fall M., Nilsson U., Stevenson N., van Klei W., Cabrini L., Miller T., Jackson S., Alkhaffaf B. (2018) Systematic review and consensus definitions for standardised endpoints in perioperative medicine: postoperative cancer outcomes, British Journal of Anaesthesia 121 (1) pp. 38-44 Elsevier

Background

The Standardising Endpoints for Perioperative Medicine group was established to derive an appropriate set of endpoints for use in clinical trials related to anaesthesia and perioperative medicine. Anaesthetic or analgesic technique during cancer surgery with curative intent may influence the risk of recurrence or metastasis. However, given the current equipoise in the existing literature, prospective, randomised, controlled trials are necessary to test this hypothesis. As such, a cancer subgroup was formed to derive endpoints related to research in onco-anaesthesia based on a current evidence base, international consensus and expert guidance.

Methods

We undertook a systematic review to identify measures of oncological outcome used in the oncological, surgical, and wider literature. A multiround Delphi consensus process that included up to 89 clinician?researchers was then used to refine a recommended list of endpoints.

Results

We identified 90 studies in a literature search, which were the basis for a preliminary list of nine outcome measures and their definitions. A further two were added during the Delphi process. Response rates for Delphi rounds one, two, and three were 88% (n=9), 82% (n=73), and 100% (n=10), respectively. A final list of 10 defined endpoints was refined and developed, of which six secured approval by e70% of the group: cancer health related quality of life, days alive and out of hospital at 90 days, time to tumour progression, disease-free survival, cancer-specific survival, and overall survival (and 5-yr overall survival).

Conclusion

Standardised endpoints in clinical outcomes studies will support benchmarking and pooling (meta-analysis) of trials. It is therefore recommended that one or more of these consensus-derived endpoints should be considered for inclusion in clinical trials evaluating a causal effect of anaesthesia?analgesia technique on oncological outcomes.

Creagh-Brown Ben (2014) Mimicking asthma: Consider vocal cord dysfunction, Journal of the Intensive Care Society 15 (1) pp. 84-87 SAGE Publications
The report and description of the issue of factitious disorder
(formerly known as Munchausen?s syndrome) was
interesting and informative.1 The patient described presented
with features of acute severe asthma but this diagnosis was
discounted when more information became available. Another
mimic of acute severe asthma deserves mention in this context ? a condition commonly known as vocal cord dysfunction (VCD)
but perhaps more accurately termed paradoxical vocal fold
motion (PVFM)2 and historically termed Munchausen?s stridor.3
It is characterised by episodic unintentional paradoxical
adduction of the vocal cords (or other laryngeal structures),
resulting in upper airway obstruction. Patients may experience a variety of symptoms including dyspnoea, cough, stridor,
wheezing, neck tightness and voice changes. These symptoms
are often precipitated by physical activity and intense emotion.
Presentation may be dramatic and can be mistaken for acute
asthma, anaphylaxis or angioedema.
Creagh-Brown Ben (2016) Respiratory failure, Medicine 44 (6) pp. 342-345 Elsevier
Respiratory failure is a common complication of acute cardiorespiratory disease and exacerbations of chronic respiratory disease. It can be a feature of advanced chronic cardiac, respiratory and neurological diseases. Respiratory failure can manifest as hypoxaemia, hypercapnia or both. This article reviews the pathophysiology of these perturbations in respiratory homeostasis, the clinical features of acute and chronic respiratory failure and a brief discussion of the management.
Konstantara Emmanouela, Vandrevala Tushna, Cox Anna, Creagh-Brown Benedict C, Ogden Jane (2016) Balancing professional tension and deciding upon the status of death: Making end-of-life decisions in intensive care units, Health Psychology Open 3 (1) pp. 1-9 SAGE Publications
This study investigated how intensivists make decisions regarding withholding and withdrawing treatment for patients at the end of their lives. This involved completing in-depth interviews from two sites of the South of England, United Kingdom by twelve intensivists. The data collected by these intensivists were analysed using thematic analysis. This resulted in the identification of three themes: intensivists? role, treatment effectiveness, and patients? best interest. Transcending these were two overarching themes relating to the balance between quantity and quality of life, and the intensivists? sense of responsibility versus burden. The results are considered in terms of making sense of death and the role of beliefs in the decision-making process.
Creagh-Brown Ben (2014) Benefits of ² blockers in chronic obstructive pulmonary disease and heart failure, BMJ 348 g3316 BMJ Publishing Group
Williams and Oakeshott caution against the use of the ² blocker bisoprolol for chronic heart failure in patients with severe asthma or chronic obstructive pulmonary disease (COPD).1 This recommendation is somewhat contentious. Patients with COPD often have cardiac comorbidities, including chronic heart failure (~20% of patients2), and in one large study of patients with COPD, 27% of deaths were attributable to cardiac causes.3 Selective ² blockers such as bisoprolol have been shown to be safe in COPD.4 5 Moreover, in addition to the beneficial effects on outcomes relating to heart failure, there is mounting evidence that ² blockade may also improve outcomes from COPD.6
Barnes J., Hunter J., Harris S., Shankar-Hari M., Diouf E., Jammer I., Kalkman C., Klein A.A., Corcoran T., Dieleman S., Grocott M.P.W., Mythen M.G., Myles P., Gan T.J., Kurz A., Peyton P., Sessler D., Tramèr M., Cyna A., De Oliveira G.S., Wu C., Jensen M., Kehlet H., Botti M., Boney O., Haller G., Grocott M., Cook T., Fleisher L., Neuman M., Story D., Gruen R., Bampoe S., Evered L., Scott D., Silbert B., van Dijk D., Chan M., Grocott H., Eckenhoff R., Rasmussen L., Eriksson L., Beattie S., Wijeysundera D., Landoni G., Leslie K., Biccard B., Howell S., Nagele P., Richards T., Lamy A., Lalu M., Pearse R., Mythen M., Canet J., Moller A., Gin T., Schultz M., Pelosi P., Gabreu M., Futier E., Creagh-Brown Ben, Fowler A., Abbott T., Klein A., Cooper D.J., McIlroy D., Bellomo R., Shaw A., Prowle J., Karkouti K., Billings J., Mazer D., Jayarajah M., Murphy M., Bartoszko J., Sneyd R., Morris S., George R., Moonesinghe R., Shulman M., Lane-Fall M., Nilsson U., Stevenson N., Cooper J.D., van Klei W., Cabrini L., Miller T., Pace N., Jackson S., Buggy D., Short T., Riedel B., Gottumukkala V., Alkhaffaf B., Johnson M. (2019) Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: infection and sepsis, British Journal of Anaesthesia 122 (4) pp. 500-508 Elsevier

Background:

Perioperative infection and sepsis are of fundamental concern to perioperative clinicians. However, standardised endpoints are either poorly defined or not routinely implemented. The Standardised Endpoints in Perioperative Medicine (StEP) initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials.

Methods:

We undertook a systematic review to identify measures of infection and sepsis used in the perioperative literature. A multi-round Delphi consensus process that included more than 60 clinician researchers was then used to refine a recommended list of outcome measures.

Results:

A literature search yielded 1857 titles of which 255 met inclusion criteria for endpoint extraction. A long list of endpoints, with definitions and timescales, was generated and those potentially relevant to infection and sepsis circulated to the theme subgroup and then the wider StEP-COMPAC working group, undergoing a three-stage Delphi process. The response rates for Delphi rounds 1, 3, and 3 were 89% (n=8), 67% (n=62), and 80% (n=8), respectively. A set of 13 endpoints including fever, surgical site, and organ-specific infections as defined by the US Centres for Disease Control and Sepsis-3 are proposed for future use.

Conclusions:

We defined a consensus list of standardised endpoints related to infection and sepsis for perioperative trials using an established and rigorous approach. Each endpoint was evaluated with respect to validity, reliability, feasibility, and patient centredness. One or more of these should be considered for inclusion in future perioperative clinical trials assessing infection, sepsis, or both, thereby permitting synthesis and comparison of future results.

Davidson C., Banham S., Elliott M., Kennedy D., Gelder C., Glossop A., Church C., Creagh-Brown Ben, Dodd J., Felton T., Foëx B., Mansfield L., McDonnell L., Parker R., Patterson C., Sovani M., Thomas L. (2016) British thoracic society/intensive care society guideline for the ventilatory management of acute hypercapnic respiratory failure in adults, BMJ Open Respiratory Research 3 (1) e000133 pp. 1-11 BMJ Publishing Group
The British Thoracic Society (BTS) published the guideline ?The use of non-invasive ventilation in acute respiratory failure? in 2002.1 This was in response to trials that had demonstrated that non-invasive ventilation (NIV) was an alternative to invasive mechanical ventilation (IMV) in life-threatening respiratory acidosis due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). It drew attention to evidence that, when NIV was used in the less severely unwell patient, it also limited progression to more severe respiratory failure.2 The trial also demonstrated the feasibility, of delivering NIV on general medical or admission wards that had enhanced support and when staff were provided with ongoing training.
Rayner L., Sherlock J., Creagh-Brown B., Williams J., de Lusignan S. (2017) The prevalence of COPD in England: An ontological approach to case detection in primary care, Respiratory Medicine 132 pp. 217-225 Elsevier

Background

Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality in England, however estimates of its prevalence vary considerably. Routinely collected and coded primary care data can be used to monitor disease prevalence, however reliance upon diagnostic codes alone is likely to miss cases.

Methods

We devised an ontological approach to COPD case detection and implemented it in a large primary care database to identify definite and probable cases of COPD. We used this to estimate the prevalence of COPD in England.

Results

Use of this approach to detect definite COPD cases yielded a prevalence of 2.57% (95% CI 2.55?2.60) in the total population, 4.56% (95%CI 4.52?4.61) in those aged e 35 and 5.41% (95% CI 5.36?5.47) in ex or current smokers. The ontological approach identified an additional 10,543 definite cases compared with using diagnostic codes alone. Prevalence estimates were higher than the 1.9% prevalence currently reported by the UK primary care pay for performance (P4P) disease register.

COPD prevalence when definite and probable cases were combined was 3.02% (95% CI 3.0?3.05) in the total population, 5.38% (95% CI 5.33?5.42) in those aged e 35 and 6.46% (95% CI 6.46-6.40-6.56) in ex or current smokers.

Conclusions

We demonstrate a robust reproducible method for COPD case detection in routinely collected primary care data. Our calculated prevalence differed significantly from current estimates based upon P4P data, suggesting that the burden of COPD in England is greater than currently predicted.

Creagh-Brown Benedict C., Evans Timothy W. (2016) Pathogenesis of acute lung injury: Clinical studies, In: Acute Respiratory Distress Syndrome pp. 72-92 CRC Press
Over the past three decades, experimental studies have contributed substantially to an
increased understanding of the pathogenesis of acute lung injury (ALI) and its extreme
manifestation, the acute respiratory distress syndrome (ARDS). However, many investigators have employed animal models that fail to accurately reproduce the heterogeneity
of human ALI/ARDS, and which are difficult to sustain for the protracted periods needed
to permit an assessment of the effects of mechanical ventilation and other supportive
measures upon the evolution of the syndrome. Clinical studies are therefore critical to
expanding our understanding of ALI/ARDS, and those that have contributed significantly
to progress in this area are summarized herein. Trials of putative treatment strategies
for ALI/ARDS are discussed elsewhere. For brevity, the abbreviation ALI is employed
throughout, unless studies were performed specifically in patients with ARDS.
Davies M., Allen M., Bentley A., Bourke S.C., Creagh-Brown Ben, D'Oliveiro R., Glossop A., Gray A., Jacobs P., Mahadeva R., Moses R., Setchfield I. (2018) British Thoracic Society Quality Standards for acute non-invasive ventilation in adults, BMJ Open Respiratory Research 5 (1) e000283 pp. 1-13 BMJ Publishing Group
Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the provision of acute non-invasive ventilation in adults together with measurable markers of good practice. Methods Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 6 quality statements have been developed, each describing a standard of care for the provision of acute non-invasive ventilation in the UK, together with measurable markers of good practice. Conclusion BTS Quality Standards for acute non-invasive ventilation in adults form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline's recommendations.