Perioperative and Intensive Care Research Group

Improving outcomes in patients undergoing surgery and those in intensive care
A team of surgeons is fighting for life. The intensive care team is fighting for the life of the patient. 
Our group is dedicated to improving clinical outcomes in patients undergoing surgery (perioperative medicine) and critically ill patients admitted to an intensive care unit (intensive care medicine).

Perioperative medicine

Surgery can result in unwanted complications that have a significant impact on patients’ lives. Many of these complications are preventable and the aim of perioperative medicine is to optimise care before, during and after surgery in order to give patients the best chance of successful recovery. Our research focuses on different elements of the surgical patient pathway with a particular focus on the preoperative period, where prehabilitation is being evaluated. We are also interested in cellular processes that may be responsible for harm after surgery.

Intensive care medicine

Severe illness that results from disease, trauma and surgery can result in organ failure and the need for organ support on an intensive care unit. Mortality and long-term morbidity is high in these patients and our research aims to tackle this. Our group has a particular interest in how oxygen levels effect clinical outcomes and how cells can adapt to the stress caused by critical illness.

PhD students

Plymouth Hospitals NHS Trust researchers

Our Projects

Evaluating the clinical and cost-effectiveness of a conservative approach to oxygen therapy for invasively ventilated adults in intensive care (UK-ROX)

Around 184,000 critically ill adults are admitted to intensive care units (ICUs) each year in the UK, over 30% of whom will require help from a ventilator, often in combination with additional oxygen. However, we do not know how much oxygen to give to patients in order to optimise their recovery.

This project, which will involve a large-scale clinical trial of 16,500 adults, aims to find out whether keeping oxygen saturations at lower levels (conservative oxygen therapy) is better than the higher level currently being used in the NHS. The results will have a large and immediate impact on clinical practice and on outcomes for critically ill patients throughout the NHS.

A study within a trial to determine the effect of skin tone on the diagnostic accuracy of pulse oximeters.

An increasing number of studies have shown that pulse oximeters – which are used throughout the world to measure the level of oxygen in a patient – may over-estimate the true oxygen level in patients with darker (pigmented) skin. This in turn could under-estimate the severity of a patient's illness, leading to them receiving inadequate treatment and come to unnecessary harm.

With the support of the Centre for Ethnic Health Research in Leicester, this project aims to determine whether skin tone affects the accuracy of pulse oximeters and confirm whether they over-estimate the level of oxygen in people with darker skin.
Funder: National Institute for Health and Care Research (NIHR)
Award: £586,200.36
Chief Investigator: Professor Daniel Martin

Home-based EXercise and motivAtional programme before and after Liver Transplantation: ExaLT trial

Liver disease is the third commonest cause of death in adults of working age and liver transplantation (LT) remains the only cure for liver failure. We know that physical frailty prior to surgery results in a longer hospital stay because of postoperative complications and contributes to one in ten patients either dying whilst still on the waiting list or shortly after LT. Exercise may have the potential to improve the lives of people with liver disease and reduce the side-effects of LT surgery in the same way it is used in other fields of elective surgery (e.g. cancer) but LT patients have often been viewed as ‘too sick’ or ‘too frail’ to exercise and there is virtually no data to support the benefits and safety of exercise in this cohort.

This project, led by Professor Matthew Armstrong from the University of Birmingham and involving the University of Plymouth’s Professor Daniel Martin , aims to determine the effect of a home-based exercise and motivation-support programme in patients undergoing LT on their quality of life after surgery.
Funder: National Institute for Health and Care Research (NIHR)
Award: £1,293,103.50
Chief Investigator: Professor Matthew Armstrong

Patient reported Outcomes, postoperative Pain and Pain relief in daY case surgery (POPPY)
Day case operations account for 80% of surgical procedures in the NHS, with more complex operations being carried out every day. We know surprisingly little about what happens to people after they leave hospital on the day of surgery. The POPPY study, is a national multi-centre project led by a network of trainee anaesthetist researchers (RAFT), designed to answer a number of questions about patient experiences after day case surgery. We aim to investigate recovery, pain and medicines use in the first week after surgery as well as longer term outcomes of chronic pain and persistent opioid use at 3 months. The project was designed and initiated at Derriford Hospital with local researchers acting as Consultant and Trainee Chief Investigators. To date, we have involved over 200 hospitals throughout the UK and Ireland and recruited more than 9700 participants. We look forward to sharing the results of this study, which will hopefully inform practice in day case surgery in the UK.
Funders: The National Institute of Academic Anaesthesia/ University Hospitals Plymouth Charitable Research Fund
Chief Investigator: Dr Mark Rockett

TBI-REPORTER
Traumatic Brain Injury (TBI) is a major cause of death and disability, leading to long-term health issues such as dementia, epilepsy, mental health problems, and a shorter lifespan. Progress in clinical care has been slow and while individual research projects have generated lots of valuable information this has not been widely used outside of the original studies.
To address this, a new platform called The UK-TBI REpository and data PORTal Enabling discoveRy (TBI-REPORTER) is being developed. This exciting initiative will bring together all the available research on TBI and make it accessible to scientists from the UK and around the world, thus aiding the development of new diagnostic techniques, therapeutic interventions, and personalized treatments. University Hospitals Plymouth is one of six pathfinder sites for this collaboration, providing biomarker, advanced imaging and experimental medicine network data to the central data hub.
Funders: Medical Research Council; NIHR; Ministry of Defence; Alzheimer’s Research UK
Award: £9.5 million
Principal Investigator (Derriford site): Dr Jessie Welbourne
 
 

Plymouth Institute of Health and Care Research

The Plymouth Institute of Health and Care Research (PIHR) is a thriving community that conducts adventurous world-leading research with the explicit purpose of improving the health and care of the populations we serve.
Our work is grounded in the needs of the people of the South West and other rural, coastal, and deprived communities worldwide, but PIHR’s research has national and international reach and impact.
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