Anaesthesia & Critical Care

Interdisciplinary Collaboration in Systems Medicine (ICSM)

Aim and expertise

We design, develop and apply pathophysiological models of human organ systems, with the aim of addressing issues of impact in critical illness and medical crisis scenarios.

The Interdisciplinary Collaboration in Systems Medicine (ICSM) simulation suite is an integrated and validated computational model of a number of organ systems, including the heart, blood vessels (and blood) and the lungs and is developed in collaboration with the School of Engineering at University of Warwick.

Medical students practising resuscitation

 

Research issues

Critical illness and medical crises are a huge drain on our society. They consume a disproportionate part of medical budgets and are tremendously disruptive to patients and their families. Due to the unpredictable nature of these issues, the heterogeneity of patients and the time critical nature of events, recruitment to clinical studies is difficult, and the results disappointingly noisy and unhelpful. There has thus developed a pressing need for a novel method to answer questions of crucial importance to these most vulnerable of patients.

What we are doing about...

  • Personalising and optimising the therapy delivered in the Intensive Care Units (ICU)
  • Obtain novel understanding of the pathophysiological state of cardiac arrest, test new cardiopulmonary resuscitation strategies and investigate clinical management strategies after cardiac arrest
  • Explore optimal rescue strategies using the Optiflow (a recent developed oxygen therapy device that delivers high-flow, humidified oxygen via nasal cannulae) in-silico obese and pregnancy subjects.
  • Prolongation of apnoea - improving the high-risk period of anaesthetic induction, and optimising gas exchange in-silico healthy and pregnancy subjects

Outcomes

Project awards

  • £2K Simulation of myocardial infarction and hypovolemic shock using an integrated and high fidelity computational model. Animal Free Research UK; 2021. Dr Marianna Laviola
  • £429K, Investigating Strategies for Mechanical Ventilation in COVID-19 via Computational Simulation of Virtual Patients, EPSRC via UKRI's COVID-19 call; 2020-2021; Prof Declan Bates and Prof Jonathan Hardman
  • Replacement of animal models of cardiac arrest and resuscitation strategies using computer simulation, NC3Rs: 2019-2022 (£90K). Prof. Jonathan Hardman and Dr Marianna Laviola
  • Investigating the evolution and application of Optiflow in managing obese patients in the perioperative period. Fisher & Paykel Healthcare, 2019-2022 (£76K). Prof. Jonathan Hardman and Dr Marianna Laviola.
  • Personlised Simulation Technologies for Optimising Treatment in the Intensive Care Unit: Realising Industrial and Medical Applications, EPSRC: 2017-2021 (£880K). Prof. Declan Bates; Prof Jonathan Hardman, Dr Luigi Camporota, Dr Marianna Laviola, Dr Anup Das and Mr Barney Sanderson.
  • Investigation of Closed-Loop Ventilation Strategies for Neonatal ICU Patients using Computational Simulation, EPSRC Healthcare Technologies Network Plus Feasibility Study, 2018-2019 (£59.7K). Prof. Declan Bates; Prof. Jonathan Hardman and Prof. Don Sharkey.
  • Development of a Computational Simulator, Bayer Healthcare, Commercial Research Contract, 2015-2017 (£220K). Prof. Declan Bates; Prof. Jonathan Hardman
  • Integrated Cardiopulmonary Modelling for the Investigation of the Management of Disturbed Tissue Perfusion, MRC, 2012-2015 (£600K). Prof. Jonathan Hardman, Prof. Declan Bates and Dr Iain Moppet
  • Preventing Ventilator Associated Lung Injury using Feedback Control Engineering, EPSRC, 2008-2011 (£500K). Prof. Jonathan Hardman and Prof. Declan Bates
  • Investigating Strategies for Mechanical Ventilation in COVID-19 via computational simulation of Virtual Pateints, EPSRC via UKRI's COVID-19 call. 2020-2021 (£346K) Prof. Jonathan Hardman, Prof Declan Bates, Dr Marianna Laviola, Dr Anup Das.
 

Key publications

L. Weaver, A. Das, S. Saffaran, N. Yehya, M. Chikhani, T.E. Scott, J.G. Laffey, J.G. Hardman, L. Camporota and D.G. Bates, "Quantifying oxygenation benefit versus risk of lung injury in non-invasive respiratory support for COVID-19 pneumonia: a computational study", to appear in the British Journal of Anaesthesia, 2022.

D. Hannon, S. Mistry, A. Das, S. Saffaran, J.G. Laffey, B.S. Brook, J.G. Hardman and D.G. Bates, "Modeling mechanical ventilation in silico – potential and pitfalls", to appear in Seminars in Respiratory and Critical Care Medicine, Special Issue on Mechanical Ventilation, 2022.

L. Weaver, D.G. Bates and L. Camporota, "Positive end expiratory pressure in invasive and non-invasive ventilation of COVID-19 acute respiratory distress syndrome: computational modeling illuminates the data" to appear in Annual Update in Intensive Care and Emergency Medicine, Springer, 2022. Preprint

S. Mistry, A. Das, J.G. Hardman, D.G. Bates and T.E. Scott, "Application of pre-hospital continuous positive airway pressure in hypovolaemic shock: A modelling study", British Journal of Anaesthesia, Special Issue on Mass Casualty Events, 128(2):151:157, 2021.

C. Daudre-Vignier, M. Laviola, A. Das, D.G. Bates and J.G. Hardman, "Identification of an optimal CPR chest compression protocol", in proceedings of the 43rd Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2021.

L. Weaver, A. Das, S. Saffaran, N. Yehya, T.E. Scott, M. Chikhani, J.G. Laffey, J.G. Hardman, L. Camporota and D.G. Bates, "High risk of patient self-inflicted lung injury in COVID-19 with frequently encountered spontaneous breathing patterns: a computational study", Annals of Intensive Care, 11:109, 2021

D. Stolady, M. Laviola, A. Pillai, J.G. Hardman. “Effect of variable pre-oxygenation endpoints on safe apnoea time using high flow nasal oxygen for women in labour: a modelling investigation”. British Journal of Anaesthesia, 126(4), 889-895, 2021.

M. Laviola, C. Niklas, A. Das, D.G. Bates and J.G. Hardman, "Ventilation strategies for front of neck airway rescue: an in silico study", British Journal of Anaesthesia, 2021.

A. Das, S. Saffaran, M. Chikhani, T.E. Scott, M. Laviola, N. Yehya, J.G. Laffey, J.G. Hardman, and D.G. Bates, "In silico modeling of COVID-19 ARDS: pathophysiological insights and potential management implications", Critical Care Explorations, 2020.

J. Laffey, M. Chikhani, D.G. Bates and J.G. Hardman, "Supporting more than one patient with a single mechanical ventilator: useful last resort or unjustifiable risk?”, British Journal of Anaesthesia, 2020. 

A. Das, T.E. Scott, M. Haque, D.G. Bates and J.G. Hardman, "Management of primary blast lung injury: A comparison of airway pressure release versus low tidal volume ventilation", Intensive Care Medicine Experimental, 2020.

S. Saffaran, A. Das, J.G. Laffey, J.G. Hardman, N. Yehya and D.G. Bates, "Utility of driving pressure and mechanical power to guide protective ventilator settings in two cohorts of adult and pediatric patients with acute respiratory distress syndrome: A computational investigation", Critical Care Medicine, 2020

M. Laviola, C. Niklas, A. Das, D.G. Bates and J.G. Hardman, "Airway Rescue and the Effect of Oxygen Fraction: A Computational Modelling Study", British Journal of Anaesthesia, 2020

M. Laviola, C. Niklas, A. Das, D.G. Bates and J.G. Hardman, "High oxygen fraction during airway opening is key to effective airway rescue in obese subjects", in the proceedings of the 41st IEEE Engineering in Biology and Medical Conference, Berlin, 2019

M. Laviola, D.G. Bates and J.G. Hardman, "Mathematical and Computational Modelling in Critical Illness". European Respiratory and Pulmonary Diseases. 5(1), 2019

M. Haque, T.E. Scott, A. Das, I. Cliff, D.G. Bates and J.G. Hardman. "Efficacy of continuous positive airway pressure (CPAP) in casualties suffering from primary blast lung injury: A modelling study", in the proceedings of the 41st IEEE Engineering in Biology and Medicine Conference, Berlin, 2019

S. Saffaran, A. Das, J.G Hardman, N. Yehya and D.G. Bates, "High-fidelity Computational Simulation to Refine Strategies for Lung-Protective Ventilation in Paediatric Acute Respiratory Distress Syndrome", Intensive Care Medicine, 2019

M. Laviola, A. Das, M. Chikhani, D.G. Bates and J.G Hardman, "Computer simulation clarifies mechanisms of carbon dioxide clearance during apnoea", British Journal of Anaesthesia, 2019

A. Das, L. Camporota, J.G. Hardman, and D.G. Bates, "What links ventilator driving pressure with survival in the acute respiratory distress syndrome? A computational study", Respiratory Research, 20:29, 2019

M. Haque, A. Das, T.E. Scott, D.G. Bates and J.G. Hardman, "The primary blast lung injury simulator: A new computerised model", Journal of the Royal Army Medical Corrps, DOI: 10.1136/jramc-2018-000989, 2018

S. Saffaran, W. Wang, A. Das, W. Schmitt, J.G. Hardman, G. Weimann and D.G. Bates, "An inhaled sGC modulator can lower PH in COPD patients without deteriorating oxygenation", CPT Pharmacometrics & Systems Pharmacology, 2018

M. Laviola, A. Das, M. Chikhani, D.G. Bates and J.G. Hardman "Investigating the effect of cardiac oscillations and deadspace gas mixing during apnea using computational simulation", in proceedings of the 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, JeJu Island, S. Korea, 2017

S. Saffaran, A. Das, J.G. Hardman, N.Yehya and D.G. Bates, "Development and Validation of a Computational Simulator for Pediatric ARDS Patients", in proceedings of the 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, JeJu Island, S. Korea, 2017

A. Das, M. Haque, M. Chikhani, O. Cole, W. Wang, J.G Hardman and D.G. Bates, "Hemodynamic effects of lung recruitment maneuvers in acute respiratory distress syndrome", BMC Pulmonary Medicine, 17:34, 2017

M. Chikhani, A. Das, M. Haque, W. Wang, D.G. Bates and J.G. Hardman, "High PEEP in ARDS evaluating the trade-off between improved oxygenation and decreased oxygen delivery", British Journal of Anaesthesia, 117 (5): 650--8, 2016

A. Das, M. Haque, M. Chikhani, W. Wang, J.G. Hardman and D.G. Bates, "Creating Virtual ARDS Patients", in proceedings of the 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Orlando, 2016

W. Wang, A Das, O. Cole, M. Chikhani, J.G. Hardman and D.G. Bates, "Computational simulation indicates that moderately high frequency ventilation can allow safe reduction of tidal volumes and airway pressures in ARDS patients", Intensive Care Medicine Experimental 3(1), 1-12, 2015

A. Das, M. Haque, M. Chikhani, W. Wang, T. Ali, O. Cole, J.G. Hardman and D.G. Bates, "Development of an Integrated Model of Cardiovascular and Pulmonary Physiology for the Evaluation of Mechanical Ventilation Strategies", in Proceedings of the 37th IEEE Engineering in Medicine and Biology Conference, Milano, 2015

A. Das, O. Cole, M. Chikhani, W. Wang, T. Ali, M. Haque, J.G. Hardman and D.G. Bates, "Evaluation of lung recruitment maneuvers in Acute Respiratory Distress Syndrome using computer simulation", Critical Care, 19:8, doi:10.1186/s13054-014-0723-62014, 2015

W. Wang, A. Das, T. Ali, O. Cole, M. Chikhani, M. Haque, J.G. Hardman and D.G. Bates, "Can computer simulators accurately represent the pathophysiology of individual COPD patients?", Intensive Care Medicine Experimental, 2:23, 2014

A. Das, P.P. Menon, J. Hardman and D.G. Bates, "Optimization of Ventilation Settings for Pulmonary Disease States", IEEE Transactions on Biomedical Engineering, 60(6):1599-607, 2013

A. Das, Z. Gao, P.P. Menon, J. Hardman and D.G. Bates, "A Systems Engineering approach to validation of a pulmonary physiology simulator for clinical applications", Journal of The Royal Society Interface, doi:10.1098/rsif.2010.0224, 2011

 

 

About ICSM

The ICSM group is a collaboration between researchers at the Universities of Nottingham and Warwick, led by Prof Jonathan G Hardman (Nottingham) and Prof Declan Bates (Warwick).

People

Directors:

Prof. Jonathan Hardman University of Nottingham

Prof. Declan Bates University of Warwick

Assistant Professor:

Dr Marianna Laviola University of Nottingham

PhD Students:

Clara Daudre-Vignier University of Nottingham

Rebecca Valentine University of Nottingham

Liam Weaver University of Warwick

Sonal Mistry University of Warwick

Past recent members:

Dr Anup Das, University of Warwick

Dr Husam Alahmadi,  University of Nottingham

Dr Sina Saffaran, University of Warwick

We collaborate with numerous NHS and international consultants in Anaesthesia and Intensive Care.

PhD opportunities

Summer 2022 - Wellcome Trust Biomedical Vacation Scholarship project:

Are you an undergraduate considering a career in research? University of Nottingham, in partnership with the Wellcome Trust, are offering promising undergraduates from underrepresented groups a number of summer research internships.

The eight-week projects are paid at the national living wage and offer a variety of learning situations to enhance your research skills, expand your network of contacts and get an introduction to life as a postgraduate researcher at the University of Nottingham.

View details of this year’s projects and how to apply.

A variety of PhD projects are offered, ranging in methodologies from clinical trials, modelling, benchtop simulations and systematic reviews.

Subject matter for PhD projects is tailored to the student and to the current state of the group’s work. Please, contact Prof Jonathan Hardman to discuss possibilities.

 

 

Anaesthesia & Critical Care

School of Medicine
The University of Nottingham
C Floor, East Block, Queen's Medical Centre
Nottingham, NG7 2UH


telephone: +44 (0) 115 823 1009