Anaesthesia & Critical Care
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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...

1. Personalised Simulation Technologies for Optimising Treatment in the Intensive Care Unit.

In this project, we are developing novel methods for personalising and optimising the therapy delivered in the Intensive Care Units (ICU), using our ICSM simulation suite. We are working closely with our business and clinical partners to transfer our high-fidelity modelling technologies from the research lab to the ICU, in order that the real-time, personalised, patient simulation can be achieved with the aim of guiding the treatment of critical illness. This work is currently funded by the EPSRC and is staffed by 2 research fellows, 1 research nurse, 1 medical doctor and 2 professors.

 

2. Replacement of animal models of cardiac arrest and resuscitation strategies using a computer simulation.

In this project, we are using and further developing the ICSM computer simulation to obtain novel understanding of the pathophysiological state of cardiac arrest, test new cardiopulmonary resuscitation strategies and investigate clinical management strategies after cardiac arrest. This work is currently funded by the National Centre of 3Rs and is staffed by 1 PhD student.

 
3. Computational modelling apnoea and high-flow upper airway oxygenation.
We are using our ICSM computer simulation to 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 subjects. This work is currently funded by the Fisher & Paykel Healthcare (New Zealand) and is staffed by 1 PhD student.
 
4. Apnoeic Oxygenation in healthy and respiratory disease: modelling investigations.
Using our computer simulator, we investigate the prolongation of apnoea - improving the high-risk period of anaesthetic induction, and optimising gas exchange. This work is currently staffed by 1 PhD student.
 
5. Development and validation of a computational simulator for paediatric and neonatal patients.
We are adapting our ICSM model to paediatric and neonatal pathophysiology in order to investigate mechanical ventilation strategies to reduce the risk of ventilator-associated lung injuries and to develop rescue ventilation strategies to hypoxic paediatric patients. This work is currently staffed by 1 PhD student and 2 research fellows.
 

Outcomes

Project awards

  • 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

M.Laviola, C.Niklas, A. Das, DG Bates and JG Hardman. Airway Rescue and the Effect of Oxygen Fraction: A Computational Modelling Study. British Journal of Anaesthesia, 2020. In press.

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 https://ieeexplore.ieee.org/document/8857109

M. Laviola, D.G. Bates and J.G. Hardman, "Mathematical and Computational Modelling in Critical Illness". European Respiratory and Pulmonary Diseases. 5(1), 2019 https://www.touchrespiratory.com/mathematical-modelling-in-critical-illness/

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, https://doi.org/10.1007/s00134-019-05559-4, 2019 http://link.springer.com/article/10.1007/s00134-019-05559-4

M. Laviola, A. Das, M. Chikhani, D.G. Batesand J.G Hardman, "Computer simulation clarifies mechanisms of carbon dioxide clearance during apnoea", British Journal of Anaesthesia, https://doi.org/10.1016/j.bja.2018.11.012, 2019 https://bjanaesthesia.org/article/s0007-0912(18)31301-1/fulltext

A. Das, L. Camporata, 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, DOI:https://doi.org/10.1186/s12931-019-0990-5, 2019 https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-019-0990-5

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 https://jramc.bmj.com/content/165/1/45.long

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, DOI: 10.1002/psp4.12308. 2018 https://ascpt.onlinelibrary.wiley.com/doi/full/10.1002/psp4.12308

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 https://ieeexplore.ieee.org/document/8036831

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 https://ieeexplore.ieee.org/document/8037125

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 https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-017-0369-7

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) DOI: 10.1093/bja/aew314, 2016 https://www.sciencedirect.com/science/article/pii/s0007091217300247?via=ihub

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 https://ieeexplore.ieee.org/document/7591294

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 https://icm-experimental.springeropen.com/articles/10.1186/s40635-015-0068-8

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 https://ieeexplore.ieee.org/document/7319592

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. https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0723-6

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, doi:10.1186/s40635-014-0023-02014, 2014. https://icm-experimental.springeropen.com/articles/10.1186/s40635-014-0023-0

A. Das, P.P. Menon, J. Hardman and D.G. Bates, "Optimization of Ventilation Settings for Pulmonary Disease States", IEEE Transactions on Biommedical Engineering, 60(6):1599-607,2013. https://ieeexplore.ieee.org/document/6410003

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. https://royalsocietypublishing.org/doi/10.1098/rsif.2010.0224

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 modelling of COVID-19 ARDS: pathophysiological insights and potential management implcatrions", to appear in Critical Care Explorations, 2020. //doi.org/10.1101/2020.07.21.20158659

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, 125 (3), 2020 DOI:10.1016/j.bja.2020.05.029

A. Das, T. E Scott, M. Haque, D. G Bates and J. G Hardman, "Managament of primary blast lung injury: A comparison of airway pressure release versus low tiday volume ventilation", Intensive Care Medicine Experimental, 8 (1), 2020 DOI: 10.1186/s 40635-020-00314-2,2020

M. Laviola, C. Niklas, A. Das, D. G. Bates and J. G Hardman, "Airway Rescue and the Effect of Oxygen Fraction: A compututational study", British Journal of Anaesthesia, 125 (1), 2020 doi:10.1016/j.bja.2020.01.004

 

 

About ICSM

This research group is a collaboration between researchers at the Universities of Nottingham and Warwick, led byProfessor Jonathan Hardman (Nottingham) and Professor Declan Bates (Warwick).  

People

Directors:

Prof. Jonathan G Hardman, University of Nottingham: mailto:j.hardman@nottingham.ac.uk

Prof. Declan G Bates, University of Warwick: mailto:D.Bates@warwick.ac.uk

Research Fellows:

Dr Marianna Laviola, University of Nottingham: mailto:marianna.laviola@nottingham.ac.uk

Dr Anup Das, University of Warwick: mailto:anup.das@warwick.ac.uk

PhD Students:

Husam Alahmadi. MSc, University of Nottingham: mailto:husam.alahmadi@nottingham.ac.uk

Clara Daudre-Vignier, MEng, University of Nottingham: mailto:clara.daudre-vignier@nottingham.ac.uk

Rebecca Valentine, BSc, University of Nottingham: mailto:rebecca.valentine@nottingham.ac.uk

Sina Saffaran, MEng, University of Warwick: mailto:S.Saffaran@warwick.ac.uk

PhD opportunities

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 Professor JG Hardman to discuss possibilities.

Fully funded PhD studentship now available.

This is a fantastic opportunity to join our world-leading research group and work on computational simulation of acute lung injury. Interested students should email mailto:jonathan.hardman@nottingham.ac.uk and/ or mailto:D.Bates@warwick.ac.uk with a CV asap.

 

 

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