Grant: Foundation Grant

Critical Care; End-Of-Life Care; Enhancing Recovery; Gastro-Intestinal Bleeding; Intensive Care Unit; Myocardial Ischemia; Nosocomial Infections; Pneumonia; Preventing Harm; Rehabilitation

<html> <body> <p>My overall <strong>vision</strong> for this Foundation Grant is improving the outcomes of critically ill adults through rigorous research and its timely application in practice. Critical illness is not defined by a single organ, system, or syndrome - thus, my <strong>vision</strong> mandates a broad, bold scientific agenda which is patient- and family-centred, nimble to address health care challenges. It will be achieved by a suite of projects in a portfolio called <strong>IMPROVE</strong>, energized by strong academic leadership and dedicated mentoring of the next generation of scientists.</p> <p>Critically ill patients are at high risk of death and long-term disability. Annually, more than 360,000 Canadians are admitted to an intensive care unit (ICU) with life-threatening conditions such as sepsis, cardiac ischemia and acute lung injury [1,2]. Critical care comprises approximately 16% of hospital expenditures in Canada or 0.5% of the national gross domestic product. Critical illness is a major healthcare concern with enormous human and economic costs for patients, families, and society.<br> </p> <p>The <strong>4 goals</strong> of this Foundation Grant are to increase survival, reduce morbidity, and maximize function of ICU survivors, and ease the dying of decedents - reflecting the trajectory of critical illness itself. These goals motivate <strong>4 research programs</strong>:1) <strong>TROPIC</strong>: to optimally treat life-threatening myocardial ischemia; 2) <strong>REVISE</strong>: to re-evaluate interventions that modify the microbiome to prevent gastro-pulmonary complications of critical illness; 3) <strong>CYCLE</strong>: to enhance function through early novel rehabilitation strategies; and 4) <strong>iCCCare</strong>: to dignify the dying process in the technologic ICU setting.<br> </p> <p>The rigour and return on investment of this research will be enhanced by 3 <strong>cross-cutting themes</strong>:<br> </p> <p>1) <strong>Methodology:</strong> Each program will include a systematic review, survey of stated practice, audit of actual practice, qualitative study, translational biology project, pilot study, and either a national or international observational study or randomized clinical trial (RCT). I will conduct integrated knowledge translation (KT) with key stakeholders throughout the inquiry process, and traditional end-of-grant KT.<br> </p> <p>2) <strong>Mentorship:</strong> Unique training opportunities will launch the careers of an MD PhD candidate (<strong>TROPIC</strong>), an MD Masters of Science graduate (<strong>REVISE</strong>), a PhD graduate Tier 2 Canada Research Chair (CRC) (<strong>CYCLE</strong>), and 4 other trainees (<strong>iCCCare</strong>). Beyond formal mentorship, trainees will have 11 additional educational opportunities, some enabled by a new Career Development and Mentoring Program of the Canadian Critical Care Trials Group [3].<br> </p> <p>3) <strong>Collaboration:</strong> By productive partnerships and leveraging other resources, I will forge new alliances with scientists from different fields (immunology, microbiology, economics), clinicians from different disciplines (physiotherapy, nursing, chaplaincy), and will spark synergies among different medical specialties (infectious diseases, cardiology, palliative care).<br> </p> <p>Improving the outcomes of critical illness will be realized by generating evidence about the best methods to treat, prevent, rehabilitate, or palliate critical illness. My research will address cost-effectiveness, enhance research efficiencies, and build and bolster national and international collaboration. Aligning with my CRC in Knowledge Translation in the ICU, I will ensure timely application of research results in practice, creating a durable impact on health care at the patient and policy level in Canada and abroad.</p> </body> </html>