Respiratory Critical Care

1. Our research and international Bronchoscopy courses (BRIC) suggest that trainees and consultants in ICU feel that instruction and opportunity in this important procedural skill, and competencies around it can be much improved.
2. The Bronchoscopy in Intensive Care one day courses (BRIC) provide a combination of knowledge, skills and competency simulation training that have received high satisfaction.
3. Use of bronchoscopy to sample the endobronchial lung and utilise rapid diagnostic platforms (Cytokine-, PCR-, metagenomic-based) for diagnostic accuracy of infection and antibiotic stewardship.
4. Infection identifying rapid diagnostic tests need to find their place in clinical ICU medicine. More research into prescribing behaviour is important in establishing their utility.
5. Burns inhalation injury increases mortality in Burns victims. But diagnostic accuracy of severity by bronchoscopy is uncertain, and so are prognostic implications. We are undertaking research into bronchoscopic images, meta-analysis of grading studies, and developing an image repository to test grading reliability.
6. TASTE-ICU -This is a relatively neglected aspect of sensory deprivation in recovering ICU patients, mainly due to unsafe swallowing. Many patients crave taste but there is no current solution except for thirst. We are developing a potential application for clinical testing and impact.
7. Microcirculatory visualisation. This is a neglected part of the assessment of haemodynamics in Shock. New technology allows its evaluation against conventional measurement tools of the microcirculation (i.e. Echo, Cardiac output monitoring).

1. We are developing an evidence base of the need for improved instruction in and maintenance of skills in Bronchoscopy within the ICU setting. By the prospective data assessment from courses, and use of new technologies (Virtual reality simulation and Augmented reality), we aim to provide better training and tools to record competencies. This will improve patient outcomes by:
   - Increasing the number of trainees able to confidently perform safe and effective bronchoscopy,
   - Offer more patients the opportunity to have a bronchoscopy in the ICU if clinically indicated.
2. New diagnostic POCT PCR-tests, and behavioural methods should allow better targeted POCT utilisation and so antibiotic stewardship
3. Improved bronchoscopy diagnostic accuracy of the severity of Burns Inhalation injury will improve prognostic accuracy and allow research into evidence based treatments.
4. TASTE-ICU - A safe oral application of taste for patients who are nil by mouth may provide pleasure and potentially motivation for rehabilitation.
5. The microcirculatory CYTOCAM ,if introduced in assessments of Cardiogenic shock on mechanical cardiac support, may better predict recovery, heart transplant or end of life pathways.

Funders

• RASeCAL - Ambu A/S
• MRC-INFINIT –  Medical Research Council (Newcastle University Clinical Trials unit)

Industry links

• Ambu A/S
• Boston BSCI
• Verathon
• Olympus
• Fisher & Paykel

RASeCAL

• Chelsea & Westminster
• Royal Brompton
• Royal Marsden
• Imperial College NHS Trust
• Kings College Hospital

MRC-INFINIT

• Multicentre UK

• BRIC
• MRC-INFINIT (Prof A John Simpson and VAPrapid collaborators UK)
• BURNS inhalation (British Burns Assn, European BA, Canadian BA, Australian BA and expanding collaborators)
• TASTE-ICU (IFF international)
• Microcirculation (Prof Can Ince, ERASMUS, Rotterdam)

• RASeCAL
• INHALE
• WHYSTOP
• MRC-INFINIT
• FOOD TRIALs

Singh S, Shah PL, 2021, Safe and efficient practice of bronchoscopic sampling from mechanically ventilated patients: a structured evaluation of the ambu bronchosampler-ascope 4 integrated system, Respiration: Vol: 100, Pages: 27-33, ISSN: 0025-7931

Du Rand IA, Barber PV .,Shah PL, Singh S, et al;  British Thoracic Society Interventional Bronchoscopy Guideline Group. British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Thorax. 2011 Nov;66 Suppl 3:iii1-21. PubMed PMID: 21987439.

Luo F, Darwiche K, Singh S, Torrego A, Steinfort DP, Gasparini S, Liu D, Zhang W, Fernandez-Bussy S, Herth FJF, Shah PL. Performing Bronchoscopy in Times of the COVID-19 Pandemic: Practice Statement from an International Expert Panel. Respiration. 2020;99(5):417-422.

Singh S. Microcirculatory dysfunction in experimental sepsis. Phd. Imperial College  2000.

Singh S, Pelosi P, Conway-Morris A.Oxford Textbook of Respiratory Critical Care. OUP 2023

Hellyer TP, McAuley DF, Walsh TS, Anderson N, Conway Morris A, Singh S, .. Simpson AJ et al. Biomarker-guided antibiotic stewardship in suspected ventilator-associated pneumonia (VAPrapid2):. Lancet Respir Med. 2020 Feb;8(2):182-191.

Pandolfo A, Horne R, Jani Y, .., Singh S…, et al., 2021, Intensivists’ beliefs about rapid multiplex molecular diagnostic testing and its potential role in improving prescribing decisions and antimicrobial stewardship: a qualitative study, Antimicrobial Resistance and Infection Control, ISSN: 2047-2994

Charles WN, Collins D, Mandalia S, Matwala K, Dutt A, Tatlock J, Singh S. Impact of inhalation injury on outcomes in critically ill burns patients: 12-year experience at a regional burns centre. Burns. 2021 Nov 26:S0305-4179(21)00337-5. doi: 10.1016/j.burns.2021.11.018. Epub ahead of print. PMID: 34924231.

Singh S, Nurek M, Moore L et al. WHY STOP? Quantifying Cognitive-Behavioural factors that influence the impact of PCR-POCT results on antibiotic cessation in ICU. https://www.researchsquare.com/article/rs-1932248/v1 

See all of Professor Singh's publications. 

MSc students – Dr Hazel Chon
BSc students – Ayush Jha, Irene Obaseki, Sana Spogmy, Adithya Mahadevan, Helena Milton-Jones, Archit Singhal, Nuwanji Amarasekera