Personalised Simulation Technologies for Optimising Treatment in the Intensive Care Unit: Realising Industrial and Medical Applications

In the UK, approximately 142,000 people are admitted to Intensive Care Units (ICU) each year. A large proportion of these patients have life-threatening pulmonary illness and require mechanical ventilation; the mortality rate in this group is around 35%, and even survival may bring ongoing suffering lasting years after discharge. Critical pulmonary disease thus has enormous financial impact and represents a significant burden of suffering for the general population. Despite years of research, there has been a lack of progress in our understanding of critical illness and in our ability to personalise treatment. Traditional clinical research approaches (using randomised clinical trials) have been costly and often inconclusive, and have provided disappointing improvements in critical care (diagnosis, survival, cost-effectiveness). The development of more effective personalised treatments for this patient population would therefore have significant national and global impact.

In this project, we will develop novel methods for personalising and optimising the therapy delivered in the ICU. We will work closely with our business and clinical partners to transfer our high-fidelity modelling technologies from the research lab to the ICU, in order that real-time, personalised, patient simulation can be achieved with the aim of guiding the treatment of critical illness. This approach offers potentially "low-cost" improvements in patient-care, since it is based on smarter strategies and technologies that exploit and optimise multiple interventions, without requiring expensive new pharmaceuticals or devices. Using large-scale integration of incoming data streams from routine patient monitoring, our technology will allow us to establish a matched simulation of an individual patient's physiology. The resulting personalised bedside simulation will allow clinicians to test planned interventions and to estimate vital parameters in the patient that would otherwise be inaccessible. In addition to acting passively, the technology will proactively advise on optimised treatment strategies that are expected to improve patient outcome. The technology will scan the patient's treatment and physiological data continually, seeking potential improvements in management, and testing proposed treatment strategies by applying them to the personalised simulation and assessing outcome.

Personalised optimisation of critical care treatment offers the opportunity to improve patient outcomes and reduce days spent receiving mechanical ventilation in the intensive care unit, and has the potential for enormous impact in terms of reducing patient suffering and healthcare expenditure. We will make this potential a reality by working closely with our business partner Medtronic (the world's largest standalone medical technology development company, and a leading ventilator manufacturer) and with our clinical partner Prof. Luigi Camporata, a consultant in intensive care medicine at Guy's and St Thomas' NHS Foundation Trust (one of the UK's leading centres for research on the treatment of critical illness).

Impact on medical practice, patients, and the NHS:

In the UK, approximately 142,000 people are admitted to Intensive Care Units each year, a significant number of whom suffer from life-threatening pulmonary illness. Such illnesses almost always mandate management using mechanical ventilation in the critical care environment, usually with deep sedation (induced coma), a requirement that currently consumes millions of pounds of UK health expenditure and results in enormous human suffering through ventilator-associated injury and infection. Although mechanical ventilation is often a life saving procedure, it also carries the risk of further damaging the lungs and impairing cardiac output, hence risking additional injury to other organs. The mortality rate of patients undergoing ventilation during critical illness is currently 31-37%. Critical pulmonary disease thus has enormous financial impact on the NHS and represents a significant financial and emotional burden on the general population.

Despite years of research, there has been a lack of progress in our ability to understand critical illness and improve the available therapeutic options. Traditional clinical research approaches have often proved costly and inconclusive, and have to date provided disappointing improvements in outcomes (diagnosis, survival, efficiency). The development of more effective and more personalised treatments for this patient population would therefore have significant national and international impact, both in terms of improved patient outcomes and cost-savings for healthcare providers. Many thousands of lives could be saved and millions of pounds of health service expenditure could be better utilised each year.

Economic impact:

The research proposed in this application has the potential for direct economic exploitation through the development of new ventilator technologies in collaboration with our business partners Medtronic. Medtronic is the world's largest standalone medical technology development company - it currently operates in more than 140 countries, employs over 85,000 people and has more than 53,000 patents. In partnership with Medtronic, we will actively develop commercial applications of our simulation technologies (e.g. next-generation mechanical ventilators), and seek to generate further opportunities for commercial exploitation and industrial research contracts, bringing direct economic benefits to UK PLC. We will work closely with our universities' Research & Knowledge Transfer Offices to explore possible spin-offs of the new results arising from our collaboration, and to seek follow-on funding from other sources, e.g. TSB, to develop any commercial opportunities that may arise, and to exploit all relevant intellectual property.

Societal Impact:

We will use the proposed research collaborations to engage with the wider public about the potential role of interdisciplinary science in addressing many important societal and healthcare challenges, such as developing personalised medicine, and reducing the economic burden of healthcare provision on the NHS. We will seek to highlight the fundamental importance of engineering and mathematical tools in helping to make future breakthroughs in medical treatments.

Impact on Education:

The proposed research will directly explore the changes that result from the hybridization of the engineering and medical sciences, how this goal is achieved in particular research contexts, and whether these achievements can improve medical practice more broadly. We will leverage the results of our research to update and expand our undergraduate and postgraduate teaching, e.g. via the M.Sc in Biomedical Engineering at the University of Warwick.