Stephen J. Brett
A5082629342- Intensive Care Unit Cognitive Disorders
- Sepsis Diagnosis and Treatment
- Cardiac Arrest and Resuscitation
- Cardiac, Anesthesia and Surgical Outcomes
- Respiratory Support and Mechanisms
- Family and Patient Care in Intensive Care Units
- COVID-19 Clinical Research Studies
- Hemodynamic Monitoring and Therapy
- Influenza Virus Research Studies
- Antibiotic Use and Resistance
- Palliative Care and End-of-Life Issues
- Trauma and Emergency Care Studies
- Disaster Response and Management
- Frailty in Older Adults
- Emergency and Acute Care Studies
- Hip and Femur Fractures
- Traumatic Brain Injury and Neurovascular Disturbances
- Thermoregulation and physiological responses
- Patient Safety and Medication Errors
- SARS-CoV-2 and COVID-19 Research
- Antibiotics Pharmacokinetics and Efficacy
- Airway Management and Intubation Techniques
- Healthcare Decision-Making and Restraints
- Pneumonia and Respiratory Infections
- Climate Change and Health Impacts
Imperial College Healthcare NHS Trust
2016-2025
Imperial College London
2016-2025
Hammersmith Hospital
2015-2025
National Health Service
2008-2025
Clinical Trial Investigators
2025
Charing Cross Hospital
2021-2023
St Mary's Hospital
2014-2023
St. Mary's Hospital
2014-2023
NIHR Imperial Biomedical Research Centre
2023
University College London Hospitals NHS Foundation Trust
2021
Six healthy young male volunteers at a contract research organization were enrolled in the first phase 1 clinical trial of TGN1412, novel superagonist anti-CD28 monoclonal antibody that directly stimulates T cells. Within 90 minutes after receiving single intravenous dose drug, all six had systemic inflammatory response characterized by rapid induction proinflammatory cytokines and accompanied headache, myalgias, nausea, diarrhea, erythema, vasodilatation, hypotension. 12 to 16 hours...
Morbidity and mortality for critically ill patients with infections remains a global healthcare problem. We aimed to determine whether β-lactam antibiotic dosing in achieves concentrations associated maximal activity affect patient outcome.This was prospective, multinational pharmacokinetic point-prevalence study including 8 antibiotics. Two blood samples were taken from each during single interval. The primary pharmacokinetic/pharmacodynamic targets free above the minimum inhibitory...
Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned methodological research prompted this review update the 2004 Utstein guidelines. Representatives International Liaison Committee on Resuscitation developed an updated reporting...
<h3>Importance</h3> Norepinephrine is currently recommended as the first-line vasopressor in septic shock; however, early vasopressin use has been proposed an alternative. <h3>Objective</h3> To compare effect of vs norepinephrine on kidney failure patients with shock. <h3>Design, Setting, and Participants</h3> A factorial (2×2), double-blind, randomized clinical trial conducted 18 general adult intensive care units United Kingdom between February 2013 May 2015, enrolling who had shock...
<h3>Importance</h3> The optimal approach to airway management during out-of-hospital cardiac arrest is unknown. <h3>Objective</h3> To determine whether a supraglottic device (SGA) superior tracheal intubation (TI) as the initial advanced strategy in adults with nontraumatic arrest. <h3>Design, Setting, and Participants</h3> Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services England responding emergencies for approximately 21 million people. Patients aged...
Abstract Introduction The socio-economic impact of critical illnesses on patients and their families in Europe has yet to be determined. aim this exploratory study was estimate changes family circumstances, social economic stability, care requirements access health services for during first 12 months after ICU discharge. Methods Multi-center questionnaire-based survivors illness at 6 Results Data 293 consenting who spent greater than 48 hours one 22 UK ICUs were obtained post-ICU There...
There remains uncertainty about the role of corticosteroids in sepsis with clear beneficial effects on shock duration, but conflicting survival effects. Two transcriptomic response signatures (SRSs) have been identified. SRS1 is relatively immunosuppressed, whereas SRS2 immunocompetent.We aimed to categorize patients based SRS endotypes determine if these profiles influenced either norepinephrine or vasopressin, septic shock.A post hoc analysis was performed a double-blind, randomized...
<h3>Background</h3> During the first wave of pandemic H1N1 influenza in 2009, most cases outside North America occurred UK. The clinical characteristics UK patients hospitalised with infection and risk factors for severe outcome are described. <h3>Methods</h3> A case note-based investigation was performed admitted confirmed infection. <h3>Results</h3> From 27 April to 30 September 631 from 55 hospitals were investigated. 13% a high dependency or intensive care unit 5% died; 36% aged <16...
Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed provide an international picture of the extent injuries and factors associated with ICU-acquired in adult ICU patients. International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors injury mortality were assessed by generalised linear mixed-effects regression analysis. Data from...
Abstract Intensive care survivors often experience post-intensive sequelae, which are frequently gathered together under the term “post-intensive syndrome” (PICS). The consequences of PICS on quality life, health-related costs and hospital readmissions real public health problems. In present Viewpoint, we summarize current knowledge gaps in our understanding approaches to management.
<h3>Importance</h3> In patients who require mechanical ventilation for acute hypoxemic respiratory failure, further reduction in tidal volumes, compared with conventional low volume ventilation, may improve outcomes. <h3>Objective</h3> To determine whether lower using extracorporeal carbon dioxide removal improves outcomes failure. <h3>Design, Setting, and Participants</h3> This multicenter, randomized, allocation-concealed, open-label, pragmatic clinical trial enrolled 412 adult receiving...
Importance Patients with septic shock undergo adrenergic stress, which affects cardiac, immune, inflammatory, and metabolic pathways. β-Blockade may attenuate the adverse effects of catecholamine exposure has been associated reduced mortality. Objectives To assess efficacy safety landiolol in patients tachycardia established requiring prolonged (&amp;gt;24 hours) vasopressor support. Design, Setting, Participants An open-label, multicenter, randomized trial involving 126 adults (≥18...
Importance Whether β-lactam antibiotics administered by continuous compared with intermittent infusion reduces the risk of death in patients sepsis is uncertain. Objective To evaluate whether vs a antibiotic (piperacillin-tazobactam or meropenem) results decreased all-cause mortality at 90 days critically ill sepsis. Design, Setting, and Participants An international, open-label, randomized clinical trial conducted 104 intensive care units (ICUs) Australia, Belgium, France, Malaysia, New...
A novel assay for endotoxin, based on the ability of antigen-antibody complexes to prime neutrophils an augmented respiratory burst response, was studied in a cohort study 857 patients admitted intensive-care unit (ICU). On day ICU admission, 57.2% had either intermediate (>or=0.40 endotoxin activity [EA] units) or high (>or=0.60 EA levels. Gram-negative infection present 1.4% with low levels, 4.9% and 6.9% levels; sensitivity 85.3% specificity 44.0% diagnosis gram-negative infection. Rates...
Endotoxin is an important pathogenic trigger for sepsis. The polymyxin B-immobilized endotoxin removal hemoperfusion cartridge, Toraymyxin (hereafter PMX), has been shown to remove in preclinical and open-label clinical studies. In a multicenter, open-label, pilot, randomized, controlled study conducted the intensive care unit six academic medical centers Europe, 36 postsurgical patients with severe sepsis or septic shock secondary intra-abdominal infection were randomized PMX treatment of 2...
Previous studies have shown associations between low mannose-binding lectin (MBL) level or variant MBL2 genotype and sepsis susceptibility. However, MBL deficiency has not been rigorously defined, with outcomes subjected to multivariable analysis.We reanalyzed results in a large cohort use of individual data from 4 involving total 1642 healthy control subjects systematically defined reliable cutoff. Subsequently, were reassessed extend previous associations, adjustment for known outcome...
<h3>BACKGROUND</h3> A study was undertaken to investigate possible reductions in mortality and/or changes outcome predictive factors patients with the acute respiratory distress syndrome (ARDS) managed a single centre. <h3>METHODS</h3> The prospective observational cohort of two patient populations ARDS. Group 1 comprised 41 enrolled between May 1990 and April 1993, group 2 consisted 78 June 1993 March 1997. end points were various death. <h3>RESULTS</h3> There marked reduction groups (66%...
Objectives. To measure levels of anxiety, depression and post‐traumatic stress among survivors a critical illness to relate these symptoms general health parameters. Design. A prospective study patients who had spent minimum 3 days (median 9 days) in intensive care unit (ICU). Of patients, 51 were interviewed months after discharge 45 them reviewed at months. Methods. General was assessed by physical symptom score, the EuroQol ‘thermometer’ Short Form 36 (SF‐36) questionnaire. Physical...