Intensive Care at the Royal Liverpool University Hospital  

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Directorate of Intensive Therapy

...on the World Wide Web since 1995...

The Intensive Care Unit (ICU) [photo] is situated on the 1st floor of the Hospital, XYZ side. It moved into its present accommodation in 1992. 

We also staff a 10 bed High Dependency Unit on the 8th floor (8B-HDU) that was opened in late 2009. HDU admitted 780 patients in 2011.

Critical Care is a separate Clinical Directorate with an annual budget of about £7M (€10M) within the Royal Liverpool University Hospital, an acute teaching hospital with an annual budget of £400M (€460M), close to Liverpool City centre.

               Contacting us

• Telephone:

ICU Secretary: Angela Garnett: 0151 706 3191 or 0151 706 3853

Who can be e-mailed with the format: firstname.surname@rlbuht.nhs.uk

The ICU direct line: 0151 706 2400

The CCOT direct line: 0151 706 5813

• Fax: 0151 706 5853 or 0151 706 5646

[If calling from overseas dial: + 44 151 706 XXXX]

• Postal address:

Department of Intensive Care, 12th Floor, Royal Liverpool University Hospital, Prescot Street, LIVERPOOL, L7 8XP

• How to find us:  area map     site map

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Medical Staff

The Clinical Director of Intensive Care:

• Dr Andrew D Axon

The other Consultant Intensivist Staff are:

• Dr Elizabeth A Flockton (Outreach Lead; Safety Lead)

• Prof Arpan K Guha (Organ Donation Lead; Trauma Lead; Associate Medical Director & Director of Medical Education; Hon Professor, School of Medical Education, University of Liverpool). (Bronze Clinical Excellence Award holder)

• Dr Alison M Hall (Infection control Lead)

• Dr Peter A Hampshire (High Dependency Unit Lead; ICNARC Lead)

• Dr Anand G Iyer (Equipment Lead; Joint Education Lead)

• Dr S Jane Harper (Member of ICS Council; Editor of JICS) (Bronze Clinical Excellence Award holder)

• Dr Gary R Masterson (Rostering Lead; Cheshire & Mersey Critical Care Network Medical Lead; Member of ICS Council.)  (Bronze Clinical Excellence Award holder)

• Dr Lawrence A McCrossan (Deputy Clinical Director)

• Dr Lee A L Poole (Audit Lead)

• Dr Jonathan Walker (ICU Rehabilitation Lead; Joint Education Lead)

• Dr Ingeborg D M Welters (Research Lead; Undergraduate Education Lead; Senior Lecturer, Dept. Anaesthesia, University of Liverpool)

• Dr Richard Wenstone (M&M and Risk Lead; AMICU Treasurer; local Bronze Clinical Excellence Award holder)

Staff can be e-mailed with the format: firstname.surname@rlbuht.nhs.uk

The consultant staff are supported by one or two Clinical Fellows (12 months' post), currently Drs. Dan Saul, and Norman Main as well as other trainees who operate on a shift system designed to produce an average working week of 48 hours:

Trainees are seconded from The Department of Anaesthesia and frequently from other departments such as Acute Medicine and Respiratory Medicine as well as "Common Stem" trainees. We also train about six Foundation Year doctors.

Occasionally supernumerary trainees from The Department of Accident & Emergency Medicine and also The Liverpool Women's Hospital (trainees in gynaecological oncology or feto-maternal medicine) are seconded to the ICU.

The Intensive Care staff have also managed the hospital's High Dependency Unit (located in 8B-HDU) since late 2009 (690 admissions in 2012)

The Department of Anaesthesia's medical staff manage the Hospital's Post-operative Critical Care Unit (POCCU) (599 admissions in 2012)

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About the ICU

• A "closed", mixed, unit providing a range of acute respiratory and renal support modalities for the population of Merseyside and beyond.

• Number of admissions (2012): 739 (in 2011, 67% of our patients were ventilated)

• Number of beds: 19  (15 funded since Dec 2010 with 17 transiently funded in Feb 2012 and Jan 2013)

• Mean [median] APACHE II score (2012): 17.6 [17]

• Formal consultant intensivist ward rounds take place twice daily at 0800 hr (0900 hr at weekends) and again at 1700 or 2000 hr.

• Tutorials for trainees take place Tuesday mornings and Educational, Audit, Radiology Rounds or other meetings are held weekly. 

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Research, Development and Audit

• We have current CLRN funding for 1 wte at level 7 and 1 wte at level 6 and provide a research service 7 days per week.
  

• We are active members of The Cheshire & Merseyside Critical Care Research Network. The network was set up in 2010 and is CLRN affiliated. The network was set up to promote research, share ideas and promote collaboration within region. Further information can be found here: www.cmccn.nhs.uk

• For information on research nurses please contact Karen Williams or Anna Walker. Staff can generally be e-mailed with the format: firstname.surname@rlbuht.nhs.uk

• This Unit was one of the sites for phases 2 and 3 of the Glaxo Wellcome study of L-NMMA in septic shock and their study of remifentanil in ventilated patients. We were also a site for the Transcend multi-centre study of glutathione in acute lung injury and multi-centre work with other nearby ICU's looking at the role of a re-formulated fluconazole. We were one of the centres involved in the recently terminated Leo Pharma  study of porcine surfactant in acute lung injury [further information from RW]. We were enrolled into the recently completed GSK phase II LIPOS study and are enrolled in their current Relenza study.

• We were involved in the ("CESAR") multi-centre study of ECMO and were one of the phase III centres involved in the study of activated protein C in sepsis. We also took part in the recently completed multi-centre study of Mycograb, a novel therapy in candidiasis [further information from GRM]. 

• We were also one of the centres recruiting into Pfizer's anidulafungin study.

• We have research interests in HLA-DR expression, GM-CSF and selenium supplementation in sepsis in co-operation with the University of Liverpool's Departments of Immunology and Chemical Pathology [further information from RW]. There is also close liaison with the Department of Chemical Pathology with a particular interest in cytokines and micro-nutrients.

• The Unit has been using, since 1996, inhaled nitric oxide therapy for patients with acute lung injury. Typically we use NO where prone ventilation has not been helpful or possible [further information from RW].

• Other projects recently completed include:

• an evaluation of sensitivity of noninvasive determinants for capillary leakage syndrome in septic patients. 

• work on failure to wean critically ill patients from mechanical ventilation due to constipation [Presented in 2000 at the Rome meeting of ESICM and published in Br. J. Anaes] [further information from RW];

• the role of acupuncture as a sedative in the ventilated patient [further information from RW];

• Using APTT waveform analysis as an early predictor of outcome in critically ill patients, in co-operation with University of Liverpool's Department of Haematology. Part of this work has already been presented at international meetings and published in haematology and critical care journals. Continuation of this work has attracted an MRC grant [further information from IW]; newer studies are ongoing (see below);

• the role of NSE and S-100 in predicting functional outcome after cerebral injury, [Presented in 2002 at the Barcelona meetings of ESICM] [further information from RW];

• We have also carried out a prospective study for estimation of cardiac responsiveness to fluid administration using stroke volume variation in mechanically ventilated patients with severe sepsis. [Presented in 2002 at the Barcelona meeting of ESICM];

• changes in fat metabolism during critical illness including the effect of body weight, in sepsis, on the production of adipokines, glucose metabolism and outcome [further info from IW];

• Use of BIS monitoring during percutaneous tracheostomy [further info from PH];

• Validation of the Charleson Score in a critical care population [further info from AG].

• RAIN  (Risk Adjustment In Neurocritical care )  ICNARC.

•            ICNARC.

• 

PRESENT STUDIES.

• Dstl.  Pre-Symptomatic detection of Early Sepsis: 

    A Multi-Centre Study to Investigate Immune Modulators for the Early Diagnosis of Sepsis in Patients Undergoing Major Elective Surgery.
Site P.I. :  Dr.  Jonathan Walker.
 

•  HARP-2 Study - Hydroxy methyl glutaryl-CoA Reductase Inhibition with Simvastatin in Acute Lung Injury to Reduce Pulmonary Dysfunction.The aim of the study is to test the hypothesis that treatment with Simvastatin 80mg once daily for a maximum of 28 days will be of therapeutic value in patients with Acute Lung Injury (ALI).  

Site P.I. :  Dr.  Ingeborg Welters.
 

•  GSK, "ZORO": A Phase III international, randomized, double-blind, double-dummy study to evaluate the efficacy and safety of 300 mg or 600 mg of intravenous zanamivir twice daily compared to 75 mg of oral oseltamivir twice daily in the treatment of hospitalized adults and adolescents with influenza.

Site P.I. :  Dr.  Richard Wenstone.
 

•  APTT waveform analysis as an early predictor of outcome in critically ill patients. A joint study with University of Liverpool's Department of Haematology.  

Prof.C.H.Toh /Dr. Ingeborg Welters.            

 

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• Some of the teaching materials used by our nursing staff to teach colleagues about Swan-Ganz catheters and the PiCCO can be found here.

• We have a well-established Critical Care Outreach Team (CCOT) [photo], in line with Comprehensive Critical Care.

• Our Nurse CCOT Leads are Karen Francis, Elizabeth Arthan and Gillian Tomlinson

• The Medical Lead is Dr Elizabeth Flockton

• The Practice/CCOT Educator is Dawn Lacey

The above may be contacted by e-mail [with the format: firstname.surname@rlbuht.nhs.uk] or by by telephone [ICU direct line: 0151 706 2400; CCOT direct line: 0151 706 5813]

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Other Staff

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Education and Training

• The Regional Advisor in Intensive Care is Dr Nagaraj, Consultant in Anaesthesia and Intensive Care, University Hospital Aintree, Liverpool.

Dr Nagaraj can provide further information about the Certificate of Completion of Specialist Training (CCST) in Intensive Care Medicine, as advised by the Intercollegiate Board for Training in Intensive Care Medicine (IBTICM). Further information is also available from the Intensive Care Society.

• See also the Education, Training and Continuing Professional Development section of AMICU's web site.

• Some of our nursing teaching materials about Swan-Ganz catheters and the PiCCO can be found here.

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About Critical Care in our local area:

• For further information about Intensive Care in the Cheshire & Mersey area, follow the links to the Association of Mersey Intensive Care Units, A.M.I.C.U. (A link to the Cheshire and Mersey Critical Care Network's own web site can be found here.)

• AMICU also acts as our Local Network in accordance with The Department of Health's Comprehensive Critical Care document which was published in May 2000.

• Our Transfer Related Group includes University Hospital Aintree and Whiston Hospital.

• The Intensive Care Unit is one of over 30 ICUs in the North West of England which take part in the Intensive Care Bed Information Service, I.C.B.I.S.

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Page last updated: 08 January 2013

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