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Acute Care

Theme Lead

Dr Becky Mitting

Consultant in Paediatric Critical Care Medicine

Becky is Consultant in Paediatric critical care medicine and service lead for Children's Critical Care at St Mary's London. Her research interests include bronchiolitis, sedation, and mechanical ventilation.

She is an honorary Senior Clinical Lecturer at Imperial. Her current research roles/grants include being the domain lead for PIVOTAL-sedation, the PICU platform trial, Critical Care and PPIE lead for the Bach-B trial, and a co-applicant and PPIE lead for an RFPB trial emulation study based on PICANET data. She is local PI for GASTRIC and PRESSURE trials and an NIHR API champion having mentored many APIs through the scheme.

Deputy Theme Lead

Dr Ruud Nijman

Consultant in Paediatric Emergency Medicine

Ruud Nijman is an Honorary Senior Clinical Lecturer at Imperial with a special interest in observational studies and clinical trials in diagnostics and clinical decision making in paediatric emergency medicine and acute childhood infections. He is also a consultant in Paediatric Emergency Medicine at St. Mary’s, London. He leads the EPISODES and ReSync projects - multinational studies looking at the epidemiology of children with acute illness and injuries presenting to emergency departments across Europe and is a member of the DIAMONDS consortium aiming to discover and validate new diagnostic biomarkers for childhood infections. Ruud co-authored two children’s books to promote patient education of children presenting to the emergency department. He is an active steering committee member of the Research in European Pediatric Emergency Medicine (REPEM) network and a member of the executive committee of the European Society of Emergency Paediatrics (EUSEP).

Current projects

Members of the Acute Care theme are currently working on a number of projects to improve the quality of care for critically ill children and young people. We are currently leading a BRC-funded project to look at children presenting acutely with asthma, obtaining metabonomic samples with lung function and repeated samples in the convalescent period to identify markers of severity of asthma exacerbation. This is a joint project with Paediatric respiratory experts at the Royal Brompton Hospital. In addition, we are running several health services studies. This includes a cohort of retired and shielded paediatricians working voluntarily for NHS 111 and is a joint venture with The Royal College of Paediatrics and Child Health and NHS England Children and Young People with an innovative mixed methodology regarding the efficacy of services being delivered.

We are also undertaking systematic reviews on pre-hospital medicine, for adults and children. Members of the theme are supporting the International Liaison Committee of Resuscitation Committees for Paediatric Life Support. This includes undertaking evidence review to review the literature that is subsequently used in international and national guidelines of paediatric resuscitation. We are also supporting writing the next iteration of guidelines for the United Kingdom Paediatric Resuscitation (2021). Our team is supporting several quality improvement programs, including the use of ambulatory teams to help keep children at home and well.

We are undertaking data analysis of children with fever, which has led to a number of cohort groups including work led by Professor Mike Levin with multiple international centres (PERFORM trial). We are also performing analysis of the PRIEST study, a national look at emergency department (ED) attendees with COVID suspected disease, for triaging and prognostic determination. Our team is looking at Paediatric Early Warning Scores (PEWS) in liaison with high and low resource income countries, and their implementation in low resource countries. We are also leading the development of a UK template in looking at improving paediatric cardiopulmonary resuscitation in telephonic episodes of care.

Members of the Paediatric Intensive Care Unit (PICU) are involved in several funded multi-centre trials including:

FIRST ABC: High flow nasal cannula treatment vs CPAP in the management of respiratory failure in children;
OXYPICU: Does Restrictive oxygen therapy have a better outcome than liberal oxygenation;
DIAMONDS: Can we distinguish bacterial for viral infections in critical illness;
Targeted blood pressure management in critical illness;
Psychological outcome of critical illness – an interventional study;
Understanding pathophysiology of acute respiratory failure and acute respiratory distress syndrome in infants and children;
Understanding gender differences in mortality.

In addition, members of PICU are involved in multiple quality improvement projects including:

Early mobilization in critical illness
Optimisation of nutrition
Optimisation of renal replacement therapies
Optimisation of sedation and reduction of delirium and withdrawal.
Management of major trauma in children

Teaching programs

An extensive teaching program is in place in the emergency department, supported by members of the Acute Care theme, that includes critical appraisal and the use of simulated training episodes, all delivered by consultants who are experts in their fields.

Critical Care - Main themes

Pathophysiology of critical illness
Outcomes of critical illness
Nutrition
ARDS
Viral vs bacterial pneumonia
Treatment of critical illness in children

There is an established teaching programme for undergraduate and postgraduate students, including a simulation programme and dedicated educational website. The Paediatric Intensive Care Unit at Imperial (St Mary’s) is recognized as a centre for training for Grid Trainees.