PhD Study : The eye conjunctiva microcirculation as prognostic indicator of post operative cerebral complications following cardiac surgeries.

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Summary

Intensivists caring for critically ill patients either after cardiac arrest or after major interventional cardiac surgeries including those which required cardiopulmonary bypass, have to make a decision on when to exubate their patients and waken them up. More often than not, 5-6 hours after been brought round after such surgeries, patients become extremely confused, delirium is severe and the patient is uncontrollable not able to coordinate or clear secretions and a further 48 hr reintubation happens not infrequently. There is currently no mechanism by which the clinician can predict who this will happen to and a crude visual assessment of the eye is conducted to estimate the potential of brain oedema and inflammation.

Microvascular alterations can result from cardiac surgical procedures, coagulation disturbances, interaction of blood with foreign surface of CPB machine, perioperative temperature changes and disturbances in pro and anti inflammatory homeostasis. Evolving septic processes modify these parameters. In particular two organs of the body are vulnerable to low molecular weight pro inflammatory mediators; the brain and the kidney. These smaller molecules can pass through the blood brain/renal barrier unaccompanied by their larger molecular weight anti-inflammatory chaperons from the plasma. Previous research by the supervisors has demonstrated acute kidney injury (AKI) following cardiac surgery significantly increases morbidity and mortality risk and the team have successfully developed methods of identifying patients at risk of perioperative AKI advancing management and treatment options^1,2. This was achieved through assessment of urinary biomarkers of inflammation; unfortunately this is not possible for the brain to achieve an indication of brain inflammation.

Our laboratory has developed a cardiac gated functional slit lamp biomicroscope with image analysis software to examine the eye vasculature and produce quantified measurements³. Data from the initial study demonstrates the feasibility of non-invasive assessment of the conjunctival vasculature with an iPhone-slit-lamp biomicroscope imaging tool provides non-invasive visualization, with great diagnostic and prognostic potential.

We hypothesis visualisation of the conjunctival vessels easily accessible at the front of the eye can be used as a surrogate marker to indicate oedema and inflammation of the brain to inform decisions on exubation.

The successful candidate will assess numerous macrovasular parameters using our eye imaging system and assess correlation to pro and anti-inflammatory mediators (tear and urine), delirium score, optic nerve ultrasound measurements and other clinical metrics related to cerebral outcomes. Measurements will be taken pre and post-surgical intervention and this PhD would be most suited to a medical doctor based in ICU.

Essential criteria

To hold, or expect to achieve by 15 August, a medical degree
Access to ICU as part of work schedule
Sound understanding of subject area as evidenced by a comprehensive research proposal
Clearly defined research proposal detailing background, research questions, aims and methodology

Desirable Criteria

If the University receives a large number of applicants for the project, the following desirable criteria may be applied to shortlist applicants for interview.

Sound understanding of subject area as evidenced by a comprehensive research proposal
Work experience relevant to the proposed project
Publications record appropriate to career stage
Experience of presentation of research findings
A comprehensive and articulate personal statement

AccessNI clearance required

Please note, the successful candidate will be required to obtain AccessNI clearance prior to registration due to the nature of the project.

Essential criteria

Applicants should hold, or expect to obtain, a First or Upper Second Class Honours Degree in a subject relevant to the proposed area of study.

We may also consider applications from those who hold equivalent qualifications, for example, a Lower Second Class Honours Degree plus a Master’s Degree with Distinction.

In exceptional circumstances, the University may consider a portfolio of evidence from applicants who have appropriate professional experience which is equivalent to the learning outcomes of an Honours degree in lieu of academic qualifications.