Southampton Academy of Research

Dr Cathy McKenzie is a Consultant Pharmacist in Critical Care at University Hospital Southampton and holder of a Research Leaders Programme (RLP) fellowship.

She is interested in drug use for critically ill patients, particularly those used in sedation, delirium and pharmacokinetics in critical illness.

Reducing the severity of delirium

Some patients experience delirium during their stay in the hospital’s intensive care unit (ICU), where they suddenly become confused and disorientated. This can be exacerbated by certain medicines, including the drugs we use for sedation and pain relief when patients are severely unwell.

About one third of these patients will development long term cognitive decline (and dementia) following brain insult and delirium during critical illness. The longer and more severe the delirium, the worse the long-term consequences including length of stay and an increased chance of dying. Around a quarter to a third of our elderly patients will never return to their own home or lead independent lives because of delirium when they are severely unwell.

As part of her fellowship, Cathy has applied for funding to run a clinical trial to assess whether intravenous thiamine (a cheap and safe intervention) can reduce the time and severity of delirium in critical illness. She is also pursuing research into whether opioid choice and dose in critical illness causes a greater chance of drug withdrawal and delirium.

Cathy is also collaborating with colleagues in Southampton including Andy Fox, Stephen Lim and Kinda Ibrahim to assess whether reducing the anticholinergic burden of medication in critical illness reduces falls, delirium and dementia in elderly cases. Cathy is a co-applicant on a number of national clinical trials for sedation and delirium in critical illness. In the field of antimicrobials she is interested in understanding how critical illness affects the pharmacokinetic of drugs frequently used in critical illness, especially aminoglycosides.

“I’m looking at our patients surviving better lives,” she explains. “I want to develop pharmacotherapies that may reduce the severity of delirium, and at continually assess their ongoing medications to reduce unnecessary harm.”

Growing UHS pharmacy research

Cathy is passionate in engaging pharmacy professionals in research and is currently supervising four predoctoral fellows, with three through the NIHR and one through the equivalent Northern Ireland scheme. All four fellows will spend time with her in Southampton.

“Pharmacy needs research leaders to design and recruit patients into clinical trials in medicines optimisation and inspire the next generation of pharmacy researchers,” she says. Cathy hopes to do this by embedding research into daily practice and making best use of research opportunities across Southampton.

Growing the research capacity in pharmacy will occur by partnering with RLP fellow Andy Fox and their pharmacy research fellow Emily Smith. Together, they intend to slowly build research capacity in the pharmacy team in Southampton.

“I think the Research Leaders Programme is going to be brilliant for the department as a whole,” she says. “Between us we’re going to bring research to the department.”

Becoming a research leader

Cathy has long been involved in research. She completed her PhD in 2005, which showed ICU patients were being sedated for too long with the drug midazolam, meaning they didn’t wake up when they should. Yet a long period of her own ill health meant her research career had to be put on hold.

So when Prof Mike Grocott suggested she apply for the RLP programme, she jumped at the opportunity. It will give her two days each week to focus solely on her research.

As well as her research into delirium, she plans to use her fellowship to continue her role as editor in chief on the e-book Critical Illness (www.medicinescomplete.com), ensure each of the critical care pharmacy team has a research project that leads to a peer-reviewed publication and become an active member of the perioperative and critical care theme of the NIHR Biomedical Research Centre in Southampton and the NIHR Wessex ARC.

After completing her RLP fellowship, she plans to apply for a fellowship or a NIHR senior investigator award so she can maintain her research career.

“While I’ve always been research active, I’ve not been involved in a scheme that’s invested in me, as a research leader, and looked at what the deficits are in my CV,” she says. “This scheme just seems fantastic for that, and I’m really excited about it.”