Section of Critical Care Medicine

A particular strength of research in the Section is possession of a singular resource, the Winnipeg Combined ICU Database.

This powerful tool links two data sets:

1. a clinical ICU database containing detailed information about every adult ICU admission, and
2. the provincial administrative database held at the Manitoba Centre for Health Policy, which contains comprehensive, linked information about all provincial residents, including vital status, all hospitalizations, outpatient visits, prescription pharmaceuticals, home care, use of chronic care facilities, and over 100 other datasets.

The provincial data dates back to 1973. The clinical ICU database originated in 1988, and since 1998 it has included detailed clinical information about all adult ICU admissions in Winnipeg. This resource enables a broad range of studies of ICU epidemiology and outcomes that are possible in few places around the world.

MindSet: the Manitoba Integrative Data Platform

The conduct of ICU research trials is typically constrained by the difficulty and expense of collecting data expressly for the purpose of the study. Recent, standard, investigator-driven efficacy RCTs done by the Canadian Critical Care Trials Group have cost in the range of $3-7 million, and industry-driven Phase 3 drug trials in sepsis cost tens of millions of dollars, or more.

There is an increasing recognition that many RCTs can be done primarily using routinely collected medical data. Such studies can be much easier and less expensive to perform. These mandate the ability to acquire these data elements in real-time (or near real-time), but patients' medical records (whether paper or electronic) typically take weeks or longer to become complete after hospital discharge. Thus, to gain the benefits of such trials, it is necessary to have a real-time data repository where the data of all types (clinical laboratory, radiology, electronic medical record, etc) are automatically deposited, cleaned and maintained.

Towards this, Dr. Ryan Zarychanski is the nominated Principal Investigator for over $6 million in funding – from combination of the Canadian Institutes for Health Research, the Province of Manitoba, The University of Manitoba, CancerCare Manitoba and others – to develop such a data repository in the province. Once complete, this resource will greatly facilitate conducting a wide range of human clinical studies relating – but not limited to – critical illness.

Our clinical trials program recruits patients at the Winnipeg Health Sciences Centre, St. Boniface Hospital, and Grace General Hospital.

• Clinical trial research personnel

Sepsis is a major worldwide health problem. The World Health Organization has identified it as an area in need of focused advancement. The Canadian Sepsis Network is a consortium of over 160 investigators and other stakeholders, funded in December 2019 by a $5.7 million dollar, five year grant from the Canadian Institutes for Health Research.

This nationally coordinated effort seeks to advance our understanding of the causes of sepsis, and improving its prevention, detection and management. The primary goal of this funding is to create a national infrastructure, encompassing all aspects of sepsis research, clinical care, and public outreach, that network members can leverage to advance knowledge and practice.

Its goals are to:

1. Improve the identification of pathogenesis, prevention, detection and management of sepsis in Canada through coordinated national research activities to generate new knowledge, technical and scientific expertise.
2. Accelerate the iterative, bi-directional translation of evidence into practice for improved patient experience and outcomes through coordinated multi-sectoral, multi-theme, and multi-disciplinary activities and knowledge sharing.
3. Develop and validate interventions that change significant aspects of practice; evaluate outcomes of implementation of interventions; and, accelerate the translation of research discoveries, and best and wise practices, to bridge gaps between research outcomes and health impact.
4. Build and promote relevant research capacity, including training and early career development, by providing high-quality, multi-disciplinary training and mentoring through active engagement of established researchers, early career investigators and trainees.

Dr. Allan Garland leads the population health pillar of this effort, the specific aims of which include:

1. Use complementary approaches to identify cases and determine the population-based incidence of sepsis
2. Identify and catalogue the scope of existing sepsis knowledge
3. Create a Metadata Catalogue of all existing relevant Canadian datasets, and within it, generate subsets of harmonized data
4. Identify societal and healthcare costs associated with sepsis that can be used to inform policy-development and future health economic evaluations

The Critical Care Hematology Research Group is comprised of faculty and research trainees from the University of Manitoba. Faculty, including members from Hematology, Critical Care and the George and Fay Yee Centre for Healthcare Innovation, have extensive expertise in research methodology including innovative trial design, and advanced statistical methods.

Research produced by this group includes human clinical trials, epidemiology and other observational studies using existing databases that range from small to very large.

This highly collaborative group has biweekly lab meetings which focus on developing the next generation of researchers. This includes discussions of: (i) progress on ongoing research projects, (ii) development of new projects, and also (iii) career development of clinician-scientists in the broad sense.

This latter prominently includes helping the trainees understand the value of, and create, hypothesis-driven programs of research that will help them on the path to becoming independently-funded researchers who successfully compete for national-level funding.