Keeping hearts steady in ICU
Doctor Khaled El-Khawas is an intensive care doctor at Grampians Health in Ballarat. He is committed to finding the best ways to help his patients in the intensive care unit (ICU).
His latest research is seeing him partner up with Austin Health in Melbourne to run a clinical trial using magnesium to find the best way to treat patients admitted to the ICU who need help keeping their blood pressure in the normal range and their heartbeat regular.
Dr El-Khawas says that many patients in ICU may experience a heart rhythm disturbance known as atrial fibrillation (AF). This means that the patient’s heart is beating too fast and out of its usual pattern and the heart is unable to pump blood properly. This can increase the risk of blood clots forming and travelling around the body.
Prevention is better than cure, and reducing the likelihood of patients experiencing an irregular heartbeat while admitted to the ICU is something Dr El-Khawas wants to investigate.
“Recognising non-invasive ways, such as replacing magnesium levels in our ICU patients, to prevent or shorten the duration of AF could improve patients’ outcomes and reduce potential side effects,” said Dr El-Khawas.
From treating atrial fibrillation in the ICU, Dr El-Khawas knows that giving patients magnesium can bring their heart and blood pressure back under control.
Magnesium is important in heartbeat regulation as it moves electrolytes such as calcium and potassium into other cells. Electrolytes are important for nerve signals and the heart’s muscle contractions to keep a normal heartbeat.
“This study will be using the latest technology of magnesium monitoring from Nova Biomedical, an industry leader in critical care analysers,” said Dr El-Khawas.
Atrial fibrillation is common for people admitted to the ICU who need a ventilator machine to help them with breathing and/or need medication to help support their blood pressure.
For patients admitted to the ICU, AF can mean a worse outcome for the patient and can hinder their recovery.
“This type of rhythm disturbance is a significant clinical problem that is associated with worse critical illness, low blood pressure and eventually undesirable poor outcomes,” Dr El-Khawas said.
Doctors have a range of treatments for AF, from giving potassium or magnesium replacement or medications that slow down the heart’s rate, all the way up to giving an electric shock to reset the heart into a normal rhythm.
“Unfortunately, such invasive treatment methods are not without significant side effects either,” Dr El-Khawas said.
Dr El-Khawas says that having access to less invasive ways of treating AF could not only improve patient outcomes, but also make prevention the heart of the treatment.
“We hope to identify whether two different methods of supplementing magnesium in the ICU prevents or shortens the incidence of AF, and subsequently identify whether one approach achieves improved clinical outcomes.”
Dr El-Khawas knows that preventing AF in patients will not only improve their overall health, it will also help their recovery while in the ICU.
“There is considerable evidence that intensive care units participating in research have better patient outcomes than a unit of similar size without such activity. That may be due to the known “Hawthorne effect” as standard best practice is being continuously measured and assessed.
“In addition, the potential benefit of a single safe intervention in a highly skilled and monitored critical care area would provide opportunities to improve the medical knowledge of previously unknown fields.”
In partnership with Austin Health, Dr El-Khawas is looking to help both current and future patients needing intensive care.
“We hope to identify better and safe interventions for ICU patients to prevent this heart rhythm irregularity. In addition, we could improve our future patient outcomes by investigating the correct method and targets for magnesium level supplementation.
“Research partnership with Austin Health is essential as it allows collaboration with one of the most active ICU research centres in Australia and New Zealand. Furthermore, it will enable opportunities to exchange knowledge and expertise that will positively impact patient care in the Grampians region,” Dr El-Khawas said.
