Her work has helped transform resuscitation

Naomi Hammond’s research collaborations have focused on the care of critically ill patients who are often unconscious. She has taken part in research that has found an intravenous fluid widely used in much of the world increases acute kidney injury and has other adverse reactions. A sister clinical trials group in Scandinavia found this IV fluid actually increases the likelihood of death in patients critically ill with sepsis.

A registered nurse, with a master’s degree in critical care nursing, a master’s degree in public health and a doctorate focused on intensive care and fluid resuscitation practices (such as hydrating patients with intra-venous drips), Hammond credits collaboration with her mentors and colleagues and cooperation with multi-national networks for the success of the research.

“We have realised over the last two decades that intravenous fluids should be treated like any drug; they do have different outcomes for different patient populations,” she says.

“The work our group has done at the critical care program at the George Institute for Global Health, in collaboration with the Australian and New Zealand Intensive Care Society clinical trials group, has included large-scale randomised trials comparing commonly used fluids.”

This body of collaborative research work around the world has transformed how medical staff use fluids for resuscitation and the types of fluids that are used, Hammond adds.

Head of the critical care program at the George Institute, a public health research institute at the University of NSW, Hammond is also conjoint associate professor at the university’s faculty of medicine and the intensive care clinical research manager at the Royal North Shore hospital in Sydney.

Patients in intensive care units usually require life support for serious illness and life-threatening injuries and they often need a large volume of IV fluid to keep their blood volume up and their hearts pumping, Hammond says. Replacing the total volume of lost blood with whole blood is usually not possible, she adds, because such large volumes of fluid are required.

Normal saline, a sterile salt and water solution, is predominantly used in Australia and elsewhere for IV resuscitation. Albumin, a solution derived from human blood, is also commonly used, particularly for critically ill patients.

Hydroxyethyl starch, a synthetic product, was previously the most commonly-used fluid for resuscitation globally but broad-scale research studies, including those Hammond has worked on, have found it can have dangerous side-effects. “Hydroxyethyl starch is still used in India and throughout Asia,” she adds. “Even though there’s clear evidence of harm, there’s still a market for it.”

Hammond and her colleagues have just completed another large trial of resuscitation fluids. The trial compared normal saline IV fluids with a balanced salt solution to determine which was more suitable for critically ill patients, she says. When this trial data was combined with international collaborators’ trial data, the results suggested balanced salt solutions were more likely to be beneficial than normal saline. Other research suggests albumin might be a better alternative for patients with sepsis.

A key part of Hammond’s work, she says, is a series of translational studies both nationally and internationally to determine how research findings have changed clinical practice around the world. “We have found that practice is very much clinician-dependent and hospital-dependent,” she says, “rather than necessarily based on best evidence.”

The Australian