Professor
Peter DargavilleProfile page
Honorary Staff Member
Menzies Institute for Medical Research
- Honorary Staff MemberMenzies Institute for Medical Research
PROJECTS
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GRANT
Safer oxygen therapy for preterm infants through automated oxygen titration
National Health & Medical Research Council1 Jan 2025 - 31 Dec 2029
People funded by this grant: Dargaville P
Project Total: $2,462,040; Preterm infants frequently require respiratory support and oxygen therapy for long periods, and are vulnerable to the effects of hypoxia with low oxygen saturation (SpO2), and also to oxygen-induced hyperoxia with inappropriately high SpO2. Innovative methods developed by Prof. Peter Dargaville have allowed preterm infants worldwide to spend more time receiving non-invasive rather than invasive respiratory support, as well as more time with oxygen levels in the safe SpO2 range. This research program will apply Prof. Dargaville’s patented technology, feedback-controlled automated oxygen titration, across the patient journey, including at the start of life in the delivery room and then partnered with all forms of non-invasive respiratory support. The overarching research question is whether automated oxygen titration can improve clinical outcomes, including mortality and retinopathy of prematurity.
Year 1 of the program will focus on i) development of an enhanced oxygen control algorithm for preterm infants, using for the first time techniques to permit auto-tuning and hence individualise algorithm function, ii) creation and bench-testing of a novel device to automatically adjust delivery of low flow oxygen therapy, iii) improvement of an existing oxygen control algorithm for oxygen therapy in the delivery room and iv) large-scale adaptation of a respiratory support device to allow automated oxygen titration in low-resource settings.
In years 2-5 clinical evaluation of these new and enhanced technologies will be undertaken in preterm infants. Randomised crossover studies of i) enhanced versus current oxygen control algorithms, ii) automated versus manual control of low-flow oxygen therapy and iii) delivery room automated oxygen titration versus standard care will be undertaken in Australian neonatal units. Further, a cluster randomized trial of automated oxygen titration for preterm infants in low resource settings will be performed in sub-Saharan Africa. Funded by: National Health & Medical Research Council - Fellowship-Investigator Grant ($2,464,048); University of Tasmania ($498,439).
GRANT
A piezoelectric sensor for the detection of obstructive apnoea in preterm infants
Royal Hobart Hospital Research Foundation1 Jan 2024 - 31 Dec 2024
People funded by this grant: Marshall A, Dargaville P, Gale T, Salmon B
Project Total: $21,750; This study aims to develop a novel device for the detection of pauses in breathing resulting from upper-airway obstruction in preterm infants. Following pre-clinical evaluation of a refined version of the device, a clinical study will be performed to allow refinement of the detection algorithm. Funded by: Royal Hobart Hospital Research Foundation - Grant-Project ($21,750); University of Tasmania.
GRANT
A Surfactant Treatment Method for Modern Neonatal Care: SURFactant by SUPraglottic Airway (The SURFSUP RCT)
National Health & Medical Research Council1 Feb 2022 - 30 Jun 2027
People funded by this grant: Roberts C, Dargaville P
Project Total: $1,613,172; The SURFSUP trial is a randomised, controlled, non-inferiority trial in preterm infants with respiratory distress syndrome. Infants requiring surfactant treatment are randomised to either supraglottic airway surfactant (intervention) or laryngoscopy and catheter surfactant administration, known as 'minimally invasive surfactant therapy' (control). The primary outcome is treatment failure, defined as need for repeat surfactant or mechanical ventilation within 72 hours. Funded by: National Health & Medical Research Council - Grant-Clinical Trial and Cohort Studies; University of Tasmania.
GRANT
Transforming Clinical Research to Improve Outcomes for Preterm Infants
Medical Research Future Fund1 Jan 2022 - 31 Dec 2024
People funded by this grant: Whitehead C, Manley B, Dargaville P, Davis P, Groom K
Project Total: $2,642,559; This research proposal comprises a series of substantial projects that use adaptive platform trial (APT) methodology to improve outcomes for preterm infants. We will i) identify and refine the priority research questions that will be answered by the APT, ii) define the endpoints for the APT, based on consumer, clinician, researcher and health system leader consultation, and iii) use cutting edge APT study design and statistical modelling to embark upon the research. Funded by: Medical Research Future Fund - Grant - Clinician Researcher; University of Tasmania.
GRANT
Biological and pathologic effects of mechanical ventilation on the cardiovascular system
Royal Hobart Hospital Research Foundation1 Jan 2021 - 31 Aug 2022
People funded by this grant: Song Y, Zosky G, Dargaville P
Project Total: $24,200; Mechanical ventilation is a life-saving strategy in premature babies and critically ill patients, but also contributes to high mortality rates in these patients due to injury in other organs such as the heart. We aim to understand how mechanical ventilation injures the heart in order to improve patient outcomes. Funded by: Royal Hobart Hospital Research Foundation - Grant-Project ($24,200); University of Tasmania.
GRANT
Two year outcome of infants in the OPTIMIST-A trial
Royal Hobart Hospital Research Foundation1 Jan 2021 - 31 Dec 2021
People funded by this grant: Dargaville P, De Paoli T, Shelton L
Project Total: $22,000; This proposal is for funding to facilitate follow-up at 2 years of preterm babies enrolled in the OPTIMIST-A trial, an NHMRC-funded investigator-initiated clinical trial of a novel technique for delivering surfactant into the lungs. The follow-up study will determine whether surfactant delivery using the new method has any lasting benefits, and will also determine whether there are any adverse consequences of this approach. Recruitment for the trial closed in March 2020, and this funding will allow the Trial Coordinator to continue to gather follow-up outcomes of the recently enrolled recruits. Funded by: Royal Hobart Hospital Research Foundation - Grant-Project ($22,000); University of Tasmania ($50,000).
GRANT
Detection, prediction and mitigation of apnoea in preterm infants
National Health & Medical Research Council1 Jan 2020 - 31 Jan 2023
People funded by this grant: Dargaville P, Lim K
Project Total: $90,793; Funded by: National Health & Medical Research Council - Scholarship-Postgraduate ($90,793); University of Tasmania.
GRANT
Prediction and detection of apnoea in preterm infants
National Health & Medical Research Council1 Jan 2020 - 31 Dec 2023
People funded by this grant: Dargaville P, Gale T, Salmon B, Turner P
Project Total: $823,982; We propose a 3 year study with the over-arching goal of developing tools to improve the management of apnoea in preterm infants on non-invasive respiratory support. Our hypotheses are that pattern recognition and machine-learning software can be used to predict impending apnoeic events with a high degree of certainty, and that a combination of innovative monitoring devices measuring torso movement and acoustic transmission of airway noises can improve the detection of central and obstructive apnoeic events.
Background
Modern respiratory management for preterm infants involves protracted use of continuous positive airway pressure (CPAP). This less-invasive form of respiratory support has advantages over intubation and ventilation, but relies on adequate respiratory drive and airway patency at a time when both of these are prone to failure. Central and obstructive apnoeic events are well-recognized causes of hypoxemic and/or bradycardic episodes in preterm infants, which may have lasting neurodevelopmental consequences. At present central pauses in respiration can be difficult to reliably identify in infants on CPAP, and most obstructive episodes go undetected. Moreover, there is no way of knowing when an infant is about to stop breathing.
Research proposal
Over a 3 year period we will assemble a unique compendium of physiological recordings in preterm infants <30 weeks gestation on CPAP using multimodal monitoring equipment. In our first aim we will apply sophisticated machine-learning techniques to the physiological data to develop a predictive tool to identify a pre-apnoeic state in real-time. In our second aim we will determine whether a) respiratory pauses can be reliably identified using a unique contactless respiratory monitoring system, and b) whether obstructive apnoea can be detected in preterm infants on CPAP with acoustic sensors. Funded by: National Health & Medical Research Council - Grant-Ideas ($823,982); University of Tasmania.
GRANT
Intratracheal budesonide mixed with surfactant to reduce bronchopulmonary dysplasia in extremely preterm infants
National Health & Medical Research Council1 Jan 2019 - 31 Dec 2022
People funded by this grant: Manley B, Kamlin C, Davis P, Doyle L, McKinlay C
Project Total: $2,113,818; Fifteen million babies are born preterm each year (>10% of all births), and 1 million die due to complications. Extremely preterm infants (EPTIs) born <28 weeks' gestation are the most vulnerable: 50% die or are diagnosed with bronchopulmonary dysplasia (BPD) - the chronic lung disease of prematurity.
Although advances in neonatal intensive care have improved survival, BPD rates are static. BPD is associated with early death and adverse long-term pulmonary and neurodevelopmental outcomes in survivors. Airway inflammation is pivotal in the pathogenesis of BPD. Systemic corticosteroids (CS) are an effective anti-inflammatory therapy, but their early use in EPTIs is associated with short- and long-term adverse effects including cerebral palsy. Inhaled CS are an alternative, but drug delivery to the distal airway is technically challenging, and whilst a recent trial (Bassler, NEJM 2015/17) found a modest effect on
BPD there was a concerning increase in death. Intratracheal CS, mixed with surfactant (a safe, routine therapy) to deliver it effectively to the distal airways, is an exciting new therapy with the potential to reduce BPD while minimising systemic side effects. A recent trial of intratracheal budesonide (Yeh, AJRCCM
2016) in 265 very low birth weight infants with severe early lung disease found a large reduction in death or BPD from 66% to 44%, and no short- or longterm adverse effects. That trial has not changed clinical practice because of skepticism of its small sample size and large effect size, and issues of generalisability (population, surfactant type). The PLUSS Trial will be the definitive trial in EPTIs: a large, international, multicentre, double-blind randomised trial of early intratracheal budesonide mixed with surfactant, compared with surfactant alone, to increase survival free of BPD. The pragmatic, inclusive trial design will maximise applicability of the results, and the world-class research team will ensure prompt translation into practice. Funded by: National Health & Medical Research Council - Grant-Project; University of Tasmania.
GRANT
Understanding why mechanical ventilation contributes to mortality in critically ill patients.
Royal Hobart Hospital Research Foundation1 Jan 2019 - 31 Dec 2019
People funded by this grant: Zosky G, Dargaville P
Project Total: $23,650; We will be assess regional variation in gene expression in the pre-injured septic lung in response to mechanical ventilation. By assessing the association between gene expression data and our quantitative imaging data, we will gain insight into how the mechanical response of the lung impacts on the biological response, which contributes to the high mortality in these patients, and how this is altered by pre-existing inflammation. By using RNAseq we also hope to identify novel pathways involved in the response. Funded by: Royal Hobart Hospital Research Foundation - Grant-Project ($23,650); University of Tasmania.
GRANT
The Peri-Peri project: the role of pericytes in placental function and perinatal outcome
Royal Hobart Hospital Research Foundation1 Jan 2018 - 31 Dec 2019
People funded by this grant: Sutherland B, Dargaville P, Edwards L
Project Total: $10,000; This project will assess how pericytes, a specific cell that may control blood flow in placenta, could contribute to restricted growth of babies during pregnancy. Funded by: Royal Hobart Hospital Research Foundation - Grant-Starter ($10,000); University of Tasmania.
CONSULTANCY/CONTRACT RESEARCH
Less invasive surfactant administration training report
Chiesi Farmaceutici1 Jan 2017 - 31 Dec 2017
People funded by this grant: Dargaville P
Project Total: $3,543; Contribute text to a training report describing the technique of less invasive surfactant administration (LISA) using a commercially-available catheter (LISAcath) Funded by: Chiesi Farmaceutici ($3,543); University of Tasmania.
GRANT
Understanding the human ischemic cascade: Improving the process of drug development for cerebral ischemia
Royal Hobart Hospital Research Foundation1 Jan 2017 - 31 Dec 2017
People funded by this grant: Howells D, Eaton E, Dottori M, Dargaville P
Project Total: $25,000; Brain ischemia is a major cause of death and disability. Drug therapies for ischemic injury which have shown promise in rodent models have had poor translation in human patients. We aim to characterise the human cellular response to ischemia and use injury-reducing hypothermia to identify human-relevant therapeutic targets. Funded by: Royal Hobart Hospital Research Foundation - Grant-Establishment ($25,000); University of Tasmania ($25,000).
GRANT
Study of automated neonatal targeting of oxygen: resuscitation trial 1 (the SANTO R1 study)
Royal Hobart Hospital Research Foundation1 Jan 2016 - 31 Dec 2017
People funded by this grant: Karayil Mohammad Ali S, Dargaville P, Gale T
Project Total: $10,000; We have developed an automated inspired oxygen controller, which in preliminary studies is very effective in keeping oxygen levels in the desired range in premature infants in the neonatal intensive care unit (NICU). The function of the controller has been further enhanced, allowing it to self-tune to an infant's needs and to predict drops in oxygen levels. We will now conduct an evaluation of the efficacy and safety of the device to maintain oxygen levels in the desired range in preterm infants requiring resuscitation at birth. Funded by: Royal Hobart Hospital Research Foundation - Grant-Starter ($10,000); University of Tasmania.
GRANT
Study of automated neonatal targeting of oxygen: trial B (the SANTO B study)
Royal Hobart Hospital Research Foundation1 Jan 2016 - 31 Aug 2017
People funded by this grant: Dargaville P, Gale T, Karayil Mohammad Ali S
Project Total: $25,000; We have developed an automated inspired oxygen controller, which in preliminary studies is very effective in keeping oxygen levels in the desired range in premature infants. The function of the controller has been further enhanced, allowing it to self-tune to an infant's needs, to predict drops in oxygen levels, and to be operated by bedside caregivers. We will now conduct a further evaluation of the device, operated independently by bedside caregivers under standard clinical conditions. Funded by: Royal Hobart Hospital Research Foundation - Grant-Establishment ($25,000); University of Tasmania.
GRANT
Finding the right ventilator settings in patients with respiratory failure
Royal Hobart Hospital Research Foundation1 Mar 2015 - 28 Feb 2016
People funded by this grant: Zosky G, Dargaville P
Project Total: $19,826; Based on data from Tasmania and across Australia the mortality rates due to acute respiratory distress syndrome (ARDS) are high (28-day mortality rate = 34%) (1). Paradoxically, mechanical ventilation, which is a necessary lifesaving strategy in ARDS, is thought to contribute to this high mortality rate (2). In the late 1990's the seminal ARDSNet trial (3), which showed a 22% reduction in mortality by reducing tidal volume from 12 to 6 mL.kg-1, was considered a major breakthrough. However, mortality rates due to ARDS have since flatlined (4) and improvements in patient outcomes has stalled. We argue that this impasse has arisen due to reliance on indirect measures of lung ventilation (5) and our inability to dynamically image the lung at a high resolution. Funded by: Royal Hobart Hospital Research Foundation - Grant-Clinical Research ($19,826); University of Tasmania.
GRANT
Regional mechanisms of ventilator induced lung injury: insights from dynamic lung imaging
National Health & Medical Research Council1 Jan 2015 - 31 Dec 2018
People funded by this grant: Zosky G, Fouras A, Dargaville P
Project Total: $603,878; Funded by: National Health & Medical Research Council - Grant-Project ($603,878); University of Tasmania.
GRANT
Studies of Neonatal Targeting of Oxygen (SANTO-A)
Royal Hobart Hospital Research Foundation12 Dec 2013 - 31 Aug 2014
People funded by this grant: Wheeler K, Dargaville P, Gale T
Project Total: $9,091; Funded by: Royal Hobart Hospital Research Foundation - Grant-Starter ($9,091); University of Tasmania.
GRANT
Surfactant distribution and efficacy in the preterm lung: the effect of spontaneous breathing
Royal Hobart Hospital Research Foundation21 May 2013 - 31 May 2014
People funded by this grant: Dargaville P
Project Total: $12,382; This is a laboratory-based project to examine distribution of surfactant in the lung using a preterm lamb model of the premature infants on continuous positive airway pressure. Funded by: Royal Hobart Hospital Research Foundation - Grant-Research ($12,382); University of Tasmania.
GRANT
Effect of vitamin D supplementation of the currently used dosage regime of 400 IU/d on vitamin D levels in infants
Royal Hobart Hospital Research Foundation1 Jan 2013 - 31 Mar 2014
People funded by this grant: Jones G, Lim B, Dargaville P, van der Mei I, Winzenberg T
Project Total: $22,716; Funded by: Royal Hobart Hospital Research Foundation - Grant-Clinical Research ($22,716); University of Tasmania.
GRANT
Randomised controlled trial of minimally invasive surfactant therapy in preterm infants 25-28 weeks gestation on continuous positive airway pressure
National Health & Medical Research Council1 Jan 2013 - 31 Dec 2020
People funded by this grant: Dargaville P, Soll R, Carlin J, Kamlin C, De Paoli T
Project Total: $1,172,977; This project is a clinical trial investigating a new and less-invasive technique of giving surfactant to improve lung function in preterm babies born between 25 and 28 weeks gestation. The trial will examine whether giving surfactant using the less invasive method results in better outcomes, including a reduction in time on respiratory support, and higher survival without chronic oxygen dependency. Funded by: National Health & Medical Research Council - Grant-Project ($1,172,977); University of Tasmania.
GRANT
Multicentre randomised controlled trial of minimally-invasive surfactant therapy in preterm infants 25-28 weeks gestation on continuous positive airway pressure
Royal Hobart Hospital Research Foundation2 Oct 2012 - 1 Oct 2013
People funded by this grant: Dargaville P, De Paoli T
Project Total: $22,728; Funded by: Royal Hobart Hospital Research Foundation - Grant-Clinical Research ($22,728); University of Tasmania.
GRANT
The efficacy of vitamin D supplementation in early life on bone health: Pilot of a double-blind randomized controlled trial
The Marian and EH Flack Trust1 Oct 2012 - 31 Dec 2013
People funded by this grant: van der Mei I, Gibson R, Winzenberg T, Dargaville P, Blizzard L
Project Total: $27,920; Funded by: The Marian and EH Flack Trust - Grant-Project ($27,920); University of Tasmania.
GRANT
Multicentre randomised controlled trials of minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure
Royal Hobart Hospital Research Foundation1 Jun 2011 - 30 May 2012
People funded by this grant: Dargaville P, De Paoli T
Project Total: $22,727; Funded by: Royal Hobart Hospital Research Foundation - Grant-Research ($22,727); University of Tasmania.
GRANT
Identifying Novel Markers of Neonatal Sepsis
Royal Hobart Hospital Research Foundation1 Jan 2010 - 17 Dec 2010
People funded by this grant: De Paoli T, Jacobson G, Lee W, Narkowicz C, Vervaart P
Project Total: $7,273; Funded by: Royal Hobart Hospital Research Foundation - Grant-Starter; University of Tasmania.