Completed Training Fellowship: Susan Berney
Host Organisation: Austin Health
TAC Funding: $61,200
Mentor: Professor Rinaldo Bellomo
Fellowship Project:
The development of a model to direct clinical decision making in airway management
in patients with spinal cord injury
Aims:
The aims of this project were to develop an algorithm to assist clinicians to decide
whether patients were able to breathe for themselves or whether they required an
artificial tube for assistance to breathe and cough.
Methods:
The airway management of all patients suffering an acute cervical spinal cord injury
in Victoria between January 2005 and August 2009 has been recorded. The factors
that clinicians identified were the most influential in their clinical decision making
process regarding airway management was also recorded. This data was then analysed
to identify the most important factors that predicted whether a patient was able to
breathe on their own or whether they received an artificial tube called a tracheostomy.
Results:
In Victoria patients who are admitted to the intensive care unit following cervical
spinal cord injury are less likely to require a tracheostomy to allow them to cough
effectively compared to elsewhere in the world. The lung volume, the amount of
oxygen in the blood and the amount phlegm in the lungs were best able to predict who
was able to breathe on their own and who would require a tracheostomy.
Conclusions:
The results of this study demonstrate that it is possible to predict patients who may be
able to breathe on their own and those that will require a tracheostomy based on 3
simple clinical assessments.
Career Development:
Sue participated in the following activities funded during the course of her TAC
Fellowship:
Short Courses:

Seminar on Muscle Mass, Professor Mary Galea, The University of
Melbourne
Knowledge Translation:

The algorithm developed in the course of the fellowship has important clinical
implications for guidelines and teaching tools in the intensive care unit
environment. It is the first attempt to provide clinicians with an evidence
based decision regarding airway management in the cervical spinal injury
population.
Post Fellowship Career Development:
Sue is well on her way to completing her PhD and will present her findings at
upcoming spinal cord conferences; she has already published several articles on her
fellowship research.
She plans to continue this area of research, specifically validating the preliminary
classification and regression tree model of clinical decision making using an
independent data set from an ICU of another specialist spinal centre. This validation is
required to either confirm or prune the model prior to implementing into clinical
practice.
Feedback on the Fellowship from Sue Berney:
“This fellowship has been invaluable to me in allowing me to complete the first draft
of my thesis almost 12 months ahead of time. The relief from clinical responsibilities
has allowed me to concentrate on the research process and I feel I have gained much
more out of my PhD that I otherwise might have and subsequently have enjoyed the
experience. In addition I have been able to write papers throughout my PhD which
means the publications are current and will assist in developing my reputation in the
area of research in spinal cord injury. This would not have been possible without the
support of the fellowship. This fellowship has been a very positive experience for me.”
Publications:
BERNEY S, OPDAM H, BELLOMO R, LIEW S, SKINNER E, EGI M, DENEHY L. An Assessment
of Early Tracheostomy after Anterior Cervical Stabilization in Patients with Acute Cervical Spine
Trauma. Journal of Trauma. 2008;64:749-753.
BERNEY S, GORDON I, OPDAM H, DENEHY L. A classification and regressions tree to assist
clinical decision making in airway management for patients with cervical spinal cord injury. Spinal
Cord. 2010;49:244-250.
BERNEY S, BRAGGE P, GRANGER C, OPDAM H, DENEHY L. The acute respiratory management
of cervical spinal cord injury in the first six weeks following injury - A systematic review. Spinal Cord.
2011;49(1):17-29.
Presentations:
BERNEY S, ODAM H, BELLOMO R, LIEW S, EKI M, SKINNER E, DENEHY L. An assessment of
early tracheostomy after anterior stabilisation in patients with acute cervical spine trauma. National
Trauma Research Institute Seminar series; 2008 October, Melbourne, Australia.
BERNEY S. The development of an airway management algorithm to assist clinical decision making in
airway management for patients with cervical spinal cord injury. The University of Melbourne
Physiotherapy Department Research Seminar Series; 2008, Melbourne, Australia.