DrBrijesh Patel

Our Mission

 

Our research aims to transform the care of patients with life-threatening cardiac and respiratory failure through precision cardiorespiratory critical care. We seek to understand why patients with apparently similar critical illness respond differently to treatment by integrating mechanistic biology, physiology, imaging, artificial intelligence and clinical trials to develop personalised therapies that improve patient outcomes.

 

Our programme spans the complete translational research pathway—from mechanistic discovery and experimental medicine, through biomarker development, advanced physiological phenotyping and computational modelling, to embedded mechanistic clinical trials, implementation science and international research networks. By integrating these complementary disciplines, we aim to accelerate the discovery, evaluation, implementation and adoption of precision therapeutics for critically ill patients.

 

Research Themes

 

Precision Cardiorespiratory Critical Care

We investigate the biological and physiological heterogeneity of severe cardiac and respiratory failure to develop personalised approaches to diagnosis, monitoring and treatment. By integrating mechanistic biology, advanced physiology, imaging and computational science, we identify clinically meaningful disease subphenotypes that inform precision therapeutic strategies.

 

Bioradiological Phenotyping and Early Experimental Medicine

We investigate non-resolving acute respiratory distress syndrome (ARDS) through integrated biological, radiological and physiological phenotyping. By combining longitudinal imaging with physiological assessment, biosampling and multi-omic analyses, we identify mechanisms of persistent lung injury, aberrant repair and fibrosis. Our goal is to identify biologically defined endotypes that can be targeted through early-phase experimental medicine studies. Through mechanistic phenotyping, we seek to discover therapeutic targets, identify biomarkers of target engagement and treatment response, and accelerate the translation of novel therapies into clinical practice.

 

Extracorporeal Organ Support and Blood–Material Interactions

We investigate the biological response to extracorporeal therapies, including venovenous and venoarterial extracorporeal membrane oxygenation (ECMO), cardiopulmonary bypass and other advanced organ support technologies. Our work focuses on blood–material interactions, inflammation, coagulation, oxygenator biology, membrane lung dysfunction and circuit biocompatibility to improve the safety, effectiveness and biological performance of extracorporeal support.

 

Mechanical Ventilation, Liberation and Severe Respiratory Failure

We develop personalised strategies for mechanical ventilation and liberation from respiratory support through advanced physiological studies and multicentre clinical trials. Our research encompasses lung-rest ventilation during ECMO, ventilator-induced lung injury, respiratory mechanics, mechanical power, ventilator weaning and liberation from extracorporeal support. We lead the NIHR-funded ROMEO trial evaluating personalised lung-rest ventilation during venovenous ECMO and collaborate internationally through the JULIET programme in North America to establish a globally harmonised evidence base for precision mechanical ventilation during extracorporeal support.

 

Cardiogenic Shock and Mechanical Circulatory Support

We investigate the physiological mechanisms of myocardial recovery and develop evidence-based strategies for mechanical circulatory support. Through the SOCRATES programme, we are evaluating physiology-guided weaning from venoarterial ECMO using Pressure-Controlled Retrograde Trial Off (PCRTO), integrating haemodynamic phenotyping with biomarker discovery to optimise assessment of myocardial recovery and liberation from mechanical circulatory support.

 

Biomarker Discovery and Precision Diagnostics

We develop novel diagnostic and prognostic biomarkers using metabolomics, volatile organic compounds, extracellular vesicles and other multi-omic technologies. Through the HITEC translational research platform, we investigate immunothrombosis, inflammation and biological signatures associated with extracorporeal therapies to improve patient stratification, identify therapeutic targets and enable precision diagnostics.

 

Physics-Informed Machine Learning and Artificial Intelligence

We develop explainable artificial intelligence (XAI) and physics-informed machine learning (PIML) approaches that integrate physiological principles with multimodal clinical, biological, radiological and multi-omic datasets to improve diagnosis, phenotyping, prognostication and treatment selection in critically ill patients. Our research combines high-resolution physiological monitoring, imaging, electronic health record data and biological datasets—including metabolomics, proteomics, transcriptomics, extracellular vesicles and other biomarker platforms—to generate biologically informed computational models of critical illness. By embedding physiological principles within machine learning frameworks, we aim to develop interpretable and trustworthy decision-support systems that identify mechanistic disease subphenotypes, predict treatment response and support precision therapeutics.

 

Embedded Mechanistic Studies within Clinical Trials

A defining feature of our programme is the integration of mechanistic science within investigator-led clinical trials. By embedding biological sampling, advanced physiological phenotyping, imaging and multi-omic analyses into multicentre studies, we seek to understand not only whether interventions are effective, but why they work, which patients benefit most and how treatment responses vary. This integrated approach bridges laboratory discovery and clinical practice, enabling identification of mechanisms of treatment response, biomarkers of target engagement and novel therapeutic targets while accelerating the development of precision therapeutics.

 

Implementation Science and Learning Health Systems

Generating evidence alone is insufficient to improve patient outcomes. We investigate implementation strategies, clinician behaviour, human-centred artificial intelligence, cognitive workload and decision-support systems to understand how innovations can be adopted safely, effectively and equitably within healthcare systems. Working closely with the UK National Adult Respiratory ECMO Network, ECMONet and international collaborators, we develop and evaluate learning health systems and implementation frameworks that accelerate the translation of discovery science and clinical trial evidence into routine care.

 

Current Research Programmes

 

Our research is delivered through a portfolio of complementary translational programmes that span discovery science, experimental medicine, multicentre clinical trials and implementation science.

 

ROMEO

A national NIHR-funded multicentre randomised clinical trial evaluating personalised lung-rest ventilation during venovenous ECMO, integrating embedded physiological and mechanistic studies to optimise respiratory support in severe ARDS.

 

HITEC

A translational research platform investigating the biological response to extracorporeal circulation through integrated biomarker discovery, metabolomics, volatile organic compounds, extracellular vesicles and immunothrombosis to improve precision diagnostics and identify novel therapeutic targets.

 

SOCRATES

A translational programme investigating physiology-guided weaning from venoarterial ECMO using Pressure-Controlled Retrograde Trial Off (PCRTO), integrating haemodynamic phenotyping with biomarker discovery to optimise assessment of myocardial recovery and liberation from mechanical circulatory support.

 

BREATHE

Development and evaluation of explainable artificial intelligence and implementation strategies to support ventilator liberation, integrating clinician-centred design, physiology-informed machine learning and implementation science to improve adoption in routine clinical practice.

 

ECMO-BIOMARKER

Mechanistic investigation of severe respiratory failure through integrated biological and physiological phenotyping to identify biomarkers of disease progression, treatment response and clinical outcomes in patients receiving extracorporeal support.

 

Bioradiological Phenotyping Programme

An interdisciplinary programme integrating imaging, physiology and multi-omic analyses to identify biological endotypes of non-resolving ARDS, discover novel therapeutic targets and support early-phase experimental medicine studies.

 

International ECMO Collaborations

International collaborative programmes, including the ROMEO–JULIET partnership, working with leading centres across North America, Europe and Australasia to harmonise mechanistic studies, clinical trial methodology and precision therapeutic strategies for patients receiving extracorporeal life support.

 

Our Vision

 

Our vision is to establish an internationally recognised programme that integrates biology, physiology, imaging, artificial intelligence and adaptive clinical trials to deliver precision therapeutics for patients with life-threatening cardiac and respiratory failure. By bringing together clinicians, scientists, engineers and data scientists within a collaborative translational research environment, we aim to accelerate the discovery, evaluation, implementation and global adoption of precision therapies that improve outcomes for critically ill patients.

 

We welcome enquiries from medical students, postgraduate researchers, doctoral candidates, clinical fellows, postdoctoral researchers and collaborators who share our ambition to advance precision cardiorespiratory critical care through interdisciplinary translational research.