Researcher perspectives: Tom Lunn

Tom Lunn is a physiotherapist working at Bristol Royal Infirmary. He specialises in respiratory physiotherapy, working with critically ill patients on the Intensive Care Unit.

Alongside his role at the hospital, he has been carrying out research funded through the National Institute for Health and Care Research (NIHR).

In August 2026, we spoke to Tom about his work, the NIHR BRC: Bristol Transition Fellowship that enabled him to start his research career, his NIHR pre-doctoral award and his hopes for a PhD focused on airway clearance in patients requiring a form of life support called extracorporeal membrane oxygenation (ECMO).

Starting out: Bristol, Brighton, London

I am a physiotherapist by trade. I qualified from the University of the West of England in Bristol, then worked as a junior therapist in Brighton. After taking time out to travel and volunteer around the world, I moved to Guy’s and St Thomas’ in London.

I spent around 8 years there working in critical care and surgery. That was where I became interested in respiratory physiotherapy, particularly airway clearance and ventilation management.

Setting up Bristol’s ECMO service

I was first exposed to extracorporeal membrane oxygenation (ECMO) in London. ECMO is used to support patients who are too unwell for a ventilator alone. It works a bit like dialysis for the lungs: blood is taken out of the body, oxygen is added, carbon dioxide is removed, and the lungs are given time to rest and recover.

In 2019, I moved to Bristol to work in critical care. In 2021, we began setting up an ECMO service here. I was responsible for developing the allied health professional (AHP) side of the service.

Getting motivated: identifying an evidence gap

My motivation to get into research came directly from clinical practice. Working with patients on ECMO, I could see a gap in the evidence. There is research on how to rehabilitate these patients, but very little on how best to clear their airways so they can be ventilated effectively.

That gap felt important. These are patients with severe respiratory failure. If we can understand how best to clear their airways, we may be able to help them ventilate better, potentially come off ECMO sooner, experience fewer complications and recover more quickly.

Airway clearance techniques

My research focuses on airway clearance techniques for patients with severe respiratory failure who are on ECMO. These patients are often sedated, intubated and ventilated, which means they cannot cough effectively or clear secretions from their lungs as they normally would.

As respiratory physiotherapists, we use different approaches to help. We can adjust the ventilator to change airflow and move secretions upwards. We can also use devices such as mechanical insufflation-exsufflation (sometimes known as cough assist). This device blows pressure into the lungs and then rapidly sucks air out, mimicking a cough for someone who cannot cough for themselves.

Fewer complications: why this research matters

The idea is simple: if we can clear patients’ airways successfully, they may ventilate better. These are very sick patients, so even small improvements in care could make a meaningful difference.

At the moment, much of airway clearance practice in ECMO is based on clinician expertise rather than robust research evidence. I want to help build that evidence base.

I also hope my research will give physiotherapists and wider intensive care teams more confidence in how they assess and manage airway clearance for these patients.

Building skills: NIHR BRC Bristol Transition Fellowship

The BRC fellowship gave me the opportunity to build the skills, knowledge and confidence I needed to turn the evidence gap I had identified into a research project.

Through the fellowship, I developed and published a scoping review protocol, wrote a commentary piece on the challenges of airway clearance in this population, and began building towards future doctoral work.

I have recently been awarded an NIHR pre-doctoral award, which gives me two years of protected research time.

During that time, I will:

• Complete my scoping review
• Develop a qualitative study exploring clinicians’ perceptions of airway clearance in ECMO patients
• Work with our national group towards a consensus document on physiotherapy management of ECMO patients

Success needs the right support

Having the right supervision team has been essential to my success so far. My supervisors are Dr Ema Swingwood, a physiotherapy consultant at Bristol Royal Infirmary, and Professor Fiona Cramp, Director of the Centre for Health & Clinical Research and Professor in Long Term Conditions. I have also been supported by Dr Steven Walker, a mentor from the respiratory arm of the NIHR BRC: Bristol.

Without the right people around me, I would not have done the work I have done or had a successful pre-doctoral application.

Working with patients

I am part of a critical care AHP research group, and we are privileged to work with around 15 post-intensive care survivors who are interested in contributing to research.

They have kindly advised me throughout my project. Their input has been invaluable and has already changed parts of my scoping review data extraction.

Future plans

My goal is to become a clinical academic, splitting my time between specialist clinical work and research. I do not want to leave clinical practice behind because that is what drives the research questions.

The BRC fellowship helped me build towards the NIHR pre-doctoral award, and I hope the pre-doc will prepare me to apply for a full PhD.

Longer term, I want to design and deliver pilot and feasibility studies that begin to address some of the key unanswered questions around airway clearance and ECMO.