The American Association of Critical-Care Nurses was part of a task force that recently issued recommendations on making the field of critical care research less fragmented and more accountable for patient heterogeneity and the complexity of critical illness.

The task force was formed by the Critical Care Societies Collaborative in conjunction with the U.S. Critical Illness and Injury Trials Group. The CCSC also includes the American Thoracic Society, the American College of Chest Physicians and the Society of Critical Care Medicine.

Identifying common challenges and establishing priorities in the field of critical care research has proven difficult, according to a news release from the American Thoracic Society. Hence the task force.

"Critical care is one of the fastest growing areas in medicine, accounting for approximately $80 billion in healthcare expenditures in the United States annually," the lead ATS representative on the task force, Polly Parsons, MD, chairwoman of the Department of Medicine at the University of Vermont College of Medicine, said in the news release.

Parsons said that enormous cost and the high mortality rates seen in ICUs "point to the urgent need for new treatments and systems of care, implementation of new research findings and identification of priorities for critical care research."

Key themes and challenges identified by the task force include the need to alter the fragmented approach to critical care research and more effectively link diverse research areas, the need to account for the complexity of critical illness and injury and patient heterogeneity in research, and the need for an enhanced clinical research infrastructure.

Recommendations

General principles for research priorities in critical care, as identified by the task force, include: clearer classification and separation of clinical entities in critical illness; identification and testing of novel biomarkers, such as protein markers, metabolites, RNA and DNA; development of improved models of critical illness and novel approaches to bench research that take into account variations in patient characteristics, care strategies and therapeutic interventions; enhanced access to clinical research data; and integration of new research areas, scientific disciplines and technology into the study of critical illness.

The task force identified key critical care research priorities in the specific areas of: basic science/cellular research, including definition of factors that transform normal stress responses into critical illness; translational research, including integration of studies of mechanism and intervention and application of standardized methodology to study design; clinical research, including development of methods for early recognition of acute, severe disease in patients at risk for imminent deterioration and improved organ support techniques; health service and delivery research, including improved mechanisms for knowledge transfer; and education research, including the incorporation of other disciplines and the use of simulations.

In addition to those areas, the task force recommended process improvements in: research environment, including improvements in the infrastructure of research facilities and greater interdisciplinary collaboration; preclinical modeling to more fully capture data on the wide range and severity of critical care conditions; the characterization of both individual patients and patient cohorts; regulatory challenges, including improvements in consent procedures for critical care patients; research networks, including expansion of existing multidisciplinary networks; and funding to encourage increased collaboration across funding sources to ensure adequate support for critical care research, which crosses disease- and age-specific boundaries.

Parsons said the increasing demand for resources in response to outcome challenges has created a need for greater investment in critical care research. "These recommendations will help facilitate the progress of research across the spectrum of critical care," she said. "Their implementation will require new initiatives, shifts in national research priorities and enhanced cooperation within the critical care community. The agenda for critical care research outlined in these recommendations provides a blueprint for future initiatives."

For more on the recommendations, which appeared in the Jan. 1 issue of the American Journal of Respiratory and Critical Care, visit http://bit.ly/zgBkLX.