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More Information about Research in King's Critical Care

This page provides more information about conducting research in our Critical Care Units both at Denmark Hill & Princess Royal University Hospital

Why should we do research in King's Critical Care?

Critical Care services that conduct research have better outcomes

Patients who participate in research do better than patients who do not

King's Critical Care staff will gain a much better understanding of the strengthens and weaknesses of the evidence base in intensive care medicine and be better able to judge new publications and guidelines and how we might change our practice. it also helps in discussions with patients and families. 

King's Critical Care will produce higher quality research  by better understanding what makes a good research question and how such questions can be most effectively answered

Research provides a better understanding and focus on long-term outcomes, including the physical, psychological and cognitive problems patients can have after intensive care

Research helps to underline the important role that staff well being and families have in the outcome of patients from critical illness

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Things the critical care community have got wrong

Fresh blood is not better than stored blood

High dose methylprednisolone reduces temperature, white blood count and pressor requirements in septic shock, but NOT outcomes

Interventions like decompressive craniectomy and hypothermia may reduce ICP in traumatic brain injury, but should be used with caution as long-term neurological outcomes may be worse

Therapeutic hypothermia may also not improve neurological outcomes after cardiac arrest

Suppression of individual components of the pro-inflammatory response (eg cytokines) or molecular structures found on pathogens (eg endotoxin) do not improve outcomes

Parentral nutrition ('TPN') is not necessarily associated with more sepsis in ICU patients

'Renal dose' dopamine may improve the urine output, but this does not make kidney injury better or improve outcomes and may have harmful effects

Monitoring devices (including flow monitoring) will not improve outcome unless they are associated with beneficial changes to patient management

Starch-based colloids are harmful when compared with crystalloids

Tight glycaemic control, whilst efficacious, is not an effective intervention and is associated with harm from hypoglycaemia

Targeting 'normal' blood gases in ICU patients is potentially harmful, especially in the setting of ARDS

Nutritional supplementation

Growth hormone worsens patient outcomes

Goal-directed therapy in septic shock may have no effect or even worsen outcomes

Increasing the blood pressure in ICU patients can be associated with worse outcomes

Asking the right research question

The research question has to be important and understandable to critical care staff and patients. Specifically, if ICU doctors, nurses, AHPs and our patients cannot understand the research question, or how the protocol seeks to answer it, then the value and validity of the  research should be questioned. It is important that if research is published, that ICU healthcare professionals believe the result and the conclusion derived from the result. This is a vital part of translating research output to clinical practice. 

Ensuring can answer this research question in our ICUs

It is critical to ensure that the research protocol is feasible within the research team and clinical service workflow. It is important to confirm that we have the appropriate patients; that there is equipoise across the consultant body

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