The Full Story
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
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
