Multisociety Task Force for Critical Care Research: Key Issues and Recommendations

Abstract

Critical care is one of the most rapidly growing areas in medicine. In the United States, care for the critically ill and injured consumes about $80 billion each year, an amount that constitutes approximately 1% of the gross domestic product (1). Mortality rates in intensive care units (ICUs) in US hospitals exceed those of all other care areas, with the result that one in five deaths in the United States occurs in the critical care setting (2). The best hope for both improving patient outcomes and containing costs lies in developing innovative treatments and systems of care, implementing new research findings, and identifying critical care research priorities. The field of critical care medicine encompasses a broad spectrum of illness and injury and is practiced in a myriad of physical locations by providers with diverse skill sets. Research in critical care extends from the bench to the bedside, from classroom to the ICU, and from the community to the hospital. It involves many departments, specialties, professional societies and research institutes/ foundations. Consequently, it has been difficult for experts representing the various communities and professional organizations to collectively identify challenges and establish priorities. After conducting joint meetings for a number of years, in 2009 the four largest professional societies involved in critical care in the United States–the American Association of Critical-Care Nurses (AACN), the American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Society of Critical Care Medicine (SCCM)–formally established the Critical Care Societies Collaborative (CCSC) to explore common issues. At that time, in spite of the importance of critical care, there was no consensus on the research agenda in the United States. The closest approach was the 1995 report of the National Heart, Lung, and Blood Institute (NHLBI) Task Background: Research in critical care extends from the bench to the bedside, involving multiple departments, specialties, and funding organizations. Because of this diversity, it has been difficult for all stakeholders to collectively identify challenges and establish priorities. Objective: To define a comprehensive agenda for critical care research using input from a broad range of stakeholders to serve as a blueprint for future initiatives. Methods: The Critical Care Societies Collaborative (CCSC), consisting of the leadership of the American Association of Critical-Care Nurses (AACN), the American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Society of Critical Care Medicine (SCCM), joined the US Critical Illness and Injury Trials Group (USCIITG) in forming a task force to define a comprehensive critical care research agenda. This group of 25 identified experts was divided into subgroups to address basic, translational, clinical, implementation, and educational research. The subgroups met via conference calls, and the entire task force met in person for a 2-day session. The result was a detailed discussion of the research priorities that served as the basis for this report. Results: The task force identified challenges, specific priority areas, and recommendations for process improvements to support critical care research. Additionally, four overarching themes emerged: 1) the traditional “silo-ed” approach to critical care research is counterproductive and should be modified; 2) an approach that more effectively links areas of research (i.e., basic and translational research, or clinical research and implementation) should be embraced; 3) future approaches to human research should account for disease complexity and patient heterogeneity; and 4) an enhanced infrastructure for critical care research is essential for future success. Conclusions: This document contains the themes/recommendations developed by a large, multiprofessional cross section of critical care scientists, clinicians, and educators. It provides a unique framework for future research in critical care medicine. (Crit Care Med 2012; 40:254–260)