Print version ISSN 0120-3347
Rev. colomb. anestesiol. vol.39 no.2 Bogotá Apr./July 2011
Research in Critical Care Medicine
Henry Oliveros Rodríguez
Especialista en Anestesiología Especialista en Medicina Crítica Magíster en Epidemiología Clínica Correspondencia: Trasversal 4E No. 61-05, Bogotá, Colombia Correo electrónico: firstname.lastname@example.org
Recibido: marzo 20 de 2011. Aceptado: marzo 30 de 2011.
The number of articles on critical care medicine and intensive care is not more than 10 % in the most important journals of anesthesia. In Anesthesia & Analgesia, the articles on this topic represent 2.8 %; in the Canadian Journal of Anesthesia, 4.5 %; in the Journal of Anesthesia, 4.9 %; in Acta Anaesthesiologica Belgica, 4.6 %; and in the Journal of Clinical Anesthesia, 5.2 %. In the mean time, those journals that explicitly acknowledge their preference of critical care, publish a larger number of articles on the topic: form 12 % in Anaesthesia and Intensive Care up to 60 % in the Journal of Critical Care (1).
In Colombia, approximately 90 anesthesiologists are devoted full time to the critical care patient, in addition to most of the professional anesthesiologists who share their practice of anesthesia with the care of critical patients. This deserves acknowledgment in the spaces available for the publication of research in critical care medicine (2).
It must be stressed that research in the area of critical care is significantly different from research in the practice of anesthesia. Critical care patients include a broad range of baseline pathologies, with multiple co-morbidities and related interventions, as opposed to the practice of anesthesia where patients are more homogeneous and their interventions are less varied, with an identifiable "time zero" with regards to the onset of treatment.
If however, we focus on the interventions in critical patients, multiple interventions coexist, leading to the most diverse outcomes: "hard outcomes" such as mortality, cure rates, length of stay and quality of life; or, "soft outcomes" or "intermediate" such as tissue hypoperfusion markers, hemodynamic parameters and rates of oxygenation.
In the end, there will be marked differences in terms of population, interventions and outcomes among the anesthesia patients and those admitted to the ICU. These differences condition the research methodology chosen, because although the expected outcomes in the critical patient have a short-term horizon and hence the cohort studies may seem very timely, the vast heterogeneity of the population and the interventions represent a real methodological challenge because of confounding variables and changing factors.
In addition to these methodological differences, there are various design preferences: only 13% of the critical care medicine trials are clinical controlled trials, while in anesthesiology, 30% of the trials accomplished are clinical controlled trials.
As already mentioned, critical care research is plagued with confounding variables that are an important obstacle to assess any intervention, since the results are not just the result of these interventions, but also of multiple confounding factors such as co-morbidity, the spectrum of severity of the disease and co-interventions. Hence the short term results in critical care patients are the result of the performance of ICU care and of the severity of the disease, while the medium and short term outcomes, such as quality of life or psychological problems following a critical condition, express the result of ICU care plus the action of the whole health care system with outcomes of greater interest to patients. Hence the obvious conclusion is that short, medium and long-term outcomes must all be kept in mind (3).
Consequently, having the opportunity to become acquainted with trials involving the various interventions and different types of outcomes from those we are used to in anesthesiology trials, expands our vision with a view to develop innovative designs and to take into account other outcomes that should be assessed. Moreover, this allows for continuity between the patient's management in the OR and his/her follow-up in the ICU where some outcomes previously hidden in the OR may become visible.
Finally, we would like to urge you to expand the spectrum of publications and include papers related to critical care medicine and care of patients in the ICU.
1. U.S. National Library of Medicine, National Institutes of Health. Pubmed [Internet]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/. Consultado en marzo 10 de 2011.
2. Celis E. Panorama del cuidado crítico en Colombia y Latinoamérica. En: Ordoñez C, Ferrada R y Buitrago R. Cuidado Intensivo y Trauma. 2 ed. Colombia: Editorial Médica Distribuna; 2009. p.433 - 448.
3. Vincent JL. We should abandon randomized controlled trials in the intensive care unit. Crit Care Med. 2010;38:S534-8.
Conflicto de intereses: Ninguno declarado.
2. Celis E. Panorama del cuidado crítico en Colombia y Latinoamérica. En: Ordoñez C, Ferrada R y Buitrago R. Cuidado Intensivo y Trauma. 2 ed. Colombia: Editorial Médica Distribuna; 2009. p.433 - 448. [ Links ]
3. Vincent JL. We should abandon randomized controlled trials in the intensive care unit. Crit Care Med. 2010;38:S534-8. [ Links ]