Research priorities in critical care medicine in the UK

Objectives: To establish priorities for research in critical care medicine in the UK using survey and nominal group (NG) techniques. Design: The senior doctor and nurse from 325 intensive care units (ICUs) in the UK were invited to contribute up to ten research questions relevant to intensive care organisation, practice or outcomes. These were then ranked twice using a Likert scale by a panel (nominal group) consisting of ten doc tors (two trainees) and two nurses from university teaching and district ge neral (community) hospitals. The first ratings were performed privately, an d the second after group discussion. Thirty questions, ten each with strong , moderate or weak support, were then returned for rating by the originatin g ICU staff and the results compared with those of the NG. Results: One hun dred eighty-five respondents (35.6 % university teaching, 62.1 % district g eneral, 2.3 % not stated) provided 811 questions of which 722 were research hypotheses. The most frequently identified topics were the evaluation of h igh dependency care, ICU characteristics, treatments for acute lung injury and acute renal failure, nurse:patient ratios, pulmonary artery catheterisa tion, aspects of medical and nursing practice, protocol evaluation, and int erhospital transfers. These were condensed into 100 topics for consideratio n by the NG. Discussion and re-rating by the group resulted in strong suppo rt being offered for 37 topics, moderate support for 48, and weak support f or 21. Following circulation of ten questions from each category, nine ques tions achieved strong support from both ICU staff and the NG. These were th e effect on outcomes from critical illness of early intervention, high depe ndency care, nurse:patient ratios, interhospital transfers, early enteral f eeding, optimisation of perioperative care, hospital type, regionalisation of paediatric intensive care and the use of pulmonary artery catheters. The absence of any questions relating to interventions targetting mediators of the immune-inflammatory response could be a consequence of the failure of recent studies in sepsis to demonstrate benefits in outcome. Conclusions: The intensive care community in the UK appears to prioritise r esearch into organisational aspects of clinical practice and practical aspe cts of organ-system support. Health services research and the biological sc iences need to develop collaborative methods for evaluating interventions a nd outcomes.