Franklin Hall

Franklin Hall

Contact Details

Franklin Hall


Significant outcomes of Critical Care

Preclinical research is essential if we want to understand the physiopathology and development of effective therapies for the management of critically ill patients.30 For instance, the confirmation of the acute pulmonary injury in ventilated animal models with high volumes was successfully translated into the clinical practice and made up the foundation of the actual protective ventilation methods. However, up to 75–90% of all the results from preclinical research published in high profile scientific journals – usually of etiological and physiopathological type, are not reproducible and, as of today, only a minimum part has been translated into substantial innovations that can be used at the patient's bedside. words counter for essays is also an instance of automated system.

As it occurs with preclinical research, the traditional clinical research focuses on analyzing the different biological manifestations of the disease (such as the cardiac output or the plasma cytokine levels). The problem here is that the scientific literature has continuously separated these physiopathological results (of interest for researchers) from the clinical results (of interest for the patient). Two of the most widely known fiascos here are the strategies to produce supranormal oxygen delivery, or the most recent early goal-oriented hemodynamic resuscitation. Many related research paper topics can be find online related to it.

From the perspective of patient-focused clinical research,36 these outcomes should be considered surrogate outcomes (or indirect evidence) of the truly significant clinical outcomes for the decision-making process such as survival, extubation after mechanical ventilation, quality of life after hospital discharge, or costs. If this indirect evidence does not translate into improved significant clinical outcomes, it leads to wasted clinical researches.

Another useless piece of clinical research occurs when one study poses one research question with relevant clinical outcomes on which we already have satisfactory scientific evidence.1,38 It has been estimated that 50% of the studies are designed without any references to prior systematic reviews, with the corresponding risk of generating redundant publications. For example, Fergusson et al.40 used one cumulative meta-analysis of 64 trials published between 1987 and 2002 to show that the effectiveness of aprotinin had already been established back in 1992 after conducting the 12th trial; this means that the following 52 trials could have been avoided with an adequate systematic review. Other than unnecessary, and ethically questionable, this clinical research is redundant which has led the civil society and some financial institutions to require systematic reviews on the topic under study before starting a new clinical trial.You can by and large find an cheap essay writing service to get essays made on the critical care Research point.

There has been a lot of discussion on what the most adequate clinical outcome is for clinical trials with critically ill patients. All-cause mortality is the most relevant outcome par excellence. In any case, mortality should relate to an adequate deadline that is consistent with the study pathology (for instance, mortality at 28 or 90 days),45 while taking into consideration the possible impact that the limitation of life-sustaining treatment (LLST) policies may have.

One of the difficulties of mortality is its dichotomic nature that increases dramatically the requirements of the sample size, particularly in situations of low incidence rates. Some have tried to solve this issue by developing combined outcomes (composite endpoints) such as the appearance of “death, infarction, or urgent reperfusion”, or “death or organic dysfunction”.47 However, combined outcomes are, sometimes, hard to interpret, can be easily manipulated by the researcher, and promote a rather optimistic standpoint of the results, which is why we should be cautious when it comes to interpreting them. For example, the use of the combined outcome “death, infarction, or urgent reperfusion” does not make a lot of sense if the differences reported are due to the differences in reperfusion only.The legit essay writing service makes stand-out essays on critical care Research.

Mortality is the only relevant outcome for the patient. Issues such as the ICU stay, the number of days on mechanical ventilation, or the quality of life after hospital discharge50 are other important outcomes as well that should be taken into consideration by the clinical practice guidelines when it comes to establishing recommendations.