Michael A Gillies1, Michael Sander2, Andrew Shaw3, Duminda N Wijeysundera4, John Myburgh5,6, Cesar Aldecoa7, Ib Jammer8, Suzana M Lobo9, Naomi Pritchard10, Michael P W Grocott11, Marcus J Schultz12,13, Rupert M Pearse14. 1. Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK. michael.gillies@ed.ac.uk. 2. Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, Justus-Liebig-University, Giessen, Germany. 3. Department of Anesthesiology, Vanderbilt University Medical Centre, Nashville, TN, USA. 4. Department of Anesthesia, University of Toronto, Toronto, Canada. 5. Department of Intensive Care Medicine, St George Clinical School, University of New South Wales, The George Institute for Global Health, Sydney, Australia. 6. The George Institute for Global Health, Newtown, Australia. 7. Department of Anaesthesia and Surgical Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain. 8. Department of Clinical Medicine, University of Bergen, Bergen, Norway. 9. Intensive Care Division, Hospital de Base de Sao Jose do Rio Preto, Sao Paulo, Brazil. 10. Patient, Carer and Public Representative, London, UK. 11. Respiratory and Critical Care Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, SO16 6YD, UK. 12. Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology (LEICA), Academic Medical Center, Amsterdam, Netherlands. 13. Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand. 14. Queen Mary University London, London, UK.
Abstract
INTRODUCTION: Surgical treatments are offered to more patients than ever before, and increasingly to older patients with chronic disease. High-risk patients frequently require critical care either in the immediate postoperative period or after developing complications. The purpose of this review was to identify and prioritise themes for future research in perioperative intensive care medicine. METHODS: We undertook a priority setting process (PSP). A panel was convened, drawn from experts representing a wide geographical area, plus a patient representative. The panel was asked to suggest and prioritise key uncertainties and future research questions in the field of perioperative intensive care through a modified Delphi process. Clinical trial registries were searched for on-going research. A proposed "Population, Intervention, Comparator, Outcome" (PICO) structure for each question was provided. RESULTS: Ten key uncertainties and future areas of research were identified as priorities and ranked. Appropriate intravenous fluid and blood component therapy, use of critical care resources, prevention of delirium and respiratory management featured prominently. CONCLUSION: Admissions following surgery contribute a substantial proportion of critical care workload. Studies aimed at improving care in this group could have a large impact on patient-centred outcomes and optimum use of healthcare resources. In particular, the optimum use of critical care resources in this group is an area that requires urgent research.
INTRODUCTION: Surgical treatments are offered to more patients than ever before, and increasingly to older patients with chronic disease. High-risk patients frequently require critical care either in the immediate postoperative period or after developing complications. The purpose of this review was to identify and prioritise themes for future research in perioperative intensive care medicine. METHODS: We undertook a priority setting process (PSP). A panel was convened, drawn from experts representing a wide geographical area, plus a patient representative. The panel was asked to suggest and prioritise key uncertainties and future research questions in the field of perioperative intensive care through a modified Delphi process. Clinical trial registries were searched for on-going research. A proposed "Population, Intervention, Comparator, Outcome" (PICO) structure for each question was provided. RESULTS: Ten key uncertainties and future areas of research were identified as priorities and ranked. Appropriate intravenous fluid and blood component therapy, use of critical care resources, prevention of delirium and respiratory management featured prominently. CONCLUSION: Admissions following surgery contribute a substantial proportion of critical care workload. Studies aimed at improving care in this group could have a large impact on patient-centred outcomes and optimum use of healthcare resources. In particular, the optimum use of critical care resources in this group is an area that requires urgent research.
Entities:
Keywords:
Intensive care; Perioperative medicine; Surgery
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