When I was a surgery resident in the 1990s, I learned a remarkable amount during my intensive care unit (ICU) rotations. Amongst the lessons learned was that norepinephrine is a bad drug that should essentially never be used—so bad, in fact, it was called “leave ‘em dead.” I was taught that expanding the lungs with big breaths is necessary in acute respiratory distress syndrome, otherwise they will collapse, which will decrease the amount of oxygen we can deliver. I was taught that sepsis is an inflammatory disease in which a large proinflammatory response is followed some time later by an anti-inflammatory response, and if we could only block the initial proinflammatory response, patients would survive. Along the same lines, I was taught that injecting lipopolysaccharide (which is part of the cell wall of gram-negative bacteria) into various animals represents a highly clinically relevant model of sepsis.
The commonality of each of these lessons is that each has been proven to be wrong over the ensuing 15 years. Following some of these well-accepted teachings likely led to excess mortality. It also led to billions of dollars in clinical trials that failed to help their intended patient population.
Does this mean that I somehow had flawed teachers? Of course not. I had the privilege of learning from some of the true visionaries in critical care, such as current Critical Care Medicine editor-in-chief (and past Society of Critical Care Medicine [SCCM] President) Tim Buchman and legendary sepsis researcher Richard Hotchkiss. So why has clinical care and our understanding of the science of critical illness changed so much and so rapidly?
The answer, of course, is research. It starts with a single individual or team asking a simple question. And there are as many (or more) questions as there are critically ill patients. The question could be about whether one treatment is better than another. Or which signaling pathway is important. Or what long-term outcomes follow an ICU stay. Or how common a disease is. The unifying thread of performing research is someone posing a question we don’t know the answer to, in an attempt to improve our understanding and improve patient care in the future.
Our mission at SCCM is to secure the highest possible care for all critically ill and injured patients. Research of all types—basic science, translational, clinical, health services, outcomes, epidemiological—directly serves our mission because, ultimately, it serves our patients. Because of this, SCCM embraces research as a core part of who we are. A few years ago, then SCCM President Cliff Deutschman wrote in this space about a new strategic plan to increase the profile of research within our organization. As a continuation of our multiyear plan, I have been honored this year to announce some exciting new initiatives to let our membership know that we are putting our resources where our values lie.
First, we have been working with a host of partners to perform research ourselves. SCCM currently has $2.5 million in grant funding from the Gordon and Betty Moore Foundation, the Agency for Healthcare Research and Quality, the American Hospital Association, the Hellman Foundation, the European Society of Intensive Care Medicine, and the Adventist Health System. Our research projects range from signature programs like the Surviving Sepsis Campaign and ICU Liberation to newer initiatives, such as understanding how changes in bedside physiologic monitors might reduce noise and enhance patient safety to decreasing catheter-associated urinary tract infections.
Next, we have doubled the amount of money we are giving out in research grants. This is a bold move on our part, but one we are confident serves the needs of our membership. After broadening the scope of SCCM’s Vision Grant program two years ago, we saw a massive increase in applications. While a one-year alteration might have been random fluctuation, the fact that we saw this increase in applications two years in a row suggests a pattern—our members are hungry to do research and hungry for research support. The SCCM Council heard you clearly and acted to meet this priority.
But that’s not all. I highlighted the THRIVE program, which is directed toward post-intensive care syndrome (PICS), in my last presidential message in Critical Connections. This represents an exciting new direction for SCCM. We believe that PICS represents the next frontier in critical illness, but unfortunately we know perilously little about it. As such, in an effort to catalyze our understanding, we have committed to funding yet another research grant. This PICS-specific grant is above and beyond the doubling of our research funding and is reflective of our commitment to this critically important topic.
To all of this, we add our signature new research initiative: the SCCM-Weil Research Trust. There will be more on that in the next issue of Critical Connections when my entire president’s message will be dedicated to details about how we are looking to the future by honoring the legacy of our founder, Dr. Max Harry Weil.
For now, I want to leave you with this message: along with our ever-expanding educational programs, research represents a cornerstone of SCCM. Together, we will look for ways to expand our research footprint, because we are committed to the discovery and innovation it will take to help treat, or even prevent, critical illness in patients we have not yet had the opportunity to meet.