Medicine of the Future in America

Intensive Care and Emergency Medicine: Our Failures

To complement and augment these studies, scoring systems (Acute Physiology and Chronic Health Evaluation, Simplified Acute Physiology Score, Sequential Organ Failure Assessment, and Therapeutic Intervention Scoring System) have been developed and have provided a level of sophistication and detail not available to any other speciality. In the United Kingdom, an ongoing audit has provided the necessary proof to convince the government into funding more critical care beds by demonstrating the impact of refused/delayed admissions, premature discharges, and nighttime discharges.
Many recent advances have occurred as a result of bench-to-bedside testing of hypotheses, and large collaborative clinical research networks. These efforts have had globally positive effects, yet we also acknowledge that many of our interventions have been deleterious (such as mechanical ventilation with high tidal volumes, RBC transfusions, and excessive sedation) [Table 1]. As we reflect on our achievements in intensive care medicine over the past 25 years, we should perhaps also briefly mention some of our failures. Link

The path of progress has not been smooth and, not infrequently, hopes have been dashed as promising approaches have been shown in randomized controlled trials to have no effect or even to worsen outcomes. Examples of such studies include the excessive use of inotropic agents to increase oxygen delivery; growth hormone administration in long-stay critically ill patients; infusion of the tumor necrosis factor receptor Fc fusion protein and the nitric oxide synthase inhibitor, NG-monomethyl L-arginine, to patients with septic shock; use of intratracheal surfactant in patients with ARDS; and infusion of diaspirin cross-linked hemoglobin in the treatment of severe traumatic hemorrhagic shock. Although not providing the hoped-for therapeutic panacea, these “failed” studies have nevertheless advanced the field of intensive care medicine.

This entry was posted in Intensive Care and Emergency Medicine and tagged ards, cardiopulmonary resuscitation, cardiovascular care, critical care, intensive care, invasive monitoring, mechanical ventilation, multiorgan failure, polytrauma, sepsis.
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