Critical care : the official journal of the Critical Care Forum
-
Intensive care medicine probably requires the artificial boundaries of an intensive care unit to nurture and legitimize the specialty. The next major step in intensive care medicine is to explore ways of optimizing the outcome of seriously ill patients by recognizing and resuscitating them at an earlier stage. Some of these ways include better education of existing staff; earlier consultation; and automatic calling by intensive care staff to abnormalities identifying at-risk patients. Some of these interventions are currently being evaluated and results should soon indicate their relative effectiveness.
-
Editorial Comment
Remifentanil for analgesia-based sedation in the intensive care unit.
Providing effective analgesia and adequate sedation is a generally accepted goal of intensive care medicine. Due to its rapid, organ independent and predictable metabolism the short acting opioid remifentanil might be particularly useful for analgesia-based sedation in the intensive care unit (ICU). This hypothesis was tested by two studies in this issue of Critical Care. ⋯ The study by Muellejans et al. reports a multicenter trial comparing a remifentanil versus a fentanyl based regimen in ICU patients. With both substances a target analgesia and sedation level was reached, and no major differences were found when frequent assessments of the sedation level and according readjustments of doses were performed. These results are in accordance with other studies suggesting that the adherence to a clear analgesia-based sedation protocol might be more important then the choice of medications itself.
-
The role of research ethics committees (RECs) is currently strained by increases in the number of protocols that are in need of review, the scientific and funding complexities of the protocols, and a lack of clear standards for ethics assessment. This commentary describes the significance of these strains and calls for clarification of reviewer accountability. To maintain or, in many cases, to restore public and professional trust in the ethics of human research and in REC review of protocols, it is imperative that steps be taken to clarify the accountability of RECs and their individual members.