Introduction

Because so many patients in critical care are very unwell, barriers to clinical research are created. Understandably, staff and patients (and their families) may feel that this is not the time for ‘experiments,’ and may be reluctant to deviate from practices thought optimal.

Cardiothoracic critical care is different from general critical care in that many of the admissions are planned and there is greater uniformity in the presentation of patients. On the other hand, the influences of surgery and anaesthesia have to be considered in any research design.

The need for research in critical care

Outcomes in critical care are improved by data-driven, evidence-based medicine (EBM).

Definition

One definition of EBM is that it is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. An important strategy to increase the implementation of EBM is the development and implementation of practice guidelines. This is a publishable form of research in itself that depends on understanding the principles of research in general. The steps involved include:

1. • Defining the population and intervention of interest;

2. • Conducting a systematic review of the literature;

3. • Incorporating other forms of evidence;

4. • Developing and implementing guidelines; and

5. • Auditing compliance, and monitoring predefined outcomes before and after the introduction of the guidelines.