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Third, the research efforts in critical care are vast. Certain key areas should be pursued with increased interest. Critical care medicine is a multidisciplinary specialty, and research efforts should be cognizant of the fact that surgeons, pediatricians, anesthesiologists, and basic scientists interested in critical care work together to solve the common problems encountered in the ill.

Many of the most important questions facing critical care medicine have not been investigated. Each year 100,000 patients suffer severe overwhelming sepsis or infection, and the resulting shock and multiple organ failure remain as the underlying core problems causing death, severe complications, and prolonged stay in the ICU.

As a result, costs continue to climb, and bed availability can be severely curtailed. Multicenter trials will increase not only the size of the studies but can insure more rapid completion as well as less biased and more powerful results.

Each year in this country over 50,000 individuals die as a result of complications from severe brain injury following trauma or ruptured blood vessels in the brain. Another 50,000 are permanently disabled. The vast majority are young and active members of the work force. Multicenter trials can be carried out to evaluate very common, critical illnesses. In fact, in 1983, NIH Consensus Conference in Critical Care Medicine recommended that such randomized studies can and should be conducted.

Not only must mortality be reduced, but the length of hospital stay and complications all impact on bed availability as well as overall cost. By the nature of their illness, critically ill patients draw heavily on hospital resources far out of proportion to the size of their population.

The society believes that only through an increase in appropriations substantially above the President's request can the Heart, Lung, and Blood Institute meet its stated goals for advances in research and training. The society recommends that the subcommittee provide the NHLBI with the financial means to fully fund the greater percentage of research grants. We also hope that the committee will encourage the Heart, Lung, and Blood Institute to support increased research in the critical care injury and illness both at the intra- and extra-mural levels.

PREPARED STATEMENT

Mr. Chairman, on behalf of the Society of Critical Care Medicine, we appreciate the opportunity to present our views and stand ready to answer any questions you might have.

Thank you.

[The statement follows:]

STATEMENT OF DR. T. JAMES GALLAGHER

Mr. Chairman and Members of the Subcommittee,

I am

T.

James Gallagher, M.D., Professor and Chief, Division of

Critical Care Medicine, University of Florida College of

Medicine.

I appear today as President of the Society of

Critical Care Medicine to present our views on funding for the

National Heart, Lung and Blood Institute.

The Society is

particularly concerned with the current rate of awards for

approved grants, the lack of full funding of awards selected

for federal funding, and the lack of research generally in the

emerging field of critical care medicine.

Critical care medicine involves life threatening or

severe illnesses which often include interaction and

involvement of more than one organ system.

Care often requires

a combination of high technology support in the form of

respirators, drugs to support blood pressure and heart

function, specialized monitoring, the use of newer biologic

agents and other medications,

as well as around-the-clock

nursing care.

The Society of Critical Care Medicine is a 20-year

old, multidisciplinary organization formed by specialists from Anesthesiology, Internal Medicine, Pediatrics and Surgery. These specialists represent 90 percent of the Society's

membership.

It is the only professional organization devoted

exclusively to critical care.

The more than 5,000 members of

the society blend the knowledge, skill and technology from the

four medical specialities, as well as nursing and the allied

health professions, into a coordinated effort to achieve an

optimal outcome for critically ill or injured patients.

The

goals of the Society include improving effective and efficient

humane care for patients with acute life-threatening illnesses

and injuries, promoting and developing optimal facilities in

which critical care medicine may be practiced, and assuring

high educational standards in critical care medicine.

Increased Award Rate for Approved Grants

The Society recommends appropriations sufficient to

allow awards of research grants up to the 35th percentile of

approved research grant applications, with full funding of the

awards, thereby eliminating the so-called "downward

negotiation" of 7 to 10 percent typical after grants win

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the Society is the fact that new grants, often applied for by

young scientists who represent the future of our field, would

be hard pressed for federal funding.

Critical care research is

still a comparatively new field and would suffer greatly under

this budget.

The Society is also concerned about the proposal to

reduce the duration of grants to four years, and instead

supports the NHLBI proposal to stabilize the proportion of five

year grant awards at a fixed level.

This will create a balance

of stabilization of funding especially for clinical studies, and an opportunity for new investigators in terms of the

competing pool of grants.

Expanded Research in Critical Care

Research efforts in critical care are vast, yet

certain key areas should be pursued with increased interest.

Critical care medicine is a multidisciplinary subspecialty, and research efforts should be more cognizant of this

characteristic.

The Society recommends that increased interest

should be paid to multidisciplinary teams of internists,

surgeons, pediatricians, anesthesiologists and basic scientists

interested in critical care who work together to solve the

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climb and bed availability can be severely curtailed. In order to evaluate various therapeutic modalities, randomized,

prospective clinical studies must be performed.

These studies

may be difficult to carry out within a single unit or

institution beause of the ethics and logistics of patient

consent, as well as the need to act quickly. Multicenter trials

increase not only the size of the study, but can

ensure more

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following trauma or rupture of blood vessels in the brain;

another 50,000 are permanently disabled.

The vast majority are

young and active members of the work force.

The complex

interaction of the brain with other vital organs after such

injury underlines the need for multidisciplinary, multicenter

investigations of these critical illnesses which have such a

devastating impact on so many productive members of society.

If multicenter trials can be performed evaluating

thrombolytic therapy in acute myocardial infarction, then they

can be carried out to evaluate very common critical illnesses.

In fact, the 1983 NIH Consensus Conference on Critical Care

Medicine recommended that such randomized studies can be

conducted by enrolling more than one ICU or institution to

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investigation must be carried out by physicians who are trained

in the care of critically ill patients and know how to perform

investigations on these same patients.

More emphasis needs to

be placed on the training and subsequent support of such academic critical care physicians.

Many previous studies in critical care medicine used

improvements in physiological perimeters as the primary outcome

variable.

More emphasis needs to be placed on the most

important outcomes, i.e. decreased severe morbidity and/or

mortality. Not only must mortality be reduced, but length of hospital stay and complications all impact on bed availability,

as well as overall cost.

By the nature of their illnesses,

critically ill patients draw heavily on hospital resources far

out of proportion to the size of their population.

Conclusion

The Society of Critical Care Medicine believes that

only through an increase in appropriations substantially above

the President's request can the NHLBI meets its stated goals

for advances in research and training for cardiac and

respiratory research.

The Society recommends that the

Subcommittee provide the NHLBI with the financial means to

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