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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.
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.
[The statement follows:]
STATEMENT OF DR. T. JAMES GALLAGHER
Mr. Chairman and Members of the Subcommittee,
James Gallagher, M.D., Professor and Chief, Division of
Critical Care Medicine, University of Florida College of
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
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
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.
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
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
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
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
climb and bed availability can be severely curtailed. In order to evaluate various therapeutic modalities, randomized,
prospective clinical studies must be performed.
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
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.
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
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
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.
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
The Society recommends that the
Subcommittee provide the NHLBI with the financial means to