Advances in the treatment of patients in intensive care can only occur as a result of research. Care of all patients is guided by the principles of medical ethics:
1. beneficence, i.e. acting for the patient's benefit;
2. non-maleficence, i.e. not intentionally doing harm;
3. autonomy, i.e. respect for a patient's right to self-determination, including to consent or otherwise to any procedure;
Research in intensive care is difficult for a number of reasons. Clinical situations are complex and it is often hard to compare patients. Each intensive care unit (ICU) attracts a differing population of patients depending on the activities of the hospital and the nature of the area where it is situated (e.g. inner city, suburban, or rural) and varying between countries. The numbers of patients with rare diseases seen in any one unit may be too small for valid generalizations and conclusions to be reached. This has led to the idea of multicenter trials and research which may have deficiencies due to non-homogeneity of patients.
Research workers are often under pressure to produce results, and unfortunately this has led to the occasional occurrence of dishonesty because of the need to be seen to be productive and the need to attract grants to continue research. This underlies the need for good control of research, usually mediated by ethics committees monitoring research projects and, it is hoped, the vigilance of editors of medical journals who ensure that only true, original, and ethical work is published.
Perhaps the greatest problem involved in research in intensive care is the question of consent which by definition must be informed, i.e. the patient must be able to make an informed decision on the risks and benefits of any procedure, research or otherwise. Patients in intensive care are frequently sedated and/or unconscious, either as a result of their disease or because of drug treatment, which makes informed consent impossible. A great deal of thought, time, and energy has gone into the development of means to obviate this problem of informed consent in intensive care, while safeguarding the rights and dignity of the patient.
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