Are negative studies bad? – “Not at all” says Jeremy Bewley, newly elected Council member
by Jeremy Bewley, Consultant in Anaesthesia and Intensive Care
I’ve been a member of the ICS for over 20 years and was on the trainee committee at the turn of the century. I have fond memories of the meetings that we ran at the Belfry, Troon, Durham and Cheltenham. It was an exciting time for the specialty with the development of the UK intensive care training programme.
I became a Consultant in 2001. Roles have included: educational supervisor, ICM Board tutor, Training Programme Director, Regional Advisor and FICM examiner – but not at the same time!
the thing that has made me tick over the last 9 years is my ICM research team
However, the thing that has made me tick over the last 9 years is my ICM research team. It arose out of the Prowess shock trial and, while for many this Lilly sponsored trial is perceived as another failure, for me it was the start of a journey. I managed to persuade our finance manager to gamble on recruiting research nurses. They have become self-financing and have enrolled patients into over 35 trials.
The studies include small ‘home grown’ trials, commercial ones and large multicentre NIHR portfolio studies. It is the latter that have given me the most satisfaction. They have changed my practice and hopefully that of others. We were top recruiters in the UK nutrition trial – CALORIES and have just finished enrolling in the largest septic shock trial ever undertaken, ADRENAL (3800 patients), with results due in the next 12 months.
Now some may look back at ICM research and comment on the large number of so-called negative trials that we have participated in. This frustrates me, as without these studies, we would still be using activated protein C, oscillators and liberally prescribing salbutamol. Instead we can use vasopressin safely and can commence early TPN knowing that mortality will not increase. These studies have changed practice as they have pointed us in new directions such as: appropriate early use of beta-blockers, alternative approaches to ventilation, early goal directed therapy in sepsis, nutrition and tracheostomy timing.
So what do I want to achieve within the ICS regarding research?
let’s come up with a replacement for negative when we talk about trial results?
First let’s come up with a replacement for negative when we talk about trial results? Any suggestions? Secondly, think about ICM research as if we are entering a maze. We can make an educated guess as to which path to take but we will walk down a few dead ends, some longer than others, and yet each time we are nearing the middle!
So I want to encourage all ICUs to enter that maze and get involved in critical care research. It need not be just for academic units. All ICUs should gamble and employ research nurses to work towards recruiting most of their patients into research studies. Only by doing so will we continue to improve patient care.