Research is a very important aspect of intensive care. It is only by conducting careful research trials that doctors can improve treatments and try new treatments that might turn out to be of great benefit to patients and make a big difference to the chances of survival. Research in intensive care is very difficult because unlike most medical research patients' permission usually can't be asked for beforehand as they don't know they are going to become suddenly unwell.
There are different types of research. There are observational studies where measurements or blood samples are taken and records kept of patients' condition and how it changes. These enable doctors to better understand illnesses and work out ways of treating them. There is no risk to the patient (apart from the risks associated with taking the measurements or samples which are usually absolutely tiny) as there is no treatment involved that is different from the normal treatment the doctors caring for the patient were planning.
There are also interventional studies. These can test an established treatment or treatments against each other or against not using the treatment. There are lots of treatments which should work because of the effect a monitor or procedure or drug is known to have in other conditions or different situations, but that have not been proven. If doctors everywhere genuinely don't know whether it is right to use the treatment or not then a study can be created to find out. This not knowing is called "clinical equipoise" and to conduct a study the doctors have to be convinced that each option has an equal chance of being the best thing to do to help the patient being enrolled in the study, otherwise they don't ask to enrol the patient.
Some studies test new treatments either against nothing, or more often "placebo" which is a fake treatment that looks identical to the real treatment or drug so that not even the doctors can tell which has been given. That way the doctors and nurses can be sure that they are not treating patients who have got the new treatment differently in any other way (this is called "bias"). After the study is complete the "code" is unlocked so the researchers can work out who was given which treatment. There are lots of safety systems used to make sure that if it is essential to find out which treatment the patient is getting it can be but then the patient is usually removed from the study.
Research ethics committees have to approve all research that is done on patients at either a local or a national level. These are a group of lay people, patients' representatives, ethicists, doctors and scientists who check through every study proposal in great detail. They request changes and revisions and make sure that the study planned not only is safe and is genuinely testing something we don't know but also that the way it is planned it is very likely to answer the questions it plans to. This makes sure that patients are not involved in research that doesn't produce results (although those results can still be negative).
Relatives, especially the next of kin, will often be approached by doctors or nurses on the intensive care unit to ask for permission to enrol patients in research studies. Relatives are asked if they know that a patient would not want to be involved in a study, and if they think that their relative would be happy to be involved in the study. This process is known as giving "assent" to the research. When the patient gets better they are then asked either in person or in writing if they are happy with this decision retrospectively and whether the information gathered on them as part of the study can be used. If they object to it then they are removed from the study and their results are not used. Since 1 April 2007 it is possible for patients to nominate a decision maker by lasting power of attorney, this person can now give formal consent on the patients' behalf.