The document discusses clinical trials and research in intensive care. It notes the inadequate staffing and resources for ICUs. It then lists various interventions that have been tested in clinical trials for conditions like ARDS, sepsis and cardiac arrest, including tight glycemic control, nitric oxide, early goal directed therapy and therapeutic hypothermia. It emphasizes conducting primary research to better understand disease mechanisms and targeting interventions to patients that may benefit based on evidence.

1. Alexander Scott
ST7 Anaesthesia and ICM
Yorkshire and the Humber

2. Alexander Scott
ST7 Anaesthesia and ICM
Yorkshire and the Humber

5.  TRIUMPH
 Totally inadequate provision
 Woeful staffing
 Internationally ridiculous bed
occupancy
 Fantastic outcomes

6.  Tight Glycaemic Control
 Xigris
 Nitric Oxide
 Early Goal Directed Therapy
 Oscillation
 Therapeutic Hypothermia

7.  Tight Glycaemic Control
 Xigris
 Nitric Oxide
 Early Goal Directed Therapy
 Oscillation
 Therapeutic Hypothermia

8.  ARDS
 Sepsis
 Cardiac Arrest
 All comers!

9.  ARDS
 SOFA Scores
 Severe ARDS
 Sepsis
 Cardiac Arrest
 All comers!

10.  ARDS
 SOFA Scores
 Severe ARDS
 Sepsis
 Severe Sepsis
 Tachycardic Sepsis
 Cardiac Arrest
 All comers!

11.  ARDS
 SOFA Scores
 Severe ARDS
 Sepsis
 Severe Sepsis
 Tachycardic Sepsis
 Cardiac Arrest
 OOH VF
 OOH All comers
 Any arrest
 All comers!

12.  Two matched groups
 Only differences are the
intervention
 Yet. . . .

13.  Equipoise
 We may harm you
 We might kill you
 Oscillate
 You are doing something to help
others and maybe yourself

14.  What if. . . .?

16.  Bacterial
 Viral
 Fungal
 Parastic
 Secondary
 Bacterial
 Viral
 Fungal
 Parasitic
 Idiopathic

17.  Oscillation is the perfect thing for
TRALI
 Nitric oxide is perfect for gram
negative ARDS
 Xigris is perfect for viral
inflammatory change

18.  We have very little money.
 Every government plan for the NHS
centres around one word:
 Value

19.  We now have more than ever an
ethical duty to squeeze maximum
value.
 How to we do this?

20.  Target our Research
 Access to ITU
 Target those patients with
evidence of benefit
 Primary science – mechanisms and
pathophysiology.

21.  Improve delivery at a clinical level.
 Set ourselves for the future by
understanding pathophysiology.
 Stop testing interventions on
consequences: understand causes.