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Upcoming and urgent challenges in critical care research based on COVID-19 pandemic experience - 10/09/22

Doi : 10.1016/j.accpm.2022.101121 
Franck Verdonk a, b, Dorien Feyaerts b, Rafael Badenes c, Julie A. Bastarache d, Adrien Bouglé e, Wesley Ely f, Brice Gaudilliere b, Christopher Howard g, Katarzyna Kotfis h, Alexandre Lautrette i, Matthieu Le Dorze j, Babith Joseph Mankidy g, Michael A. Matthay k, Christopher K. Morgan g, Aurélien Mazeraud l, Brijesh V. Patel m, Rajyabardhan Pattnaik n, Jean Reuter o, Marcus J. Schultz p, Tarek Sharshar l, Gentle S. Shrestha q, Charles Verdonk r, Lorraine B. Ware d, Romain Pirracchio s, Matthieu Jabaudon t, u,
a Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Paris, Assistance Publique-Hôpitaux de Paris, France and GRC 29, DMU DREAM, Sorbonne University, Paris, France 
b Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, CA, United States 
c Department of Anaesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, Valencia, Spain 
d Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States 
e Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France 
f Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, at the TN Valley VA Geriatric Research Education Clinical Center (GRECC) and Vanderbilt University Medical Center, Nashville, TN, United States 
g Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, United States 
h Department Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland 
i Medical Intensive Care Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France 
j Department of Anaesthesiology and Critical Care Medicine, AP-HP, Lariboisière University Hospital, Paris, France 
k Departments of Medicine and Anesthesia, University of California, and Cardiovascular Research Institute, San Francisco, CA, United States 
l Service d’Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France 
m Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, and Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, Guys & St Thomas’ NHS Foundation trust, London, UK 
n Department of Intensive Care Medicine, Ispat General Hospital, Rourkela, Sundargarh, Odisha, India 
o Department of Intensive Care Medicine, Centre Hospitalier de Luxembourg, Luxembourg 
p Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands 
q Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal 
r Unit of Neurophysiology of Stress, Department of Neurosciences and Cognitive Sciences, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France 
s Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, CA, United States 
t Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France 
u iGReD, Université Clermont Auvergne, CNRS, INSERM, Clermont-Ferrand, France 

Corresponding author at: Department of Perioperative Medicine, CHU Clermont-Ferrand, iGReD, Université Clermont Auvergne, CNRS, INSERM, 58 rue Montalembert, 63000 Clermont-Ferrand, France.Department of Perioperative MedicineCHU Clermont-FerrandiGReDUniversité Clermont AuvergneCNRSINSERM58 rue MontalembertClermont-Ferrand63000France

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Highlights

COVID-19 pandemic challenged critical care research paving the way to redesign new research frameworks and strategies.
Worldwide availability of clinical and translational research networks are critical to develop treatments preventing or curing diseases during next pandemics.
Prediction at the individual level and rapid clinical responses are key factors to reduce healthcare burden.
Researchers and physicians should always prioritise realistic and ethical goals for both clinical care and research.

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Abstract

While the coronavirus disease 2019 (COVID-19) pandemic placed a heavy burden on healthcare systems worldwide, it also induced urgent mobilisation of research teams to develop treatments preventing or curing the disease and its consequences. It has, therefore, challenged critical care research to rapidly focus on specific fields while forcing critical care physicians to make difficult ethical decisions. This narrative review aims to summarise critical care research —from organisation to research fields— in this pandemic setting and to highlight opportunities to improve research efficiency in the future, based on what is learned from COVID-19. This pressure on research revealed, i.e., (i) the need to harmonise regulatory processes between countries, allowing simplified organisation of international research networks to improve their efficiency in answering large-scale questions; (ii) the importance of developing translational research from which therapeutic innovations can emerge; (iii) the need for improved triage and predictive scores to rationalise admission to the intensive care unit. In this context, key areas for future critical care research and better pandemic preparedness are artificial intelligence applied to healthcare, characterisation of long-term symptoms, and ethical considerations. Such collaborative research efforts should involve groups from both high and low-to-middle income countries to propose worldwide solutions. As a conclusion, stress tests on healthcare organisations should be viewed as opportunities to design new research frameworks and strategies. Worldwide availability of research networks ready to operate is essential to be prepared for next pandemics. Importantly, researchers and physicians should prioritise realistic and ethical goals for both clinical care and research.

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Keywords : COVID-19, Critical care, Research, Pandemic, Perspectives

Abbreviations : AI, ARDS, COVID-19, eCASH, EWS, FAIR, HICs, HFNO, ICU, ISARIC, LMICs, NIH, NIHR, PICU, RRT, UK-CTAP, UPH


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Vol 41 - N° 5

Article 101121- octobre 2022 Retour au numéro
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