Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr-Jun;33(2):312-319.
doi: 10.5935/0103-507X.20210040.

What outcomes should be evaluated in critically ill patients?

[Article in Portuguese, English]
Cassiano Teixeira  1 , Marcelo Kern  2 , Regis Goulart Rosa  3
Affiliations

What outcomes should be evaluated in critically ill patients?

[Article in Portuguese, English]
Cassiano Teixeira et al. Rev Bras Ter Intensiva. 2021 Apr-Jun.

Abstract
in English, Portuguese, Portuguese

Randomized clinical trials in intensive care prioritize disease-focused outcomes rather than patient-centered outcomes. A paradigm shift considering the evaluation of measures after hospital discharge and measures focused on quality of life and common symptoms, such as pain and dyspnea, could better reflect the wishes of patients and their families. However, barriers related to the systematization of the interpretation of these outcomes, the heterogeneity of measurement instruments and the greater difficulty in performing the studies, to date, seem to hinder this change. In addition, the joint participation of patients, families, researchers, and clinicians in the definition of study outcomes is not yet a reality.

Estudos clínicos randomizados em terapia intensiva priorizam desfechos focados em doença e não desfechos centrados no paciente. Uma mudança de paradigma considerando a avaliação de medidas após a alta hospitalar e medidas focadas na qualidade de vida e em sintomas comuns, como dor e dispneia, poderiam refletir melhor os desejos de pacientes e de seus familiares. No entanto, barreiras relacionadas à sistematização da interpretação desses desfechos, a heterogeneidade de instrumentos de medida e a maior dificuldade na execução dos estudos, até o momento, parecem dificultar essa mudança. Além disso, a participação conjunta de pacientes, familiares, pesquisadores e clínicos na definição dos desfechos dos estudos ainda não é uma realidade.

Estudos clínicos randomizados em terapia intensiva priorizam desfechos focados em doença e não desfechos centrados no paciente. Uma mudança de paradigma considerando a avaliação de medidas após a alta hospitalar e medidas focadas na qualidade de vida e em sintomas comuns, como dor e dispneia, poderiam refletir melhor os desejos de pacientes e de seus familiares. No entanto, barreiras relacionadas à sistematização da interpretação desses desfechos, a heterogeneidade de instrumentos de medida e a maior dificuldade na execução dos estudos, até o momento, parecem dificultar essa mudança. Além disso, a participação conjunta de pacientes, familiares, pesquisadores e clínicos na definição dos desfechos dos estudos ainda não é uma realidade.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Prevalence of randomized clinical trials evaluating critically ill patients with primary or secondary patient-centered outcomes, as well as their distribution based on the focus of the study. The definitions “including mortality” and “excluding mortality” refer to the evaluation of all studies involving critically ill patients (MV + nutrition + sepsis). The definitions “MV”, “nutrition” and “sepsis” refer to studies of specific populations. The definition “excluding mortality” refers to the evaluation of other outcomes, in addition to mortality. MV - mechanical ventilation.
See this image and copyright information in PMC

References

    1. Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis. Crit Care Med. 2014;42(3):625–631. - PMC - PubMed
    1. Zambon M, Vincent JL. Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest. 2008;133(5):1120–1127. - PubMed
    1. Pool R, Gomez H, Kellum JA. Mechanisms of organ dysfunction in sepsis. Crit Care Clin. 2018;34(1):63–80. - PMC - PubMed
    1. Donovan AL, Aldrich JM, Gross AK, Barchas DM, Thornton KC, Schell-Chaple HM, Gropper MA, Lipshutz AKM, University of California. San Francisco Critical Care Innovations Group Interprofessional care and teamwork in the ICU. Crit Care Med. 2018;46(6):980–990. - PubMed
    1. Halpern NA. Innovative designs for the smart ICU: Part 2: The ICU. Chest. 2014;145(3):646–658. - PubMed