Basic science is needed to lay the foundations for the care of tomorrow. Clinical outcome research is necessary to apply todays knowledge to the care of todays children. Economic pressures, and the demands of critically ill children will further restrict basic and clinical scientific research. The effort in this direction must be optimized and shared to assure future improved outcomes for critically ill children. Improving the quality of care requires shared research.
Clinical research is central to the progress of clinical medicine.
In a market environment providing the best care in the most efficient way is a national priority. These RCTs are expensive and logistically complex because they rely on manual data acquisition and comparison. Unless clinical equipoise is real within the study domain RCTs are fraught with ethical problems. The current situation is that the vast majority of clinical decisions are made by biased interpretation, albeit well intentioned, of clinicians acting on individual anecdotal experiences which are imprecisely remembered and from which, more often than not, wrong inferences can evolve. This form of medieval practice can only be dispelled by the provision of randomized prospective patient management protocols coordinated in multiple ICUs involving large numbers of patients.