Evaluation of Patients With Critical Illness

This protocol is designed as a training study, to permit evaluation and treatment of subjects with critical illnesses. A data base, not otherwise obtainable, will be collected of disease processes related to critical illness. Observation of the short-term effects of intensive care interventions will also take place. Minimal studies scheduled for each admission will include a medical history and physical examination, monitoring of hemodynamic status, routine laboratory tests, and evaluation for possible causes of the critical illness. Treatment plans will be individualized for each patient's condition, and the number and length of additional visits and diagnostic evaluations will vary accordingly. Any medical care recommended or provided to the patient will be consistent with routine standards of practice as outlined in Clinical Center (CC) and Critical Care Medicine policies. In selected patients, blood samples may be stored for future research. The CC is a JCAHO-accredited medical facility with protocols both for standard medical care and also for research. The Critical Care team is made up of intensivists, critical care fellows, nurses, nurse practitioners, and a pharmacist. All of the intensivists are certified in one or more medical subspecialties including critical care and/or cardiology, infectious diseases, pulmonology, and anesthesiology. The CC Medical Intensive Care Unit (MICU) is a state-of-the-art facility that provides comprehensive care for patients with multi-organ failure, sepsis, and medical emergencies. There are daily multi-disciplinary rounds. Attending physicians are in-house during normal business hours and on-call at home at night. A MICU Fellow is always available in-house. Suitable candidates for this study could include critically ill patients with a diagnostic or therapeutic dilemma, an unusual presentation of disease, or a disease requiring novel therapy available at the CC. Because inter-hospital transfer of the critically ill may increase patient risk, patients will be accepted only if there is a likely medical benefit that outweighs the risk of transfer and if the risk of transfer is thought to be acceptable by both the referring and accepting physicians. Critically ill patients represent a vulnerable population because of serious illness that may affect their ability to make decisions. They must have an identified durable power of attorney designated for decision making, prior to transfer to the CC. The risks of this study include the risk of transfer of a critically ill patient from one facility to another and the risks of standard or accepted medical care. There may be no benefit to participation in this study. In addition to the care available through enrollment in this protocol, patients may also enroll in other NIH protocols if they wish. The establishment of this protocol will provide a means to evaluate and treat patients, and to generate hypotheses and protocols based on this clinical experience in critical illness.