title: Clinical research ethics for critically ill patients: a pandemic proposal.
abstract: Pandemic H1N1 influenza is projected to be unprecedented in its scope, causing acute critical illness among thousands of young otherwise healthy adults, who will need advanced life support. Rigorous, relevant, timely, and ethical clinical and health services research is crucial to improve their care and outcomes. Studies designed and conducted during a pandemic should be held to the same high methodologic and implementation standards as during other times. However, unique challenges arise with the need to conduct investigations as efficiently as possible, focused on the optimal outcome for the individual patient, while balancing the need for maximal societal benefit. We believe that clinical critical care research during a pandemic must be approached differently from research undertaken under nonemergent circumstances. We propose recommendations to clinical investigators and research ethics committees regarding clinical and health services research on pandemic-related critical illness. We also propose strategies such as expedited and centralized research ethics committee reviews and alternate consent models.
authors.affiliation: International Forum for Acute Care Trialists (InFACT) Ethics Committee, Department of Medicine, McMaster University, Hamilton, Canada. debcook@mcmaster.ca
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
authors.forename: Karen
authors.initials: K
authors.lastname: Burns
authors.forename: Simon
authors.initials: S
authors.lastname: Finfer
authors.forename: Niranjan
authors.initials: N
authors.lastname: Kissoon
authors.forename: Satish
authors.initials: S
authors.lastname: Bhagwanjee
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
authors.forename: Rob
authors.initials: R
authors.lastname: Fowler
authors.forename: Nicola
authors.initials: N
authors.lastname: Latronico
authors.forename: John
authors.initials: J
authors.lastname: Marshall
mesh_terms: D016638:Critical Illness; D004196:Disease Outbreaks; D028744:Ethics Committees, Research; D032984:Ethics, Research; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human; D007258:Informed Consent