( sun tzu , the art of war , c.500 bc ) the challenge of conducting high - quality clinical studies in the critically ill population is widely recognised .
heterogeneity in patient populations and clinical practice , diagnostic uncertainty , concerns with consent , and the overlapping nature of the presenting illnesses are amongst the inherent difficulties
. influential studies in this population therefore increasingly involve multicentre , collaborative efforts using rigorously defined inclusion criteria and outcome measures  such projects aim to obviate the aforementioned difficulties and to reduce the influence of individual intensive care units ( icus ) and case - mix variations on the findings .
ultimately , the quality of the data justifies the logistical challenge involved . for this reason ,
the recent article from the newly - formed irish critical care trials group is a welcome announcement of a further such alliance .
the data presented describe 1,029 patients admitted to icu services in a 10-week period in 2006 , covering a slight majority of all icu beds in ireland .
the data include national specialist centres and university teaching hospitals , as well as regional units .
the overall pattern depicts a busy service , with 78% of admissions being emergent in nature , a mean sequential organ failure assessment score of 5.4 , and 70% of patients needing mechanical ventilation .
previous research in ireland  showing an icu bed occupancy rate of 97% , an unscheduled discharge rate of 23% , and frequent cancellation of elective surgery  is consistent with this pattern .
the icu readmission rate of 7.5% is perhaps attributable to these service realities  as indeed may be the failure to collect data in four of the 14 units that entered the study , including 23% of relevant patients . while accepting that the missing patient data compromise the validity of the findings , the outcomes nonetheless appear compatible with international standards and indeed are broadly indicative of the success of modern intensive care medicine .
the outcomes in the subgroups are more striking : over 75% of readmitted patients survived and , of the 93 patients with five or six systems failing on admission , just over one - half survived .
compatibility with international outcomes is perhaps most evident from those diagnostic categories where standard , consensus definitions are established . for severe sepsis ,
the icu mortality of 24% compares with a reported 35% in england , wales and northern ireland for severe sepsis in the first 24 hours . for acute lung injury / acute respiratory distress syndrome , the irish mortality was 32%  and the irish critical care trials group has previously shown that this is consistent with modern international studies in the protective ventilation era .
although the numbers are relatively small ( n = 289 ) , an icu mortality of 38% for renal failure compares unfavourably with the hospital mortality of 26.3% reported by hoste and colleagues using the same criteria . nonetheless , the study arguably further validates these rifle ( risk - injury - failure - loss - end stage ) descriptors as outcome predictors in acute renal dysfunction .
seasonal and regional variations can not be detected as data from a short collection period are pooled together .
the use of icu mortality alone as a measure of outcome is not ideal , and more meaningful outcome assessment tools including hospital mortality should be utilised in future projects ; for example , patients who were refused readmission and who might have gone on to die in hospital wards will appear as survivors in such a crude analysis .
future scientific publications should also avoid the irritation of new data introduction in the discussion of the findings .
the value of the present data will be more fully realised when the irish critical care trials group produces further , hypothesis - testing studies . having taken advice from the anzics critical care trials group , the irish critical care trials group set out to achieve this epidemiological study to provide baseline information for research planning .
the data provide insight into disease prevalence ( for example , of acute respiratory distress syndrome ) , and enable planning for the study duration and resource allocation once power analysis has indicated the size of the study population required .
the demonstration of the willingness of team members to cooperate and of the capacity of information systems to gather and collate such information is a further key to such studies and collaborations .
the authors identify an urgent requirement for audit resources to maintain the ambition shown by this study .
participation in the uk 's intensive care national audit and research centre would be one option , opening up the possibility of a uk / irish database .
the ability demonstrated by the irish critical care trials group study to establish a research ethos that straddles the relatively contentious border linking the irish republic with the united kingdom is scientifically encouraging .
icu : intensive care unit ; rifle : risk - injury - failure - loss - end stage .
 quality research , requiring large numbers of participants , in the intensive care unit ( icu ) population requires multicentre collaboration . 
 although logistically challenging , this methodology reduces the influence of individual units and has greater validity and broader relevance to patients and practitioners . 
 the nascent irish critical care trials group opens additional such opportunities . in the accompanying epidemiologic study , 
 the group present data gathered over 10 weeks of 2006 describing 1,029 patients , from 10 irish icus representing over one - half of ireland 's critical care bed capacity . 
 the data depict a busy service , with 78% of admissions being emergent and with a moderately high ( 7% ) readmission rate . while recognising that there were missing data , the outcomes in organ failure and sepsis  where international definitions exist  and the icu survival rate ( 83% ) were consistent with international standards . 
 the achievement of this planned first epidemiological step lays the foundation for the conduct of prospective scientific studies . 
 these studies might occur in ireland or in cooperation with other audit / scientific groups such as the uk 's intensive care national audit and research centre , the european critical care research network , or others . 
 this brings us a small step closer to the prospect of global , high - volume studies in critical care . 
None
Abbreviations
Competing interests