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Erschienen in:
15.11.2018 | Editorial
Focus on randomised clinical trials
Erschienen in: Intensive Care Medicine | Ausgabe 12/2018
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Randomised clinical trials (RCT) are the core of evidence-based medicine (EBM) because their results may inform clinical practice, either directly or after the uptake in systematic reviews and clinical practice guidelines. While the interpretation and translation of RCT results into clinical practice is complex [1, 2], the continued development, conduct and publication of RCTs advances our knowledge and care, even though the majority of trials produce neutral results. Importantly, the trials should have the highest possible internal and external validity to have full impact on clinical practice. In this article, we highlight recent RCTs published in Intensive Care Medicine (ICM). Their results add to what appears to be a constant theme in critical care, ‘less is more’ based on RCT results (Table 1) [3].
Table 1
Randomised clinical trials done in the ICU setting where the results indicated that doing less is as good or better than doing more
|
Intervention vs. control in the pivotal trial
|
Interventions that can be used less in the ICU
|
|---|---|
|
Lower vs. higher tidal volume in patients with ARDS: the ARMA trial
|
Less use of higher tidal volumes
|
|
Restrictive vs. liberal blood transfusion in general ICU patients with anaemia: the TRICC trial
|
Less use of blood transfusion
|
|
Low dose dopamine vs placebo in ICU patients with SIRS and early renal dysfunction
|
Less use of dopamine
|
|
Albumin vs. saline in general ICU patients: the SAFE trial
|
Less use of albumin
|
|
Strict vs. moderate glycaemic control in general ICU patients: the NICE-SUGAR trial
|
Less use of strict glycaemic control
|
|
HES vs. crystalloid in patients with sepsis: the 6S trial
|
No more use of HES
|
|
Higher- vs. lower-intensity CRRT in ICU patients with AKI: the RENAL trial
|
Less intensive CRRT
|
|
APC vs. placebo in ICU patients with persistent septic shock: the PROWESS shock trial
|
No more use of APC
|
|
Restrictive vs. liberal blood transfusion in ICU patients with septic shock and anaemia: the TRISS trial
|
Less use of blood transfusion
|
|
Targeted temperature management at 33 °C vs 36 °C in unconscious adult survivors of out-of-hospital cardiac arrest: the TTM trial
|
Less use of cooling to 33 °C
|
|
HFOV vs. standard ventilation in patients with moderate-to-severe ARDS: the OSCILLATE trial
|
Less use of HFOV
|
|
Early vs. late parenteral nutrition in ICU patients to supplement insufficient enteral nutrition: the EPANIC trial
|
Less use of early parenteral nutrition
|
|
Permissive underfeeding vs. standard enteral feeding in adult ICU patients: the PERMIT trial
|
Less use of early enteral nutrition
|
|
Pantoprazole vs. placebo in ICU patients at risk of gastrointestinal bleeding: the SUP-ICU trial
|
Less use of prophylactic pantoprazole
|