DOI: 10.1097/01.sa.0000158563.25218.52
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Issn Print: 0039-6206
Publication Date: 2005/04/01
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Excerpt
(Anesth Analg, 99:566-572, 2004)
Department of Anesthesia and Perioperative Care and Cardiovascular Research Institute, University of California, San Francisco, CA.
A number of important clinical trials focusing on critically ill patients have been completed in recent years. These trials have been among the first critical care clinical trials to show mortality reduction in the critically ill. As in any adaptation of evidence-based medicine, it is important to examine the trials and ascertain whether the benefits demonstrated can be translated to the individual patient. In addition to the primary outcome, usually survival benefit, it is also important to look at cost-effectiveness. All of the trials examined in this review could demonstrate mortality reduction. Most focused on patients with severe sepsis, because this population has been associated with both frequent mortality and increased hospital costs. Some interventions, such as a small tidal volume mechanical ventilation in patients with acute lung injury or the administration of low-dose corticosteroids for patients with septic shock, are cost-effective and relatively simple to implement. Others, such as use of activated protein C in patients with severe sepsis or "tight" glycemic control in patients with hyperglycemia, require either major pharmaceutical expenditures or, possibly, additional health care personnel. Notwithstanding, the trials discussed represent significant advances in the field of critical care medicine and should at least be considered for implementation in all intensive care units.
