Randomized Controlled Trials

In critically ill adults requiring renal replacement therapy, does higher intensity dialysis compared to lower intensity dialysis reduce mortality?

High intensity - no benefit. Risk hypophos, incr $ & workload, micronut & Abx clearance

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In mechanically ventilated and sedated patients, do Spontaneous Awakening Trials (SAT) in addition to Spontaneous Breathing Trials (SBT) reduce dependence on mechanical ventilation?

SAT + SBT > dec MV duration, ICU & hosp LOS. ?? Over sedation in control grp

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Intensive > no mort benefit, more hypotension, low K & phos

In adult patients with severe septic shock, does hydrocortisone versus placebo reduce mortality at 28 days?

No difference in mortality. This deviates from the results of Annane 2002. Hastened reversal of shock.

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90% immed & accurate Dx made with POCUS - single pathology, 2 exp clinicians

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No improvement in composite outcome

In adult patients with septic shock, does the addition of vasopressin infusion to a norepinephrine infusion compared to a norepinephrine infusion alone decrease mortality rate at 28 days?

No benefits but was underpowered for observed mortality rate. No increase adverse effects. Low vasopressin dose, high baseline MAP suggesting no refractory shock, internal validity issues due to post-randomisation exclusion.

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In patients with septic shock, is mortality affected by the use of adrenaline (epinephrine) alone in comparison to noradrenaline ± dobutamine?

The purpose of this clinical trial was to assess the efficacy of early decompressive craniectomy in patients with malignant MCA infarction.

Decompressive surgery (hemicraniectomy) for life-threatening massive cerebral infarction

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In patients with early ARDS, does continuous methylprednisolone compared to placebo reduce lung injury scores within 7 days?

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Improved mortality in more unwell pts. Poor A/E assessment. Mult study flaws

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Cons: decreased MV, ICU LOS. No diff 60d mortality, other organ failures

In patients with severe sepsis or septic shock, is the timing of first administration of antibiotics associated with the in-hospital mortality rate?

Decreased resp failure & ICU mortality. 90d mortality benefit in hypercapnia only

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