Randomized Controlled Trials

In critically ill patients who are at high risk for re-intubation, is high flow nasal oxygen non-inferior to non-invasive ventilation in reducing re-intubation and post-extubation respiratory failure?

HFNC > dec reintubation rates. No diff mortality. Frag Index 5. Baseline differences

In hypoxic adults presenting to the emergency department, does nasal high-flow oxygen compared to standard oxygen therapy reduce the need for advanced respiratory support?

No diff HFNP vs std O2 conversion to NIV or MV. No diff tolerance HFNP

In patients with convulsive status epilepticus, does the addition of therapeutic hypothermia to standard care improve neurological outcomes?

No change GOS-E < 5l; ICU or hospital mortality, LOS, seizure duration

In patients with severe sepsis does hydrocortisone compared to placebo prevent the development of septic shock?

No diff-ICU/hosp mort, LOS, MV, RRT, SOFA. Etomidate & steroid allowed pre

In adult mechanically ventilated patients, does inhaled heparin compared to inhaled saline or usual care reduce the incidence of ventilator acquired pneumonia (VAP)?

No benefit. Stopped early (futility). Poor generalisability (90% excluded)

In critically ill patients who are anaemic, does early administration of intravenous iron compared to placebo reduce the requirement for blood transfusion?

Inconclusive. No red PRBC. D/C Hb higher. Low proportion med pts

In patients with ARDS does open-lung ventilation compared with ARDSnet ventilation improve 60 day mortality?

Open lung vent > improved oxygenation, lung mech & driving p. No diff A/E, mort

Does intravenous vitamin C, hydrocortisone and thiamine in addition to standard treatment, improve mortality in ICU patients with severe sepsis or septic shock, compared with standard treatment alone?

Hyp gen only-red hosp mort, duration pressors, AKI.Improve PCT clearance

In patients with acute respiratory failure, does early delivery of a standardised ICU and hospital rehabilitation programme improve physical function and reduce hospital length of stay?

No diff in hosp LOS or QoL at hosp D/C, 2 or 4m

In patients who develop acute hypoxaemic respiratory failure after abdominal surgery, does non-invasive ventilation compared to standard oxygen therapy prevent the need for re-intubation?

6hrs/d NIV > reduced reintubation w/i 7d. (Frag index 2). No mort diff

In patients who have undergone major abdominal surgery does the application of high flow nasal cannulae compared with standard oxygen therapy, decrease the incidence of hypoxemia at one hour after …

No dec hypoxia. No mortality benefit

In critically ill adults, does conservative oxygen therapy compared to liberal oxygen therapy reduce mortality?

Sig mort benefit, less shock, liver failure, bacteraemia (stopped early-earthquake)

In patients with acute intracerebral haemorrhage, associated with antiplatelet therapy, does platelet transfusion compared with standard care reduce death or dependence?

Worse neuro o/c at 3 mnths with platelet transfusion (some trial weakness)

In patients with acute respiratory distress syndrome (ARDS), does the use of non-invasive ventilation (NIV) delivered by helmet compared to NIV delivered by face mask reduce the need for intubation?

Dec intubation, ICU LOS, hosp & 90d mortality. NNT 3 (Frag index 10). Stopped early

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No change mort Inc rad dose. 46% control ended up with whole body scan

In patients with a traumatic brain injury (TBI) and refractory intracranial hypertension, does decompressive craniectomy, result in more favourable mortality and neurological outcomes at 6 months, compared with barbiturate coma …

Crani > less mortality (6&12m), more PVS & disability-37% x-over med>crani

Is ultrasound guided percutaneous tracheostomy (PCT) a non-inferior technique compared with bronchoscopy guided PCT?

USE BOTH - US non-inferior major complications, 50% more minor Cx

Does early vasopressin use reduce the risk of kidney failure in patients with septic shock compared with norepinephrine?

Less RRT in vasopressin group but no difference in number of renal failure free days in all four groups. Low use of steroids.

In intensive care patients who require a central venous catheter (CVC), does the choice of insertion site affect the complication rates?

In critically ill patients requiring blood, does transfusion with "fresh" RBC's (stored for 8 days or less) compared with standard issue RBCs (stored 2-42 days) reduce 90 day mortality?

No diff in 90d mortality - incl subgroup analysis

Early Versus Late Tracheostomy for Critically Ill Patients - a Meta-Analysis

In healthy adults taking either apixaban (ANNEXA-A) or rivaroxaban (ANNEXA-R) does andexanet alfa compared to placebo normalise anticoagulation?

Adexanet > rapidly restores Xa activity, thrombin. Reduces unbound Xa inhib fraction

In patients with ST-elevation-myocardial infarction (STEMI), without hypoxia, does receiving supplemental oxygen compared with no supplemental oxygen reduce early myocardial injury?

In adult ICU patients on beta-lactam antibiotics, does continuous infusion compared to intermittent bolus increase survival?

In elective surgical patients with atrial fibrillation who are suspending their normal warfarin peri-operatively, does no bridging anticoagulation compared to bridging anticoagulation with dalteparin increase the incidence of thromboembolism or …

Placebo non-inferior. Exlcude high risk srugery, mech valves. Low CHADS2 score