Randomized Controlled Trials

Loading...

Liberal > reduced mort & serious complications (composite o/c)

A prospective observational study. In patients with suspected acute coronary syndrome (ACS) does a novel accelerated diagnostic protocol (ADP) identify low risk patients suitable for discharge after a single high-sensitivity …

In adults with severe sepsis or septic shock, does 20% albumin solution with crystalloid fluid compared to crystalloid fluid alone reduce death with 28 days?

No benefit. Maintenance, not resus. Alb > more PRBCs

In adult patients with septic shock, does early goal-directed therapy (EGDT) compared with standard therapy reduce mortality at 90 days?

No 28d or 90d mortality benefit, MV dur, ICU LOS, RRT. Usual care > less ICU, rbc, CVC

In critically ill patients, does parenteral nutrition compared with enteral nutrition improve mortality?

No harm or benefit early PN. EN > more vomiting, low BSL. < 40% met daily calorific goals

Question not recorded

Loading...

Thrombolysis > reduced all-casuse mortality, increased major bleeding (esp >65yo)

#N/A

Question not recorded

Early hemicrani > dec mort, most mod-sev disability (mRS 0-4)

Observational. In patients with refractory ventricular fibrillation does the use of esmolol improve mortality?

Esmolol > improved mortality, not sig. ? Direct effect or confouder (hypoT). Consider use

In mechanically ventilated adults with acute respiratory distress syndrome (ARDS), does simvastatin compared to placebo reduce ventilator dependence?

No diff in vent free days, 28d mort, oygenation.Statins > more biochem A/E ,not serious

Can a clinical decision rule be derived and validated for use in the Emergency Department that allows immediate exclusion of ACS?

#N/A

Reduced incidence of invasive candidiasis - no sig difference

In patients with intermediate-risk/sub-massive pulmonary embolism (PE), does the addition of tenecteplase, compared with heparin alone improve the composite outcome of death and haemodynamic decompensation?

Mild haemodynamic benefit. No mort. benefit (not powered). 10x ICH, 5x major bleed

In adult patients with sepsis, does protocol-based care compared to usual care reduce death within 60 days?

No diff 60d mort, LOS, A/Es. More new RRT in in std Rx. No CVC, dobutamine, Hb<75 ok

In patients with severe pancreatitis, does early enteral feeding compared with on-demand feeding reduce death or major infection?

3-4d delay to oral intake safe & effective. No improvement in mort or major infection

In patients with septic shock does a high target mean arterial pressure (MAP), compared to a low target MAP, improve mortality?

No mortality difference but the subgroup with chronic hypertension had lower rates of AKI and dialysis. Underpowered because of lower than predicted mortality. Limited external validity due to use of steroids and protein C

In patients with acute kidney injury (AKI) and severe sepsis or septic shock, does extended daily haemofiltration (EDHF) compared with continuous venovenous haemofiltration (CVVHF) reduce time to renal recovery or …

No benefit EDHF over CVVHF (8-12h vs 24h)

In patients with submassive PE, does the use of tenecteplase + heparin, compared to heparin alone, improve patient orientated outcomes?

Nil sig. Complex composite primary outcome (PE or treatment related, 5d, w/i 90d)

In patients with septic shock, does blood transfusion at a lower or higher haemoglobin threshold improve mortality?

No diff mort or ischaemic events (ACS excluded, haem malig stratified)

Loading...

No diff hosp LOS. Trends toward mortality benefit. Needs large MC RCT

Does intravenous or nebulised MgSO4 improve symptoms of breathlessness and reduce the need for hospital admission in adults with severe acute asthma?

No diff iv or neb Mg > hosp w/i 7d, SOB at 2hrs (VAS), PEFR, LOS, MV. More N&V, dec BP

In patients with aneurysmal subarachnoid haemorrhage does induced hypermagnesaemia reduce the incidence of cerebral artery vasospasm?

Underpowered. High Mg > n/sig decrease vasospasm, inc NAd use, lower Ca

Loading...

No diff 28d mort. 90d mort confounded by HES use. Inc vol with crystalloids

In critically ill patients with relative contraindications to early enteral nutrition (EN), does providing early parenteral nutrition (PN), improve mortality?

No diff 60d mort or infection rates. Homogeneous usual care control, incl 40% PN