Population
Intervention
RCTs
VExUS (2025)
Adult ICU Patients
Mixed medical and surgical ICU patients expected to be admitted for at least 24 hours.
Ultrasound
Point-of-care venous excess ultrasound (VExUS) grading
Assessment of IVC diameter and Doppler waveforms of hepatic, portal, and interlobular renal veins within 48h of admission and every other day.
65-trial (2020)
Adult ICU Patients
requiring vasopressors, > 65 years old
Permissive Hypotension
Standard Care
PEPTIC (2020)
Adult ICU Patients
ICU patients requiring invasive mechanical ventilation
PPI
Proton pump inhibitor
Histamine-2 Receptor Blocker
ICU-ROX (2019)
Adult ICU Patients
Requiring mechanical ventilation
Oxygen
Sats 91 - 96%
Standard Care
PreVent (2019)
Adult ICU Patients
Bag-mask Ventilation
BMV performed between induction and laryngoscopy
No ventilation between induction and laryngoscopy
SPICE 3 (2019)
Adult ICU Patients
Requiring mechanical ventilation
Dexmedetomidine
Dexmedetomidine infusion (1 - 1.5 µg/kg/hr)
Dexmedetomidine infusion 1 to 1.5µg/kg/hr
Standard Care
TARGET (2019)
Adult ICU Patients
Enteral Nutrition
Energy dense feed
Target rate of 1ml/kg of 1.5 kcal/ml (~1900kcal/day)
Enteral Nutrition
Standard feed
Target rate of 1ml/kg of 1kcal/ml (~1300kcal/day)
Skrobik (2018)
Adult ICU Patients
Delirium free
Dexmedetomidine
Dexmedetomidine nocturnal intravenous infusion
Dexmedetomidine nocturnal intravenous infusion
Placebo
SUP-ICU (2018)
Adult ICU Patients
at least 1 risk factor for GI bleeding
PPI
40mg Pantoprazole IV daily
40mg Pantoprazole IV daily
Placebo
TRANSFUSE (2017)
Adult ICU Patients
Requiring RBCs
RBCs
Transfusion of the freshest available blood ~12 days old
Transfusion of the oldest available compatible blood ~22d
Hernandez (2016)
Adult ICU Patients
At least 1 risk for re-intubation
Nasal High Flow
High-flow nasal oxygen
NIV
OXYGEN-ICU (2016)
Adult ICU Patients
>72 hours in ICU
Oxygen
Target SpO2 94%-98%
Standard oxygen therapy
TRACHUS (2016)
Adult ICU Patients
Tracheostomy
Ultrasound guided percut dilatational tracheostomy
Ultrasound guided PCT
Bronchoscopy guided
Andriolo (2015)
Adult ICU Patients
Risk of prolonged ventilation
Tracheostomy
Early
Tracheostomy
Late
Day 10 or later
PermiT (2015)
Adult ICU Patients
Enteral Nutrition
Permissive underfeeding
Caloric goal 40-60% of requirement, maintain protein requirement
Standard feed
THE Refeeding Syndrome TRIAL (2015)
Adult ICU Patients
hypophataemia
Enteral Nutrition
Restricted caloric management
No calorific restriction
CALORIES (2014)
Adult ICU Patients
Parenteral Nutrition
Total PN started within 36h of admission for 5 days
Enteral Nutrition
Early PN (2013)
Adult ICU Patients
Parenteral Nutrition
Early PN with contraindications to EN
PN within 24 hours of admission
Standard Care
TRACMAN (2013)
Adult ICU Patients
Risk of prolonged ventilation
Tracheostomy
Early
Tracheostomy within 4 days
Tracheostomy
Late
Tracheostomy day 10 or later
PRODEX/MIDEX (2012)
Adult ICU Patients
Dexmedetomidine
Dexmedetomidine 0.2-1.4 mcg/kg/hr
Propofol or Midazolam
EPaNIC (2011)
Adult ICU Patients
Enteral Nutrition
Started day 2
+
Parenteral Nutrition
Late parenteral nutrition
Started day 8
Parenteral Nutrition
Early parenteral nutrition
Started day 3
Determann (2010)
Adult ICU Patients
Tidal volumes
Low volumes
6 ml/kg
Tidal volumes
High volumes
10 ml/kg
PRORATA (2010)
Adult ICU Patients
Procalcitonin
Procalcitonin-based antibiotic care
PCT > 0.5 start antibiotics. PCT < 0.25 stop abx. PCT > 0.5 and increasing, change abx.
Clinical decision
NICE-SUGAR (2009)
Adult ICU Patients
Insulin
Intensive BSL control
BSL 4.5 to 6.0 mmol/L
Insulin
Conventional BSL control
BSL < 10.0 mmol/L
CULPRIT-SHOCK (2018)
AMI
Multivessel Coronary Artery Disease
Coronary Angiogram
Culprit-lesion only
Culprit-lesion treated first
All other lesions left untreated at time of initial procedure
Further staged revascularisation was recommended on the basis of patient’s clinical status and the presence of residual ischaemia on object testing
Coronary Angiogram
Multi-vessel
Culprit-lesion treated first
All other major coronary arteries with >70% stenosis of diameter (including chronic occlusions) treated
CHARLI (2021)
ARDS
Heparin
25 000 IU in 5 mL, administered using a vibrating mesh membrane nebuliser every 6 hours to day 10 while invasively ventilated
Placebo
RECOVERY-covid-19-dexamethasone (2020)
ARDS
COVID-19
Steroids
Dexamethasone
6mg daily dexamethasone for 10 days
Standard Care
EPVENT2 (2019)
ARDS
PaO2/FiO2 < 200
Transpulmonary Pressure
Transpulmonary pressure to titrate PEEP
ARDSnet protocol
PHARLAP (2019)
ARDS
Severe ARDS
Recruitment maneuvers
Open lung ventilation with recruitment maneuvres
Staircase RMs - 20 -> 30 -> 40 cmH2O. Stepwise PEEP titration, min 15 cmH2O
Recruitment manoeuvres not permitted
EOLIA (2018)
ARDS
MV < 7 days, Disease refractory to standard optimisation
VV ECMO
Standard Care
VV ECMO if SpO2 < 80% 6hrs
ART (2017)
ARDS
PaO2/FiO2 < 200
Recruitment maneuvers
Recruitment maneuvers + open lung ventilation
PEEP 25 (1min), then 35 (1min), then 45 cmH2O for 2 minutes
ARDSnet protocol
NIVAS (2016)
ARDS
Type 1 Respiratory Failure
NIV
NIV for acute respiratory failure post abdominal surgery
Standard oxygen delivery
OSCAR (2013)
ARDS
PaO2/FiO2 <200mmHg
High Frequency Oscillatory Ventilation
Ventilation frequency of 10 Hz
ARDSnet protocol
OSCILLATE (2013)
ARDS
PaO2:FiO2 <200mmHg
High Frequency Oscillatory Ventilation
High Frequency Oscillatory Ventilation
EDEN (2012)
ARDS
Enteral Nutrition
Trophic enteric feeds
6 days trophic (10 mL/hr) feeds
Enteral Nutrition
Full enteric feeds
6 days full feeds
ACURASYS (2010)
ARDS
PaO2/FiO2 < 150
NMJB
Early cisatracurium infusion
Cisatracurium 15mg bolus, then 37.5mg/hr for 48 hours
Placebo
EPVent1 (2010)
ARDS
PaO2/FiO2 < 300mmHg
Transpulmonary Pressure
TPP to titrate PEEP
ARDSnet protocol
Meduri 2007 (2007)
ARDS
Early ARDS
Steroids
Methylprednisolone infusion
Methylprednisolone infusion for 28 days
Placebo
ARDSnet (2000)
ARDS
PaO2/FiO2 < 300mmHg
Tidal volumes
Low volumes
6ml/kg
Tidal volumes
High volumes
12ml/kg
Meduri 1998 (1998)
ARDS
Steroids
Late Methylprednisolone
Methylprednisolone for 32 days from day 7
Placebo
COACT (2019)
Cardiac Arrest
Shockable rhythm without STEMI
Coronary Angiogram
Immediate angiography
Within 2 hours of randomisation
Coronary Angiogram
Delayed angiography
After neurological recovery
HYPERION (2019)
Cardiac Arrest
PEA arrest
Hypothermia
33°C compared to 37°C
33°C compared to 37°C for 24 hours
Normothermia
AIRWAYS-2 (2018)
Cardiac Arrest
Pre-hospital Cardiac Arrest
Supraglottic Airway
Paramedics randomised to SGA or ETT
Intubation
Jabre (2018)
Cardiac Arrest
Pre-hospital Cardiac Arrest
Bag-mask Ventilation
Bag-mask Ventilation
Intubation
PART (2018)
Cardiac Arrest
Pre-hospital Cardiac Arrest
Laryngeal Tube
Paramedics randomised to LT or ETT
Intubation
SHENFU (2017)
Cardiac Arrest
Post In-hospital Cardiac Arrest
Shenfu
Shenfu injection 100ml twice daily for 14 days
Standard Care
ALPS (2016)
Cardiac Arrest
VF/pVT
Antiarrhythmics
Amiodarone or lignocaine
amiodarone or lidocaine along with standard care
Placebo
ROC-CCC (2015)
Cardiac Arrest
Pre-hospital Cardiac Arrest
CPR
Continuous chest compressions
uninterrupted chest compressions
Interrupted chest compressions
TTM (2013)
Cardiac Arrest
GCS < 8, Out of Hospital Cardiac Arrest, Presumed cardiac cause
Hypothermia
36°C compared to 33°C
28 hours targeting 36°C, rewarmed 0.5°C per hour
Target temp 33°C
VSE (2013)
Cardiac Arrest
In-hospital cardiac arrest , vasopressor-requiring
Vasopressin
Vasopressin + adrenaline + methylprednisolone
Adrenaline + Vasopressin + Methyprednisolone
Adrenaline
Jacobs (2011)
Cardiac Arrest
Pre-hospital Cardiac Arrest
Adrenaline
Adrenaline 1mg every 3 minutes
Placebo
Olasveengen (2009)
Cardiac Arrest
Pre-hospital Cardiac Arrest
IV Medication
Pre-hospital IV medications
No IV Medication
Bernard (2002)
Cardiac Arrest
VF/pVT Arrest
Hypothermia
33°C for 12h within 2h of ROSC
33°C for 12h within 2h of ROSC
No temperature management
HACA (2000)
Cardiac Arrest
VF/pVT Arrest
Hypothermia
32–34°C for 24h
32–34°C for 24h
No temperature management
TRICS-3 (2017)
Cardiac Surgery
RBCs
Hb < 75
Transfuse for Hb < 75
RBCs
Hb < 95
Transfuse for Hb < 95
IABP-SHOCK-2 (2012)
Cardiogenic Shock
Acute MI with or without STE
IABP
Inserted either before or immediately after PCI
Standard Care
SHOCK (1999)
Cardiogenic Shock
Myocardial Infarction, STEMI or other ECG changes of ischaemia
Coronary Angiogram
Early angiogram
Emergency revascularization within 6hrs
Medical therapy
Medical stabilisation
Delayed revascularization after 54hrs
PEITHO (2014)
Pulmonary Embolism
Submassive PE
Anticoagulation
Heparin
Infusion
+
Thrombolysis
Tenecteplase
30-50mg bolus
Placebo
TOPCOAT (2014)
Pulmonary Embolism
Submassive PE
Anticoagulation
Heparin
+
Thrombolysis
Tenecteplase
Placebo
MOPETT (2013)
Pulmonary Embolism
Submassive PE
Anticoagulation
Enoxaparin
1mg/kg SC BD
+
Thrombolysis
tPA
10mg bolus, followed by 40mg within 2 hours (half standard dose)
None
ADRENAL (2018)
Sepsis
Steroids
Hydrocortisone 200 mg/day as a continuous infusion for 7 days
Hydrocortisone 200 mg/day as a continuous infusion for 7 days
Placebo
IDEAL-ICU (2018)
Sepsis
Failure stage of RIFLE
RRT
Start of RRT within 12 hours of documentation of ‘failure-stage’ acute kidney injury
Standard Care
LeoPARDS (2017)
Sepsis
Levosimendan
Levosimendan (0.05-0.2ug/kg/min) for 24 hours plus standard of care
Levosimendan (0.05-0.2ug/kg/min) for 24 hours plus standard of care
Placebo
VANISH (2016)
Sepsis
Vasopressin
Vasopressin (up to 0.06 U/min) + (Hydrocortisone or Placebo)
Vasopressin (up to 0.06 U/min) + (Hydrocortisone or Placebo)
Norepinephrine + (Hydrocortisone or Placebo)
BLING2 (2015)
Sepsis
Severe sepsis on B-lactam
Antibiotics
Continuous infusion
Antibiotics
Intermittent infusion
ALBIOS (2014)
Sepsis
Fluids
20% albumin on top of crystalloid
20% albumin on top of crystalloid
Crystalloid
ProCESS (2014)
Sepsis
EGDT
EGDT vs protocol based care
EGDT vs protocol-based vs standard of care
Standard Care
FEAST (2011)
Sepsis
Fluids
Albumin or saline bolus, 20-40ml/kg
Albumin or saline bolus, 20-40ml/kg
No bolus
Jones (2010)
Sepsis
Target Lactate
target lactate clearance
target lactate clearance
target ScvO2 > 70%
CORTICUS (2008)
Sepsis
Steroids
Hydrocortisone 50 mg QID for 5 days
Hydrocortisone 50 mg QID for 5 days
Placebo
VASST (2008)
Sepsis
Septic shock
Noradrenaline
>5 microg/min
+
Vasopressin
0.01-0.03 U/min
Noradrenaline
5 to 15 microg per minute
SOAP-II (2010)
Shock
MAP < 70 mmHg
Noradrenaline
+
Dopamine
Dopamine up to 20 mcg/kg/min then added noradrenaline
Noradrenaline
HAMLET (2009)
Stroke
malignant MCA infarction
Decompressive Craniectomy
decompressive craniectomy
Standard Care
DECIMAL (2007)
Stroke
malignant MCA infarction
Decompressive Craniectomy
large hemicraniectomy
Standard Care
DESTINY (2007)
Stroke
malignant MCA infarction
Decompressive Craniectomy
decompressive craniectomy
Standard Care
RELIEF (2018)
Surgical Patients
Risk of post operative complications
Fluids
Restrictive fluids
CSL bolus up to 5ml/kg,
then 5ml/kg/hr for surgery,
then 0.8ml/kg/hr for 24hrs
Fluids
Liberal fluids
CSL bolus 10ml/kg,
then 8ml/kg/hr for surgery,
then 1.5ml/kg/hr for 24hrs
CHEETAH (2017)
Surgical Patients
Preop LV dysfunction
Levosimendan
Levosimendan infusion
Levosimendan infusion
ITACTIC (2020)
Trauma Patients
RBCs
Use of viscoelastic haemostatic assay
Use of viscoelastic haemostatic assay
Use of conventional coagulation tests
CRASH-2 (2010)
Trauma Patients
within 8 hours of trauma, significant haemorrhage, risk of significant haemorrhage, sBP < 90 mmHg
TXA
TXA
TXA 1g/10mins then 1g/8hrs
Placebo
CRASH-3 (2019)
Traumatic Brain Injury
within 3 hrs of injury
TXA
TXA
TXA 1g over 10 mins, then 1g over 8 hours
Placebo
DECRA (2011)
Traumatic Brain Injury
ICP over 20 for 15 minutes
Decompressive Craniectomy
Decompressive Craniectomy
Standard Care
Bouderka (2004)
Traumatic Brain Injury
Tracheostomy
Early tracheostomy (Day 5/6)
Early tracheostomy (Day 5/6)
Prolonged endotracheal intubation