Evidence-based medicine and critical care.
Applying the best available scientific evidence to selecting the most appropriate action for the care of individual patients is not a novel concept. Nevertheless, in these times of exponential growth in medical literature, heavy time constraints on clinicians and increasing health care costs, this approach needed to be reemphasised. The promoters of evidence-based medicine have contributed significantly to this task, by making explicit the steps from the search for the best evidence (randomised controlled trials and meta-analyses) to its application to clinical practice. Moreover, they have developed and made available several invaluable tools for critical appraisal of the medical literature. To illustrate the usefulness of evidence-based medicine, we applied this approach to two clinical situations: (1) the decision whether to use NPPV instead of conventional ventilation in a patient with acute respiratory failure due to severe pneumonia; and (2) whether to administer albumin to critically ill patients with hypovolaemia, burns or hypoalbuninaemia. Finally, the limitations of evidence-based medicine and its main instruments, i.e. randomised controlled trials and meta-analyses, are briefly discussed.
Perrier
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Department of Medicine, Geneva University Hospital. Arnaud.Perrier@medecine.unige.ch
D000368:Aged; D003422:Critical Care / Q000592:standards; D019317:Evidence-Based Medicine / Q000592:standards; D005260:Female; D006801:Humans; D015201:Meta-Analysis as Topic; D011014:Pneumonia / Q000503:physiopathology / Q000628:therapy*; D011785:Quality Assurance, Health Care; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results