Evidence-based medicine in the ICU: important advances and limitations.
Evidence-based medicine (EBM) is an important strategy for assessing the vast amounts of published data and applying them appropriately to our patients. However, in intensive care medicine, there is a shortage of "gold standard" randomized controlled trial evidence to support (or not support) therapeutic decisions. In addition, even when well-conducted randomized trials have been performed, we are still left with unanswered questions. In the last 5 years, several clinical trials have yielded positive results with a number of interventions being shown to improve outcomes. Here, we will outline the limitations and advances of EBM in intensive care medicine, by discussing the key findings in the last few years from studies of therapeutic agents for ICU patients.
Department of Intensive Care, Erasme Hospital, Free University of Brussels, Brussels, Belgium. jlvincen@ulb.ac.be
Jean-Louis
JL
Vincent
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001803:Blood Transfusion; D003422:Critical Care; D019317:Evidence-Based Medicine; D006801:Humans; D007036:Hypothermia, Induced; D007328:Insulin / Q000627:therapeutic use; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control; D011486:Protein C / Q000627:therapeutic use; D011868:Radioisotopes / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000628:therapy; D018805:Sepsis / Q000188:drug therapy; D012772:Shock, Septic / Q000188:drug therapy
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007328:Insulin; D011486:Protein C; D011868:Radioisotopes; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated