Critical care trials which showed reduced mortality

Carlos A. Santacruz, Adriano J. Pereira et el published a systematic review in Critical Care Medicine about trials which showed reduced mortality.

All trials published since inception to April, 2019 were searched in MEDLINE and pubmed (Adult, multicenter randomized controlled). A total of 212 trials were included. 27 trials reported reduction in mortality. 16 trials reported increase in mortality.

Here is the summary of trials which showed improvement in mortality :-

Author, Year Study  Results p value
Amendola 2018 Goal directed therapy versus standard care in patient with acute kidney injury  31% in-hospital mortality in goal-directed therapy versus 51% in usual care 0.048
Annane 2018  Hydrocortisone and fludrocortisone versus placebo in sepsis  43%  versus  49% mortality in  steroid group 0.03
 De Jong 2016  Procalcitonin guided antibiotic therapy in patient with sepsis  20%  -28 day mortality  in procalcitonin group  versus  25% in usual 0.001
Guerin 2013  Prone versus supine position in ARDS  16% mortality in prone position versus  33% in supine position 0.001
Guntupalli 2013  Talactoferrin versus placebo in sepsis  21%  mortality in the treatment group  at 6 months versus 35% 0.03
Nava 2011 Noninvasive ventilation  versus standard practice  in acute hypercapnic respiratory failure Six months mortality was 11.7% in the treatment group versus 50% in the standard practice 0.014
Papazian  2010    Cisatracurium versus placebo in ARDS  90 day hospital mortality was 31% in treatment group versus 44.6%  in standard practice 0.04
Ferrer 2009 Non invasive ventilation after extubation in hypercapnic patients versus conventional oxygen in chronic respiratory failure 11% mortality in noninvasive ventilation group versus 31% 0.02
de Smet 2009 Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) versus usual care  Reduction of mortality by 3.5% in Selective oral  decontamination group 0.045
Ferrer  2006  Early noninvasive ventilation in ICU  to prevent reintubation  Intensive care unit mortality was 3% in noninvasive ventilation group  versus 14% 0.015
Villar 2006  high PEEP,  low tidal volume ventilation in ARDS  32% mortality in treatment group versus 53% 0.04
Panacek 2004  Afelimomab in  patient with severe sepsis and elevated interleukin 6 levels  43.6  % mortality in the treatment group versus  47.6% 0.041
Ferrer  2003   Noninvasive ventilation  during persistent weaning failure in ICU  90% ICU survival in the treatment group versus 59 % 0.04
 Ferrer 2003  Noninvasive ventilation versus high concentration oxygen therapy in acute hypoxic respiratory failure  18% ICU mortality in noninvasive group  versus  39% 0.028
Annane  2002  Hydrocortisone plus fludrocortisone  versus placebo in sepsis  53% , 28 day survival  in treatment group versus  63% 0.02
Bernard  2001 Drotrecogin alfa activated  versus placebo in patients with severe sepsis  24 .7% mortality in the treatment group versus 30.8% 0.005
Brower  2000  6 mL/kg of tidal volume versus 12mL per kg  in ARDS  31% mortality in  lower tidal volume group versus 39.8% 0.007
 Esteban 2000  Pressure control ventilation versus volume control ventilation in ARDS  51% Hospital mortality in the PCV group  versus  78%  in volume group 0.02
 Fagon 2000  Invasive management strategy (bronchoscopic protected specimen brush samples or bronchoalveolar lavage) for ventilator associated pneumonia  16.2%,  14 day mortality in the invasive group versus  26% 0.022
Nava 1998  Noninvasive mechanical ventilation in the weaning of patients with COPD who are on mechanical ventilation  60 day survival was 92% in non invasive pressure support  versus  72%  in invasive group 0.009
 Amato  1998  Protective ventilation strategy in ARDS( 6 mL/kg of tidal volume,  lower driving pressures with permissive hypercapnia)  38% mortality in protective group versus 71% in conventional Group 0.001
Baudo 1998  Anti thrombin III (in patients with low levels <70%) versus placebo in sepsis replacement therapy reduces mortality in the subgroup of septic shock patients only 0.03
Brochard 1995  Noninvasive ventilation  in acute  exacerbation of COPD  9% in  hospital mortality  in noninvasive group versus 29%  in standard 0.02
 Fisher 1994 Human recombinant interleukin-1 receptor antagonist
in the treatment of sepsis syndrome
 human recombinant IL-1ra  provided does related mortality benefit,  16% versus 44% in the highest dose 0.015
Gutierrez 1992 Gastric intramucosal pH as a
therapeutic index of tissue oxygenation in critically ill
 for those admitted with normal pHi, survival was significantly greater in the protocol than in the control group (58% vs 42%; p less than 0.01)  <0.01
Dominioni 1991  High-dose IgG versus placebo in sepsis  38% ICU mortality in IgG group versus 67% in placebo 0.05
Ziegler 1991 Gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody
against endotoxin
 30% mortality in treatment group for says 49% in placebo 0.014



As you can see, there  are whole bunch of trials,  which showed improved mortality with various interventions but  could not be reproduced in the future.   Any new intervention,   however promising , should be taken with a grain of salt.  Trial of vitamin C in sepsis is eagerly  awaited.

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