More randomized controlled trials in acute lung injury? Not so fast, my friend.

摘要

Negative clinical trials have predominated in critical care research over the past decade (1). Since the landmark Acute Respiratory Distress Syndrome Network study confirming the benefit of lung-protective ventilation over traditional ventilation for patients with acute lung injury (ALI) (2), the critical care field has attempted to further refine the management of ALI. Some therapies such as higher positive end-expiratory pressure, corticosteroids, and prone positioning have been studied in multiple randomized controlled trials that were unable to detect a difference in mortality between the intervention and control arms (3). Subsequent meta-analy-ses suggested benefit in sicker patients (4-6), yet questions remain regarding the role of these interventions (3, 7, 8). This path to refining the management of ALI has certainly been costly and inefficient. How might we reduce the costs and accelerate the pace of innovation in ALI management?