Kapadia Farhad, Bharadwaj Shreya, Sharma Ritika
Department of Intensive Care, PD Hinduja Hospital & Medical Research Center, Mumbai, Maharashtra, India.
Department of Critical Care, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India.
Indian J Crit Care Med. 2024 Jun;28(6):533-551. doi: 10.5005/jp-journals-10071-24717.
The concept of "Less is more" has been gaining increasing awareness and acceptance in Critical Care. In 2017, we attempted to systematically answer the question "Can less be more in intensive care" with empirical data. We reviewed all the critical care randomized clinical trials (RCTs) between 1 January 2008 and 5 October 2016 in the New England Journal of Medicine (NEJM). This article attempts to repeat the earlier exercise using data from 5 October 2016 to 31 December 2023. This analysis of critical care RCTs in the NEJM has shown three findings. Approximately three-quarter of RCTs in critical care in the NEJM between 2008 and 2023 failed to show benefit or harm. In the years 2008-2016, patients in the intervention cohort had a higher mortality compared to controls, but in the years 2016-2023, the difference in overall mortality in patients in the intervention and control arms was not statistically significant. Compared to the years 2008-2016, in the years from 2016 to 2023, the number of RCTs showing harm decreased and those showing benefit increased.
Kapadia F, Bharadwaj S, Sharma R. Is "Less be More" Still a Valid Concept in Intensive Care? A Review of Critical Care Randomized Clinical Trials from the New England Journal of Medicine. Indian J Crit Care Med 2024;28(6):533-551.
“少即是多”的理念在重症监护领域正日益受到关注和认可。2017年，我们试图用实证数据系统地回答“在重症监护中少是否可以是多”这一问题。我们回顾了《新英格兰医学杂志》（NEJM）在2008年1月1日至2016年10月5日期间的所有重症监护随机临床试验（RCT）。本文试图利用2016年10月5日至2023年12月31日的数据重复之前的研究。对NEJM中重症监护RCT的分析显示了三个发现。2008年至2023年期间，NEJM上约四分之三的重症监护RCT未显示出有益或有害效果。在2008 - 2016年期间，干预组患者的死亡率高于对照组，但在2016 - 2023年期间，干预组和对照组患者的总体死亡率差异无统计学意义。与2008 - 2016年相比，2016年至2023年期间，显示有害的RCT数量减少，显示有益的RCT数量增加。
卡帕迪亚F，巴拉德瓦伊S，夏尔马R。“少即是多”在重症监护中仍然是一个有效的概念吗？对《新英格兰医学杂志》重症监护随机临床试验的综述。《印度重症监护医学杂志》2024；28(6):533 - 551。
