?? Paper of the day
Prashant Nasa
Intensivist-Anaesthesiologist II Editor: Rational use of IV Fluids in Critically ll PROVE Network -Delphi Methodology II Fluid and Oxygen are Drugs
Summary:
The article "Positive Single-Center Randomized Trials and Subsequent Multicenter Randomized Trials in Critically Ill Patients: A Systematic Review" evaluates the reproducibility of survival benefits observed in single-center randomized controlled trials (sRCTs) in critically ill patients by subsequent multicenter randomized controlled trials (mRCTs).
?? takeaways:
1??Most survival benefits observed in sRCTs were not replicated by mRCTs, with the majority of mRCTs reporting neutral results on mortality.
2?? Only a small proportion of sRCTs were followed by mRCTs replicating a significant mortality reduction, while one sRCT showing intensive glycemic control contradicted by a subsequent mRCT documenting a significant mortality increase.
3??Clinical guidelines have included recommendations based on positive results of sRCTs, but over time, some interventions have been removed or suggested against in the most recent versions of relevant guidelines.
Limitations:
1. The discrepancies in results between sRCTs and mRCTs may be attributed to the inherent limitations of sRCTs, such as biases due to local effects, inadequate blinding, and a low fragility index.
2. Single-center trials may deliver larger treatment effects than multicenter trials, potentially influencing the reproducibility of survival benefits in subsequent mRCTs.