Clinical trials in patients with the acute respiratory distress syndrome: Burn after reading

Excerpt

Burn After Reading is a film written and directed by the Coen brothers which was released in 2008 (http://​en.​wikipedia.​org/​wiki/​Burn_​After_​Reading). The plot is seemingly without direction and is based upon computer files, medical records, numerical data, money, exchange of information, and erratic behaviors. Everything ends badly. Analysts of the Central Intelligence Agency made attempts to understand what really happened in the film and concluded that although individually everything sounded important, as a whole everything was meaningless. This is exactly how we feel after reading the review by Tonelli et al. [1] of 159 randomized controlled trials (RCTs) and 29 meta-analyses of trials in patients with acute respiratory distress syndrome (ARDS). On first glance this review appeared to be an excellent summary of ARDS research which we, as clinicians involved in the field, were very keen to read, but which ultimately left us still looking for more. After 25 years and hundreds of millions of euros/dollars of clinical research funding, only three specific interventions have been found that can decrease ARDS mortality, namely, the use of low tidal volumes, prone positioning, and neuromuscular blockade early in the course of severe ARDS. According to Tonelli et al., the survival benefit of these specific interventions has only been demonstrated in a single RCT for each intervention [2‐4], without any further validation or confirmatory trial. …