Do trials that report a neutral or negative treatment effect improve the care of critically ill patients? Yes

Excerpt

Over the last half-century, the emergence and evolution of critical care has made possible the conduct of incredibly complex lifesaving surgery and the recovery of untold thousands of critically ill medical patients who previously had no chance of survival [1]. Despite this success, most interventions delivered to critically ill patients were adopted based on physiological theory or “borrowed” from other settings, e.g., positive pressure ventilation from the operating room and fluid resuscitation from the infirmaries and battlefields of the world wars. While this approach was entirely appropriate in the early days of our specialty, it is now clear that many standard practices of the past, and some new ones, harmed the very patients they were designed to help. We know this predominantly because academic researchers have designed and conducted high-quality, robust, pragmatic randomised clinical trials (RCTs); many of the trials that have improved the care of our patients have reported neutral or negative treatment effects. …