Is prophylaxis worse than treatment in the ICU?

Excerpt

Prophylaxis, an ancient practice in medicine and healthcare [1], has become a victim of its own success. It is now intrinsically rooted in medical behavior and stands out as a significant example of framing bias in patient care, i.e., a tendency to selectively display and promote positive aspects of an idea [2]. Most medical conditions are considered ominous, so prophylactic strategies are considered a priori good [1]. By avoiding disease, prophylaxis sounds better than cure. This rationale is present in several reports on the effects of prophylactic treatments, which use optimistic jargon to compel the reader, including magnification of the problem to be prevented, inappropriate measurement of adverse events, quoting the number of lives saved, number of events avoided, and numbers needed to treat [3‐6]. It is uncommon to see the same focus on the direct harms of prophylaxis. These are rarely adequately reported, and uncertainty is not always acknowledged. Indirect harms, including those that affect patient care by draining workforce time or increasing costs, are even less frequently reported. Ventilator bundles to prevent adverse events associated with mechanical ventilation—which are mostly comprised of low-quality evidence interventions—is for example very time consuming [7]. However, this does not mean that all prophylaxis is useless. We perform many simple prophylactic actions in daily clinical practice, i.e., fixation of devices, tubes, drains, and catheters, communication with patients and relatives, hand washing, and cleaning of rooms. The benefits of such prophylactic intervention may not always be obvious, but they often add value to patients, relatives and society. …