Less is More: not (always) simple—the case of extracorporeal devices in critical care

Excerpt

The history of critical care is littered with examples of the “cost” of trying to normalize abnormal physiology during critical illness in the attempt to improve outcomes—supranormal oxygen delivery, liberal red cell transfusion, ventilation to normal blood gas parameters, and intensive glycemic control [1]. This sobering list of “failed” critical care interventions has bolstered the call for “Less is More” in the intensive care unit (ICU), as has been done in other medical specialties [2]. Indeed, the Critical Care Societies Collaborative have endorsed a list of five low-value care propositions as a part of broader choosing wisely initiative of the American Board of Internal Medicine (ABIM) Foundation. In fact, many of these evidence-based recommendations promulgating restraint have been associated with improved outcomes. …