Clinical Q, Bottom Line,Primary Outcome 1)Critical Illness

Question 1

BICAR-ICU Clinical Q

Answer 1

In acutely ill patients in the intensive care unit with severe metabolic acidosis, does treatment with sodium bicarbonate reduce all-cause mortality at day 28 or the presence of ≥1 organ failure at day 7?

Question 2

BICAR-ICU Bottom Line

Answer 2

n this study, ICU patients with severe metabolic acidosis treated with sodium bicarbonate did not have improvement in all-cause mortality at day 28 or the presence of ≥1 organ failure at day 7. However, patients with AKI (a pre-specified subgroup) did experience a reduction in this endpoint.

Question 3

BICAR-ICU Primary Outcome

Answer 3

All-cause mortality at day 28 or the presence of ≥1 organ failure at day 7

Question 4

MIND-USA Clinical Q

Answer 4

Among critically ill patients with hypoactive or hyperactive delirium, does administration of the antipsychotic medications haloperidol or ziprasidone improve the number of days alive without delirium or coma when compared to placebo?

Question 5

MIND-USA Bottom Line

Answer 5

Among critically ill patients with hypoactive or hyperactive delirium, administration of the antipsychotic medications haloperidol or ziprasidone did not improve the number of days alive without delirium or coma when compared to placebo.

Question 6

MIND-USA Primary outcome

Answer 6

Days alive without delirium or coma

Question 7

SPICE-III Clinical Q

Answer 7

In critically ill adult patients undergoing mechanical ventilation, does the use of dexmedetomidine as the primary sedative as compared to usual care with other sedatives, lead to improvements in mortality?

Question 8

SPICE-III Bottom Line

Answer 8

Among patients undergoing mechanical ventilation, primary use of dexmedetomidine as compared to usual care with other sedatives led to more adverse events without improving mortality.

Question 9

SPICE- Primary outcome

Answer 9

90-day mortality

Question 10

PRORATA Clinical Q

Answer 10

In critically ill ICU patients with suspected bacterial infections, what is the benefit of a procalcitonin-guided strategy on mortality and antibiotic-free days?

Question 11

PRORATA Bottom Line

Answer 11

Among critically ill patients with suspected bacterial infections, a procalcitonin-guided antibiotic strategy to treat suspected bacterial infections led to fewer days of antibiotic exposure without a >10% increase in mortality at 28 or 60 days.

Question 12

PRORATA Primary outcome

Answer 12

Mortality at days 28 and 60 (non-inferiority analysis), and number of days without antibiotics by day 28 (superiority analysis)

Question 13

SAFE Clinical Q

Answer 13

Among ICU patients, does albumin compared to normal saline for fluid resuscitation improve clinical outcomes?

Question 14

SAFE Bottom Line

Answer 14

Albumin and normal saline result in similar clinical outcomes when administered to ICU patients for volume resuscitation, except for those with traumatic brain injury who do worse with albumin.

Question 15

SAFE Primary Outcome

Answer 15

28-day survival

Question 16

SEDCOM Clinical Q

Answer 16

in mechanically ventilated ICU patients, what is the efficacy and safety of prolonged sedation with dexmedetomidine compared to midazolam?

Question 17

SEDCOM Bottom Line

Answer 17

Among mechanically ventilated ICU patients, there was no difference between dexmedetomidine and midazolam in achieving the time within the targeted sedation level, but dexmedetomidine resulted in less time on the ventilator, less delirium, and less tachycardia and hypertension, at the cost of more bradycardia.

Question 18

SEDCOM Primary Outcome

Answer 18

Percentage of time within target Richmond agitation sedation scale (RASS) range

Question 19

SMART-MED/SURG Clinical Q

Answer 19

Among medical and surgical ICU patients, does the choice of fluid (normal saline versus a balanced crystalloid such as LR or Plasma-Lyte) impact rates of death, need for renal-replacement therapy, or persistent renal dysfunction?

Question 20

SMART-MED/SURG Bottom Line

Answer 20

Among medical and surgical ICU patients, balanced crystalloids such as LR or Plasma-Lyte reduce the rate of death, need for renal-replacement therapy, or persistent renal dysfunction, when compared to normal saline

Question 21

SMART-MED/SURG Primary Outcome

Answer 21

Composite of death, new renal-replacement therapy, or persistent renal dysfunction

Question 22

Yang-Tobin Study Clinical Q

Answer 22

In mechanically ventilated patients, what predictors determine success or failure of weaning patients from mechanical ventilation?

Question 23

Yang-Tobin Bottom Line

Answer 23

The rapid shallow breathing index (RSBI) is the ratio of respiratory rate to tidal volume (f/VT). RSBI >105 accurately predicts weaning failure, while RSBI <105 is associated with weaning success.

Question 24

Yang-Tobin Primary outcome

Answer 24

RSBI predicting ventilator weaning success or failure