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FFICM PREP > Clinical Trials > Flashcards

Clinical Trials Flashcards

1
Q

ARDSNET

A

LPV 4-6ml/kg and plateau pressure less than 30 reduced mortality increased ventilator free days and increased days without organ failure

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2
Q

ACURASYS (2010)

A

Neuromuscular blockade reduced adjusted mortality in ARDS and reduced pneumothorax but not reproducible on ROSE. (2019)

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3
Q

PROSEVA (2014)

A

Proning reduces all cause mortality in severe ARDS

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4
Q

CESAR (2009)

A

Randomised to transfer to ECMO centre or standard treatment
ECMO centre increased survival but not specifically ECMO treatment

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5
Q

EOLIA (2018)

A

No mortality benefit to in severe ARDS. But 28% crossover to ECMO

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6
Q

SUPERNOVA (2019) and REST (2021)

A

ECCO2R doesn’t work

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7
Q

DEXA-ARDS (2020)

A

Dexamethasone in Moderate to severe ARDS reduces mortality and increases ventilator free days

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8
Q

RECOVERY (2021)

A

Dexamethasone in Covid-19 reduces mortality in patients with oxygen requirement. NNT 25 or 8 if mechanically ventilated

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9
Q

NICE-SUGAR (2009)

A

Tight glucose control increases mortality vs aim BM <10

Also increased risk of severe hypoglycaemia

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10
Q

CRASH-2

A

Tranexamic acid is safe and improves mortality in trauma if given within 3 hours of injury

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11
Q

REMAP-CAP (2020 + 2021)

A
  • Hydrocortisone likely reduces mortality
  • Tocilizumab improves mortality and reduces organ support, progression to IMV/ECMO/Death
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12
Q

Villanueva et al (2013)

A

Restrictive Hb target in UGIB (>70) had significantly lower mortality

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13
Q

HALT-IT (2020)

A

TXA in GI bleeding makes no difference to mortality and increases VTE risk

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14
Q

NICO (2024)

A

In patients with a GCS <8 due to simple acute poisoning with no other adverse features, close monitoring and delaying intubation for up to 4 hours reduces ICU admissions and ICU LOS

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15
Q

DANGER SHOCK (2024)

A

Routine use of a microaxial flow pump in the treatment of patients with STEMI related cardiogenic shock led to a lower risk of death at 180 days. The incidence of adverse events was higher

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16
Q

EPIC 2 (JAMA 2009)

A

Most icu patient have at least one ICU acquired infection

63% resp tract
20% abdominal
15% bacteraemia
15% urinary tract

17
Q

SMART and SALT-ED Trials (2018)

A

• Demonstrated that using balanced crystalloids (such as Lactated Ringer’s or Plasma-Lyte) over normal saline reduced the incidence of major adverse kidney events in critically ill patients.
• Impact: Shift toward balanced crystalloids in fluid resuscitation.

18
Q

The ABC Trial (2008)

A

• Investigated the effect of daily spontaneous awakening trials (SATs) combined with spontaneous breathing trials (SBTs) in mechanically ventilated patients. The intervention reduced ventilation duration and improved outcomes.

Impact: Routine use of daily sedation breaks in ICU patients

19
Q

TRICC Trial (1999) and TRISS Trial (2014)

A

Restrictive transfusion strategy reduces mortality in critically ill

AND in septic patients

-> restrictive target of >70

20
Q

AKIKI Trial (2016) and IDEAL-ICU (2018)

A

• Showed no benefit of early initiation of RRT in critically ill patients with AKI, suggesting a delayed or more conservative approach to starting RRT.

• Impact: Encouraged delayed initiation of dialysis in certain critically ill patients.

21
Q

AKIKI Trial (2016) and IDEAL-ICU (2018)

A

• Showed no benefit of early initiation of RRT in critically ill patients with AKI, suggesting a delayed or more conservative approach to starting RRT.

• Impact: Encouraged delayed initiation of dialysis in certain critically ill patients.

22
Q

RENAL trial (2009)

A

Compared high-intensity versus standard-intensity continuous renal replacement therapy (CRRT) in ICU patients with acute kidney injury (AKI). No mortality benefit was found with high-intensity RRT.
• Impact: Supports the use of standard CRRT dosing in AKI.

23
Q

TTM Trial (2013)

A

• Compared therapeutic hypothermia (33°C) to controlled normothermia (36°C) and found no difference in mortality or neurological outcomes.
• Impact: Changed practice from strict hypothermia (33°C) to a broader temperature management strategy (36°C).

24
Q

ICU-ROX Trial (2020)

A

• Compared liberal oxygen therapy (PaO2 target 90-97%) with conservative oxygen therapy (PaO2 target 90-95%) in ICU patients. While there was no significant difference in mortality, concern over the potential harms of hyperoxia has grown.

• Impact: More judicious use of oxygen therapy to avoid hyperoxia, focusing on maintaining oxygen saturation levels between 90-95%.

25
Q

CLASSIC Trial (2022)

A

• Evaluated restrictive fluid therapy versus standard fluid therapy in critically ill patients with septic shock. Restrictive fluid therapy showed no significant difference in mortality but reduced the use of vasopressors and mechanical ventilation.
• Impact: Supported a move toward restrictive fluid resuscitation strategies to prevent fluid overload.

26
Q

VASST Trial (2008)

A

• Compared vasopressin to norepinephrine as first-line vasopressors in septic shock. While there was no difference in mortality, vasopressin reduced norepinephrine requirements.
• Impact: Vasopressin became an alternative vasopressor in septic shock, particularly for patients requiring high-dose norepinephrine.

27
Q

PRODEX and MIDEX Trials (2012)

A

• Compared dexmedetomidine to propofol and midazolam in ICU sedation. Dexmedetomidine was associated with less delirium and a shorter time to extubation.
• Impact: Led to the increased use of dexmedetomidine for sedation, particularly in patients who require lighter sedation and quicker weaning from mechanical ventilation.

28
Q

SPICE III Trial (2019)

A

• Compared dexmedetomidine to other sedatives in critically ill patients requiring mechanical ventilation. No significant difference in mortality, but the trial highlighted the potential benefits of lighter sedation strategies.
• Impact: Reinforced a trend toward using lighter sedation in mechanically ventilated patients, with the aim of improving outcomes such as shorter time on ventilation and reduced delirium.

29
Q

Morris Study (2008) & EPICC Trial (2022)

A

early mobilization in ICU patients had improved outcomes, including shorter ICU stays and better long-term functional outcomes.

30
Q

REALITY trial (2019)

A

A restrictive transfusion strategy (>80) in patients with Acute myocardial infarction and anaemia is safe with a non-statistically significant trend towards superiority

31
Q

AVOID trial (2015)

A

Oxygen Vs no oxygen in STEMI

  • oxygen therapy led to larger myocardial infarcts.
  • A larger infarct size due to oxygen could be expected to increase mortality

No effect on mortality, but showed evidence that oxygen can be harmful

32
Q

DETO2X-AMI (2017)

A

No evidence of improved outcome with oxygen for normoxic patients with acute myocardial infarction
- 1 year all cause mortality the same

33
Q

MAGPIE (2002)

A

Magnesium in treatment of pre-eclampsia

34
Q

SEPSISPAM (2014)

A

No mortality difference with low MAP target (65-70mmHg)

  • cause higher AKI /RRT rates in chronic hypertensives
35
Q

Civil contingencies act (2004)

A

Act for major incidents
Cat 1:
999 services
Local authorities
Hospitals and NHS bodies
Environmental agency

Cat 2
Energy businesses
Charities
Transport companies

36
Q

Major incident declaration (METHANE)

A

M - Major incident declared
E - Exact location
T - Type of incident
H - Hazards
A - Access and Egress
N - Number of Casualties
E - Emergency services

37
Q

Major incident command
(CSCATTT)

A

C- Command
S- Safety
C - Communications
A - Assessment
T - Triage
T - Treatment
T - Transport

38
Q

IABP - SHOCK 2 trial (2012)

A

No evidence of mortality benefit in IABP
Improves coronary perfusion

39
Q

PEITHO (2014)

A

Thrombolysis in submassive PE
- reduced mortality
- massive morbidity including intracranial bleeding

  • we do not do it

FFICM PREP (10 decks)

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