TABLE 11.

Interventions demonstrated to reduce mortality in critically ill patients (supported by evidence from clinical trials)

InterventionEvidence
Goal-directed therapyEarly goal-directed therapy (based on fluid and blood product infusions, inotropes, and ventilation with invasive monitoring) associated with a fall in mortality in a clinical trial (31 vs 47%) (359)
Insulin infusionIntensive glycemic control (4.4 to 6.1 mmol/liter) by means of an insulin infusion associated with a fall in mortality in surgical intensive care patients in a clinical trial (8 vs 5%) (450)
Sedation protocolUse of sedation protocols associated with reduced length of stay and duration of ventilation (57)
Polyclonal immunoglobulinUse of polyclonal immunoglobulin associated with mortality benefit in a meta-analysis (relative risk, 0.64) (4); concerns about quality of the pooled studies
Activated protein CUse of drotrecogin alfa in patients with severe sepsis associated with a fall in mortality in a large clinical trial (31 vs 25%)
Limiting tidal volumesVentilation with lower tidal volumes (6 ml/kg) in patients with acute lung injury or acute respiratory distress syndrome associated with a fall in mortality (40 vs 31%) (2); other smaller studies show conflicting results (135)
Physiological-dose steroidsLow-dose hydrocortisone and fludrocortisone in patients with relative adrenal insufficiency due to severe sepsis associated with a fall in mortality in a clinical trial (63 vs 53%) (8)
Deep venous thrombosis prophylaxisMultiple large studies of heparin and/or mechanical devices in general intensive care unit populations (135)
Stress ulcer prophylaxisMultiple large studies of proton pump inhibitors or histamine receptor antagonists (135)