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VOLUME 28 , ISSUE 6 ( June, 2024 ) > List of Articles

COMMENTARY

Is “Less be More” Still a Valid Concept in Intensive Care? A Review of Critical Care Randomized Clinical Trials from the New England Journal of Medicine

Farhad Kapadia, Shreya Bharadwaj, Ritika Sharma

Keywords : Clinical outcomes, Less is more, Mortality in randomized clinical trials

Citation Information : Kapadia F, Bharadwaj S, Sharma R. Is “Less be More” Still a Valid Concept in Intensive Care? A Review of Critical Care Randomized Clinical Trials from the New England Journal of Medicine. Indian J Crit Care Med 2024; 28 (6):533-551.

DOI: 10.5005/jp-journals-10071-24717

License: CC BY-NC 4.0

Published Online: 31-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

The concept of “Less is more” has been gaining increasing awareness and acceptance in Critical Care. In 2017, we attempted to systematically answer the question “Can less be more in intensive care” with empirical data. We reviewed all the critical care randomized clinical trials (RCTs) between 1 January 2008 and 5 October 2016 in the New England Journal of Medicine (NEJM). This article attempts to repeat the earlier exercise using data from 5 October 2016 to 31 December 2023. This analysis of critical care RCTs in the NEJM has shown three findings. Approximately three-quarter of RCTs in critical care in the NEJM between 2008 and 2023 failed to show benefit or harm. In the years 2008–2016, patients in the intervention cohort had a higher mortality compared to controls, but in the years 2016–2023, the difference in overall mortality in patients in the intervention and control arms was not statistically significant. Compared to the years 2008–2016, in the years from 2016 to 2023, the number of RCTs showing harm decreased and those showing benefit increased.


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