Extract

Evidence-based and good sense-based critical care medicine

Critical care medicine has improved greatly, thanks to the implementation of guidelines and good clinical practice protocols. For this reason, the present clinical practice requires evidence-based medicine to answer unresolved debates and to further improve applied protocols. Randomized controlled trials are (even if not always [ 1 ]) essential in order to achieve a high level of scientific evidence good enough to support the application of new life-saving strategies or to change significantly current practice [ 2 ]. Such trials are now strongly needed because mortality has improved to such a level that large investments will be required to achieve relatively small improvements in clinical outcomes. Nevertheless, this approach has justified and encouraged changes in therapeutic strategies sometimes contradicted after only a few years. This not only demonstrates how difficult it is to reach a definitive consensus in the world of critical care medicine but it may also induce perplexity and diffidence among the operators of the field.

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