The Bottom Line, ART, and DETO2X-AMI

The Alfred ICU Journal Club has teamed up with The Bottom Line. This means that critical appraisals from our Journal Club discussions are now being published on The Bottom Line, which is rapidly becoming the definitive resource for critical appraisals of the intensive care research.

Recent examples from the Alfred ICU Journal Club production line include summaries of the DETO2X-AMI and ART trials, created by Aidan Burrell and Emma Browne respectively. Here are ‘the bottom lines’:

    • This large MCRCT shows that supplemental oxygen does not make any difference to outcomes in normoxic patients with suspected AMI
    • This result combined with other recent studies that have suggested potential harm from oxygen, plus the fact oxygen is not free, suggests that oxygen therapy in this population is no warranted
    • We await more up to date guidelines that will reflect this
  • ART
    • This trial confirms that protective lung ventilation is the standard of care for moderate-to-severe ARDS and that an open lung approach with recruitment manoeuvres should not be used routinely.
    • The increased mortality due to the intervention in this study is statistically fragile and may lack external validity to other settings
    • Specific subgroups of ARDS patients may benefit from OLA ventilation with recruitment manoeuvres (e.g. adequately resuscitated patients with PEEP-responsive ARDS and few other risk factors for barotrauma or haemodynamic collapse) but identification of such subgroups is uncertain, the evidence for benefit is weak, and there is risk of harm to patients as found in the ART trial


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