In Three New Studies, Interventions Beyond Usual Care for Critically Ill Patients Yielded No Benefit

The New England Journal of Medicine recently published several randomized trials on important topics in critical care medicine. Interestingly, in all trials, the studied intervention was no better than standard care. The findings are as follows:

• Most institutions perform spontaneous breathing trials (SBT) with low-level pressure support ventilation (PSV). However, experts have debated whether high-risk patients should undergo SBTs with a T-piece (i.e., blow-by oxygen with no support from the ventilator) to simulate breathing once extubated. Nearly 1000 patients were randomized to 1-hour SBT by T-piece or PSV (8 cm H₂O without positive end-expiratory pressure). Although patients were slightly more likely to pass the initial SBT on PSV, no dif…