In his editorial, Dr. Slutsky says that basing treatments strictly on physiological endpoints-in this case, increasing oxygenation in the blood by mechanically increasing volumes of air in the lungs and changing patients' position during treatment-is "seductive" for several reasons:

In many ways, the intensive care unit is a physiology laboratory in which patients' vital signs and other functions are monitored and treated around the clock, seven days a week. By explaining why a patient has a physiological abnormality such as a decrease in oxygenation or worsening kidney function, these measurements can suggest therapies to correct the abnormal physiology.

Many physiological interventions can be quickly instituted and monitored at the bedside. They are usually relatively inexpensive or seen as "free," which makes them attractive and easy to implement.

"But while physiological insights developed at the bedside have led to important, lifesaving therapies, it's been difficult to obtain convincing proof of better clinical outcomes for many such interventions," Dr. Slutsky says.

One solution would be to design large, simple, generalizable trials undertaken by a large global network of investigators. "The time for this may be especially opportune because the world's critical care community is coalescing around an initiative to perform large-scale clinical trials to rapidly address the potential H1N1 pandemic," he says, adding that such trials are necessary to "separate fact from seduction."

Dr. Art Slutsky is a researcher in the Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, and Professor of Medicine, Surgery and Biomedical Engineering at the University of Toronto. He is also Director of the Interdepartmental Division of Critical Care Medicine, University of Toronto.

Source: St. Michael's Hospital