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Grand Rounds April 28, 2023: Oxygen-Saturation Targets for Critically Ill Adults Receiving Mechanical Ventilation: An Embedded Cluster-crossover Trial (Matthew W. Semler, MD, MSc)

Rethinking Clinical Trials

Assistant Professor of Medicine and Biomedical Informatics Medical Director, VICTR Center for Learning Healthcare Vanderbilt University Medical Center Slides Keywords Pragmatic Clinical Trials, Cluster-crossover Trial Key Points More than 3 million adults receive invasive mechanical ventilation each year in the U.S.

Trials 130
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Grand Rounds February 3, 2023: Pragmatic Trials For Children With Congenital Heart Disease – Insights From The NITRIC Trial (Luregn Schlapbach, PhD, FCICM)

Rethinking Clinical Trials

The primary outcome was ventilator-free days (VFD) from start of cardiopulmonary bypass to day 28, with a number of secondary outcomes. The hypothesis was that patients with nitric oxide would recover quicker allowing for more ventilator-free days, but there was no difference between the intervention and standard of care.

Trials 130
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Grand Rounds November 18, 2022: The FIRST-ABC Pragmatic Trials of Non-Invasive Respiratory Support In Children (Padmanabhan Ramnarayan, MBBS, MD, FRCPCH, FFICM)

Rethinking Clinical Trials

Sick children, when they are acutely ill, start with standard oxygen therapy, which escalates to noninvasive respiratory support (CPAP/BIPAP or high flow nasal cannula) before invasive ventilation support in the ICU. Reader in Pediatric Critical Care. Imperial College London. Pragmatic Clinical Trials. Key Points.

Trials 130
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Grand Rounds January 27, 2023: The PREPARE II Trial: Embedding a Pragmatic Trial Into Clinical Care During an Emergency Procedure (Derek W. Russell, MD; Matthew W. Semler, MD, MSc)

Rethinking Clinical Trials

There was an interesting consistent pattern of subgroups of patients who were exposed earlier or more intensive positive pressure ventilation modalities, such as non-invasive ventilation, that was applied earlier in the procedure seemed to have better outcomes. It was conducted with waiver of informed consent.

Trials 130