Worth reading: Less is more in intensive care

Catherine Auriemma et al. writing in Intensive Care Medicine:

“The notion that ‘less is (or may be) more’ in intensive care medicine has been contemplated by experts for decades. However, not until Kox and Pickkers’ review in 2013 had there been careful consideration of the evidence supporting this theory.1 Their thought-provoking article focused specifically on sepsis, but the intervening years have yielded expanded evidence supporting this notion across many critical conditions. As healthcare systems seek to incentivize high-value care, transparency, and adherence to evidence-based practice guidelines, we must assess the strength of the evidence base regarding less is more. Here, we discuss recent randomized clinical trials (RCTs) that support the notion that even in intensive care units (ICUs), less intensive interventions may prove superior.”

Table 1 summarizes findings on a range of ICU therapies showing no mortality benefit and/or worse outcomes.

Auriemma, C.L., Van den Berghe, G. & Halpern, S.D. Less is more in critical care is supported by evidence-based medicine. Intensive Care Med 45, 1806–1809 (2019). https://doi.org/10.1007/s00134-019-05771-2

[1] Kox M, Pickkers P (2013) “Less is more” in critically ill patients not too intensive. JAMA Intern Med 173:1369–1372. doi: 10.1001/jamainternmed.2013.6702