AIIMS November 2011 – MCQ 192
Which of the following were proved to be false by use of evidence based medicine in critical care management?
A. Monitoring blood glucose and preventing hyperglycemia has been shown to be effective in recovery in ICU patients
B. APACHE score >25, dinopaeraux should be stopped
C. ?
D. ?
Please contribute to the discussion by posting the answer with references and pointing out the errors in the question!
One Comment
A is true-Intensive insulin therapy achieving sustained blood glucose control < 110 mg/dL and avoiding prolonged hypoglycemia reduces mortality and morbidity of critical illness. A reduction of mortality by an absolute 3 to 4% is to be expected with this therapy. The survival benefit appears to increase to approximately 8% absolute reduction in the risk of death when intensive insulin therapy is continued at least 3 days, irrespective of the cause of illness.
http://chestjournal.chestpubs.org/content/132/1/268.long
B is true-
Recombinant human activated protein C (also called drotrecogin alfa) promotes fibrinolysis and inhibits thrombosis. It was hypothesized that rhAPC may benefit patients with sepsis because it modulates the procoagulant response that is believed to contribute to multisystem organ dysfunction. This hypothesis was initially tested in the PROWESS trial, which reported that rhAPC improved 28-day mortality in patients with severe sepsis or septic shock, with its greatest benefit among patients with a high risk of death (ie, APACHE II score ≥25). However, conflicting data from subsequent studies eventually led to a new trial, the PROWESS-SHOCK trial. In this trial, 1696 patients with vasopressor-dependent septic shock were randomly assigned to receive rhAPC or placebo. Preliminary analyses done by the maker of the drug indicated that rhAPC did not improve 28-day mortality.
So we need more choices to get to the answer.