In Reply: We appreciate the high esteem in which Dr Zijlstra and colleagues place RCTs and join them in wishing that more trials would be undisputedly positive. They suggest changing, and possibly lowering, the standards of evidence on which intensivists should base care because the interventions tested in RCTs generally target only 1 of many problems; thus, outcomes such as mortality are hard to modify and, by extension, the trials will always have a high likelihood of failure.
Chiche J, Angus DC. Randomized Controlled Trials in Critical Care Medicine—Reply. JAMA. 2008;300(1):43-44. doi:10.1001/jama.300.1.43-b