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February 13, 2008

Testing Protocols in the Intensive Care Unit: Complex Trials of Complex Interventions for Complex Patients

Author Affiliations

Author Affiliations: Department of Critical Care Medicine, AP-HP, Hopital Cochin, University René Descartes, Paris, France (Dr Chiche); CRISMA Laboratory, Department of Critical Care Medicine, School of Medicine, and Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Angus). Dr Angus is Contributing Editor, JAMA.

JAMA. 2008;299(6):693-695. doi:10.1001/jama.299.6.693

In this issue of JAMA, Meade and colleagues1 and Mercat and colleagues2 report the results of 2 large international trials of alternative strategies for setting positive end-expiratory pressure (PEEP) in ventilated patients with acute lung injury or acute respiratory distress syndrome. Both trials asked whether higher PEEP would reduce mortality, and both concluded it did not. Many readers not familiar with intensive care might reasonably wonder why such a seemingly innocuous intervention would deserve such attention, but the story behind PEEP is a long one, and these latest, largest trials do not provide a conclusion. They do, however, serve to demonstrate that answering even the simplest questions can become an endeavor of immense proportions.