Master Trial Index (All Years)

Chest

Dexmedetomidine showed a mortality trend (P=0.091, NS) with significant physiological improvements.

AJRCCM

Lung-protective ventilation in severe brain injury WORSENED mortality, ventilator dependency, and neuro outcome.

Intensive Care Med

The 1-hour sepsis bundle showed no clear in-hospital mortality benefit in this stepped-wedge ED trial.

BMJ

Cardiac output-guided hemodynamic therapy did not reduce postoperative infection in major GI surgery.

JAMA Netw Open

Iloprost showed no organ-dysfunction benefit even in biomarker-selected endotheliopathy septic shock.

JAMA

Acetaminophen no benefit overall; promising high-cell-free-hemoglobin subgroup warrants phase 3.

Nutr Metab (Lond)

Smaller single-center trial found early high protein reduced mortality — contradicts the larger PRECISe trial.

JAMA

Continuous beta-lactam infusion trended toward lower mortality (P=0.08) with significant clinical-cure benefit.

NEJM

Liberal transfusion trended better in TBI but didn't reach significance; pooled meta-analysis found no clear difference.

NEJM

Andexanet gave superior hemostasis in factor Xa-ICH but significantly increased thrombotic events.

JAMA

HFNO noninferior to NIV in 4 of 5 ARF groups, but WORSE in immunocompromised patients with hypoxemia.

JAMA

Thrombectomy for large infarct selected by noncontrast CT alone: no significant functional benefit, wide CI.

JAMA

Liberal transfusion significantly improved outcome in acute brain injury (62.6% vs 72.6% unfavorable, P=0.002).

NEJM

IO-first vs IV-first vascular access in OHCA: 30d survival unchanged (4.5% vs 5.1%).

Intensive Care Med

Conservative vs liberal oxygen on VA-ECMO; full quantitative results not accessible for this summary.

JAMA

EEG-guided anesthesia reduced EEG suppression time 66% but did NOT reduce postoperative delirium.

NEJM

7-day antibiotics noninferior to 14 days for bloodstream infections (90d mortality 14.5% vs 16.1%).

JAMA

Nonselective extracorporeal blood purification significantly reduced cardiac-surgery-associated AKI (28.4% vs 39.7%).

JAMA

Dedicated kidney action team improved implementation but did not reduce worsening AKI, dialysis, or death.

NEJM

Liberal transfusion did not clearly improve neurologic outcomes specifically in aneurysmal SAH.

NEJM

IV amino acids reduced AKI occurrence, but benefit limited to mild stages with no RRT/mortality effect.

JAMA

qSOFA-based electronic sepsis screening significantly reduced 90-day in-hospital mortality (NNS~206).

Circulation

Mechanical thrombectomy beat catheter-directed thrombolysis on composite (win ratio 5.01), but hard outcomes equivalent.

Intensive Care Med

Early spontaneous ventilation gave identical hospital mortality vs conventional volume assist-control.

JAMA

Tenecteplase noninferior to alteplase for standard-window acute ischemic stroke.

Lancet Respir Med

Individualized short-course antibiotics for VAP noninferior, cut antibiotic side effects from 38% to 8%.

Lancet Respir Med

Neither haloperidol nor ziprasidone for ICU delirium showed long-term cognitive, functional, or psychological benefit.

JAMA

Neither screening frequency nor SBT technique alone mattered, but combining them unexpectedly slowed extubation.

JAMA

Automated fever prevention reduced fever burden but did NOT improve 90-day functional outcomes.

NEJM Evidence

Early in-bed cycle ergometry did not improve physical function after ICU discharge.

JAMA

Early restrictive vs liberal oxygen in trauma patients: death/major respiratory complications identical.

NEJM

Danish trial confirms no significant difference between IO-first and IV-first access in OHCA.

Intensive Care Med

Landiolol significantly controlled persistent tachycardia in septic shock (P=0.013) without added vasopressor need.

Chest

Adding metagenomic sequencing to conventional testing significantly sped clinical improvement in severe CAP.

JAMA Netw Open

Investigational 4-factor PCC matched a licensed comparator for VKA reversal before urgent surgery; now FDA-approved.

NEJM

First randomized trial to meet its primary endpoint for surgical ICH evacuation, after decades of neutral trials.

JAMA

PCT-guided (not CRP-guided) antibiotic-stopping protocol safely reduced duration by ~0.9 days.

Intensive Care Med

Ilofotase alfa phase 3 did not improve 28d survival in sepsis-associated AKI, despite promising phase 2 signal.

NEJM

IV pantoprazole significantly reduced GI bleeding (1.0% vs 3.5%) with no mortality penalty.

Hepatology

Tranexamic acid significantly reduced 5-day treatment failure (6.3% vs 13.3%) in cirrhosis-associated UGIB.

Lancet

High-protein enteral feeding resulted in significantly WORSE quality of life, no functional benefit.

Intensive Care Med

Low-dose clonidine gave ~100 more minutes of sleep in postoperative HDU patients, no serious adverse events.

NEJM

First mechanical circulatory support to show a mortality benefit in STEMI-cardiogenic shock (45.8% vs 58.5%).

NEJM

15h/day long-term oxygen therapy as effective as 24h/day; largest trial of its kind.

Circulation

Mechanical thrombectomy improved RV/LV ratio in intermediate-high-risk PE; first RCT of its kind since 2013.

NEJM

Ketamine vs etomidate for RSI: no mortality difference, but ketamine caused more CV collapse.

Lancet

Biomarker-guided KDIGO prevention bundle significantly reduced postoperative AKI (14.4% vs 22.3%).

JAMA

Cryopreserved platelets failed noninferiority vs liquid-stored (bleeding ratio 1.13), more costly.

JAMA

Adjunctive IA alteplase after successful thrombectomy improved outcome AND reduced mortality.

Crit Care

Adjunctive terlipressin improved hemodynamics at 6h (P=0.039) but effect didn't persist; mortality unchanged.

BMJ

Thymosin α1: no mortality benefit in unselected sepsis (HR 0.99), largest trial of its kind.

JAMA

Liberal vs restrictive transfusion in high-cardiac-risk surgery: composite unchanged, cardiac-complication signal noted.

Thorax

Tocilizumab and sarilumab both improved organ-support-free days in critical COVID-19; anakinra did not.

JAMA

Bicarbonate in severe acidemia+AKI: no mortality benefit, but significantly delayed/reduced RRT.

JAMA Intern Med

Slow-tempo music did not reduce delirium, pain, or anxiety in ventilated older adults.

Lancet

Two Factor XI antibodies for VTE prevention: one beat enoxaparin, the other did not — mechanism matters.

Intensive Care Med

Dexmedetomidine controlled agitation in hyperactive delirium (P=0.001), stopped early for efficacy.

JAMA

Adjunctive IA tenecteplase after EVT improved outcome (P=0.02); contrasts with negative POST-TNK at lower dose.

Intensive Care Med

Hydrocortisone in severe CAP showed numerically higher mortality, stopped for futility.

JAMA

Capillary-refill-guided resuscitation beat usual care on hierarchical composite (win ratio 1.16, P=0.04).

JAMA

Automated closed-loop ventilation matched but didn't beat high-quality conventional ventilation.

Lancet Respir Med

Subglottic-suction/polyurethane-cuff ETTs: no benefit on infection, mortality, or long-term outcomes.

Intensive Care Med

High MAP target (80-85) in older septic shock, stopped early for harm: mortality 39.3% vs 28.6%.

Intensive Care Med

mPCR+PCT-guided strategy missed antibiotic-free-days endpoint but cut cumulative antibiotic duration.

Crit Care Med

First direct proof paracetamol lowers cerebral (not just systemic) temperature by ~0.6°C.

Intensive Care Med

Low-dose melatonin failed to prevent delirium; PK-limited (only 50% hit target profile).

JAMA

Largest oxygen-target trial ever (n=16,500): conservative vs usual oxygen, identical 90d mortality.

JAMA

Levosimendan did not facilitate VA-ECMO weaning or improve survival in cardiogenic shock.

Crit Care Med

Lower MAP (50-65) with tissue-perfusion guidance: no benefit, but safely achievable.

NEJM Evidence

Subcutaneous zalunfiban at first medical contact improved a hierarchical composite in STEMI (OR 0.79).

Am J Gastroenterol

Empirical antifungal therapy substantially improved survival in high-IFI-risk ACLF (35% vs 13%).

AJRCCM

Diaphragm neurostimulation: high Bayesian probability of improved weaning, but more serious adverse events.

NEJM

Hospital-wide lactated Ringer's vs saline: no difference across 43,626 patients.

JAMA

Augmented enteral protein: no benefit; third major trial confirming higher protein doesn't help.

Intensive Care Med

Early catheter drainage in necrotizing pancreatitis: no benefit, reinforces delay paradigm.

JAMA

Inhaled sevoflurane sedation in ARDS: worse ventilator-free days, mortality, and AKI vs propofol.

NEJM

Early tirofiban after thrombolysis improved outcome but authors/experts explicitly urge caution.

JAMA

Conservative dialysis improved recovery at discharge (64% vs 50%) but rates converged by day 90.

Lancet Respir Med

Corticosteroids for non-HIV PJP missed 28d mortality but cut 90d mortality and intubation significantly.

NEJM

Deferring arterial catheterization for noninvasive BP monitoring was noninferior for 28d mortality.

JAMA

Dalbavancin missed statistical superiority but performed comparably to standard therapy for S. aureus bacteremia.

JAMA

Biomarker-guided precision immunotherapy improved organ dysfunction (SOFA drop 35.1% vs 17.9%, P=0.002).

NEJM

Low-dose glucocorticoids reduced CAP mortality ~16% in low-resource, general-ward Kenyan setting.

NEJM

PAV+ did not accelerate ventilator liberation vs pressure-support ventilation after 30 years of smaller trials.

JACC

Early IABP in HF-cardiogenic shock: no benefit, but likely underpowered per editorials.

NEJM

Restricted-fluid/early-vasopressor vs fluid-forward in ED septic shock: DAOH90 identical (76 vs 76 days).

Lancet Respir Med

Polymyxin B haemoadsorption in EAA-selected endotoxic shock: 28d mortality 39% vs 45% (95.3% posterior probability).

Intensive Care Med

Ketamine vs etomidate for RSI: MAP difference not clinically meaningful, no outcome benefit.

JAMA Netw Open

≥30 mL/kg fluid associated with lower mortality in septic hypoperfusion (26.0% vs 30.4%).

Intensive Care Med

Integration vs separation of CRRT/ECMO circuits: equivalent circuit lifespan (72h vs 71h).

NEJM

Balanced fluid vs saline in pediatric septic shock: MAKE30 identical (3.4% vs 3.0%).

Intensive Care Med

Remimazolam vs propofol non-inferiority; exact primary-outcome figures inaccessible.

Crit Care Med

Combined exercise/nutrition for ICU survivors, n=39 completers; primary result inaccessible.

NEJM Evidence

Targeted hyponatremia correction improved sodium but not 30d death/rehospitalization (20.5% vs 21.8%).

NEJM

Thrombectomy for medium-vessel-occlusion stroke improved functional independence (58.6% vs 46.6%).

NEJM

Whole blood vs strong comparator (red cells+plasma) for hemorrhage: composite identical (48.7% vs 47.7%).

AJRCCM

EIT-guided PEEP null overall (HR 0.96) but strong benefit in higher-recruitability subgroup (P=0.024).

Lancet Respir Med

PCT+NEWS2 missed stewardship goal but cut mortality 16.6%→13.6% (P=0.0009) via unclear mechanism.

World J Crit Care Med

Magnesium sped lactate clearance (5.73h vs 8.54h, P<0.001); underpowered for mortality.

Lancet Neurol

Dexamethasone in HSV encephalitis: no memory benefit but proved safe (no enhanced viral replication).

AJRCCM

Doubling protein bolus dose did not further augment muscle protein synthesis — mechanistic explanation for clinical nulls.

Hepatology

Therapeutic plasma exchange improved 28d survival in ACLF (44.3% vs 63.9% mortality, P=0.006).

NEJM

HFNO vs standard oxygen in AHRF: 28d mortality identical (14.6% both arms, P=0.98).

JAMA Netw Open

Albumin targeting ≥3.0 g/dL: 90-day mortality 43.3% vs 45.9%, underpowered after early stop.

JAMA

Rapid AST sped diagnosis dramatically but did not improve the patient-centered DOOR outcome.

Crit Care Med

Ivermectin no benefit for hospitalized COVID-19; small sample, disputed reporting timeline.

JAMA

Augmented enteral protein gave no benefit on days alive/free of hospital at day 90.

Lancet

IV tenecteplase up to 24h after basilar occlusion: excellent outcome 38% vs 29% (NNT~11).

JAMA

Restrictive vs liberal wrist restraint: no difference in delirium/coma-free days, no safety penalty.

JAMA

Remote rehab: no overall HRQoL benefit at 8 weeks, though shorter-ventilation subgroup benefited.

Lancet

rFVIIa for ICH stopped early: reduced bleeding, no functional benefit, tripled thromboembolic events.

NEJM

Prehospital whole blood vs components: 30d mortality 25.9% vs 20.5% (NS, wide CI).

NEJM

Catheter-directed fibrinolysis for intermediate-risk PE: composite improved (P=0.005) but driven by decompensation, not death.

NEJM

Sodium bicarbonate in severe acidemia+shock: MAKE30 identical (40.2% vs 39.4%).

JAMA

A video game for ED physicians cut under-triage of older trauma patients (57%→49%).

JAMA

4% tetrasodium EDTA catheter lock reduced CVAD-associated complications by ~32%.

NEJM

Elective LV unloading (Impella) in high-risk PCI: no benefit, excess CV mortality (HR 1.91).

JAMA Netw Open

Prophylactic HFNOT after cardiac surgery: no benefit over standard oxygen (DAH90 median 0 both arms).