Evidence Based Medicine and Critically Ill Patient
The practice of evidence based medicine in the setting of intensive care unit is very important part and contributory component of optimal clinical practice. Integration of personal clinical expertise, best available evidence from systematic research and patients’ values and expectations, should be accomplished in order to have the best approach in diagnostics and therapy. There have been many advancements and progress in the treatment of critically ill patients in last decades, with introducing many new techniques of invasive and noninvasive monitoring and appliance of devices and machines that support vital functions and prolong the time which is available for resuscitation and intensive treatment. In the same time conduction of good randomized controlled trials is limited because of ethical issues, complicated procedures and different protocols of care, ambiguous definitions of diseases and syndromes, and results that sometimes could not be translated in practice. Despite considerable limitations, many large controlled randomized studies and observational studies have contributed a lot to the clinical expertise, what resulted in changing the practice of intensive care medicine. There is general consensus on the ways of treatment of cardiovascular and respiratory failure, with emphasis on early starting of resuscitation and adapting mechanical ventilation to individual needs of patients. Optimal glycemia levels, levels of haemoglobin, the role of corticosteroid therapy in septic shock will continue to be the issue of future investigations in order to obtain valid recommendations.