ABSTRACT
For years the concept of ‘‘evidence-based critical care’’ was largely theore-
tical because of a lack of high-grade clinical trial evidence demonstrating a survival benefit for any specific therapy for acute lung injury (ALI) and
severe sepsis. The last decade has produced a number of clinical trials in
critical care demonstrating significant effects on important clinical out-
comes (lung-protective ventilation for ALI, activated protein C for severe
sepsis, and protocolized ventilator weaning) and other trials raising ques-
tions about the benefit of treatments thought to be effective (human growth
hormone for chronic critical illness, pulmonary artery catheterization, and
colloid resuscitation). A natural assumption would be that this evidence would be followed by the rapid integration of these results into clinical prac-
tice. Experience tells us otherwise. Whether trying to change practice in
business or medicine, change is a slow process. Entire industries are devel-
oped to improve systems and processes to incorporate change into the
industry. Critical care medicine is new to this phenomenon and also to
the situation of having evidence-based medicine with which to guide clinical
practice. Until recently, the problem was not knowing the answer; now the problem is figuring out how to apply the answers.
