Respiratory Trials·org

Explaining the most important trials in respiratory medicine

309 trials across 39 topics. Every citation is checked against PubMed. Pick a therapy to see what its evidence actually showed, or start typing to search.

Topic Therapy group Therapy Effect Trial Finding
Asthma Biologics Benralizumab ABRA 2025 A single dose of benralizumab at the time of an eosinophilic exacerbation beat prednisolone
Asthma Biologics Depemokimab SWIFT 2024 Two injections a year roughly halved exacerbations in eosinophilic severe asthma
Asthma Inhaled therapy Albuterol/budesonide as needed MANDALA 2022 Adding budesonide to the albuterol reliever cut severe exacerbations by a quarter
Asthma Biologics Tezepelumab NAVIGATOR 2021 Tezepelumab halved exacerbations in severe asthma, including in patients with low eosinophils
Asthma Biologics Dupilumab QUEST 2018 Dupilumab halved severe exacerbations and improved lung function, most in eosinophilic patients
Asthma Inhaled therapy Budesonide/formoterol as needed SYGMA 1 2018 As-needed ICS/formoterol beat reliever alone on symptoms and exacerbations, but lost to daily ICS on symptom control
Asthma Inhaled therapy Budesonide/formoterol as needed SYGMA 2 2018 As-needed ICS/formoterol matched daily ICS for exacerbations on a quarter of the steroid dose
Asthma Oral therapy Azithromycin AMAZES 2017 Azithromycin cut asthma exacerbations by 41% and improved quality of life, at the cost of diarrhoea
Asthma Biologics Benralizumab SIROCCO 2016 Benralizumab cut exacerbations by around half in eosinophilic severe asthma
Asthma Biologics Mepolizumab MENSA 2014 Mepolizumab roughly halved exacerbations in severe eosinophilic asthma
Asthma Inhaled therapy Tiotropium PrimoTinA-asthma 2012 Adding tiotropium to ICS/LABA gave modest bronchodilation and 21% fewer severe exacerbations
Asthma Inhaled therapy Salmeterol SMART 2006 Salmeterol added to usual care increased asthma deaths — 13 versus 3 — and produced the LABA black-box warning
Asthma Inhaled therapy Low-dose budesonide START 2003 Low-dose daily budesonide nearly halved severe exacerbations in mild asthma
Asthma Non-invasive ventilation Bilevel positive airway pressure Soroksky 2003 2003 Bilevel positive pressure in acute severe asthma improved FEV1 and cut admissions, in 30 patients
COPD Biologics Mepolizumab MATINEE 2025 Mepolizumab reduced exacerbations by 21% in eosinophilic COPD on triple therapy, without improving symptoms
COPD Oxygen Long-term oxygen therapy REDOX 2024 24 hours a day of oxygen was no better than 15 in severe hypoxaemia
COPD Biologics Dupilumab BOREAS 2023 Dupilumab cut exacerbations by 30% in eosinophilic COPD already on triple therapy
COPD Inhaled therapy Ensifentrine ENHANCE 2023 Ensifentrine improved lung function in both replicate trials and reduced exacerbations, with placebo-level tolerability
COPD Inhaled therapy Budesonide/glycopyrrolate/formoterol ETHOS 2020 Triple therapy beat both dual therapies, and the lower steroid dose worked as well as the higher
COPD Inhaled therapy Fluticasone furoate/umeclidinium/vilanterol IMPACT 2018 Triple therapy reduced exacerbations versus either dual therapy, at the cost of more pneumonia
COPD Bronchoscopic intervention Endobronchial valves LIBERATE 2018 Endobronchial valves improved lung function and exercise capacity in emphysema without collateral ventilation
COPD Inhaled therapy Indacaterol/glycopyrronium SUNSET 2018 Stopping inhaled steroids cost a little lung function but no extra exacerbations, except in eosinophilic patients
COPD Inhaled therapy Beclometasone/formoterol/glycopyrronium TRIBUTE 2018 Extrafine triple therapy modestly reduced exacerbations versus dual bronchodilation, without excess pneumonia
COPD Inhaled therapy Indacaterol/glycopyrronium FLAME 2016 Dual bronchodilation beat LABA/ICS for exacerbation prevention, with less pneumonia
COPD Oxygen Supplemental oxygen LOTT 2016 Oxygen for moderate desaturation did nothing for survival, admissions, or quality of life
COPD Oral therapy Roflumilast REACT 2015 Roflumilast missed its primary endpoint by a whisker and hit it on the sensitivity analysis
COPD Oral therapy Azithromycin MACRO 2011 Daily azithromycin for a year cut exacerbations and improved quality of life, at the cost of hearing loss and resistance concerns
COPD Inhaled therapy Tiotropium POET-COPD 2011 Tiotropium prevented exacerbations better than salmeterol
COPD Inhaled therapy Tiotropium UPLIFT 2008 Four years of tiotropium improved lung function, symptoms and exacerbations but did not slow the rate of decline
COPD Inhaled therapy Salmeterol/fluticasone TORCH 2007 Salmeterol/fluticasone narrowly missed a mortality benefit but reduced exacerbations, at the cost of more pneumonia
COPD Surgery Lung volume reduction surgery NETT 2003 No overall survival benefit, but a real one for upper-lobe emphysema with low exercise capacity
COPD Corticosteroids Systemic glucocorticoids SCCOPE 1999 Systemic steroids reduced treatment failure in COPD exacerbations, with no benefit beyond two weeks and no effect on mortality
COPD Antibiotics Broad-spectrum antibiotics Anthonisen 1987 1987 Antibiotics helped exacerbations defined by increased dyspnoea, sputum volume and purulence
COPD Oxygen Domiciliary oxygen MRC oxygen 1981 Domiciliary oxygen for at least 15 hours a day improved survival in hypoxaemic cor pulmonale
COPD Oxygen Continuous oxygen NOTT 1980 Continuous oxygen halved mortality compared with nocturnal-only oxygen in hypoxaemic COPD
Bronchiectasis Oral therapy Brensocatib ASPEN 2025 Brensocatib cut exacerbations by about 20% — the first drug licensed specifically for bronchiectasis
Bronchiectasis Mucoactive therapy Hypertonic saline and carbocisteine CLEAR 2025 Neither hypertonic saline nor carbocisteine reduced exacerbations in bronchiectasis
Bronchiectasis Inhaled antibiotics Colistimethate sodium PROMIS 2024 Inhaled colistimethate reduced exacerbations in one trial and not in its replicate
Bronchiectasis Oral therapy Azithromycin BAT 2013 Maintenance azithromycin roughly halved the proportion of patients having any exacerbation
Bronchiectasis Oral therapy Erythromycin BLESS 2013 Erythromycin modestly cut exacerbations, including in Pseudomonas-infected patients, at the cost of increased macrolide resistance
Bronchiectasis Oral therapy Azithromycin EMBRACE 2012 Azithromycin cut exacerbations by 62% without improving lung function or quality of life
Bronchiectasis Mucoactive therapy Recombinant human DNase rhDNase in bronchiectasis 1998 DNase made idiopathic bronchiectasis worse, not better
Cystic fibrosis CFTR modulators Vanzacaftor/tezacaftor/deutivacaftor SKYLINE 2025 The once-daily triple matched the twice-daily standard on lung function
Cystic fibrosis Mucoactive therapy Hypertonic saline and dornase alfa withdrawal SIMPLIFY 2023 Patients on triple modulator therapy could stop hypertonic saline or dornase alfa without losing lung function
Cystic fibrosis Antibiotics Shorter intravenous antimicrobial courses STOP2 2021 Ten days of intravenous antibiotics matched fourteen in early responders, and twenty-one beat nothing in slow responders
Cystic fibrosis CFTR modulators Elexacaftor/tezacaftor/ivacaftor VX18-445-104 2021 Triple therapy added a further 3.7 points of FEV1 even in patients already on an effective modulator
Cystic fibrosis CFTR modulators Elexacaftor/tezacaftor/ivacaftor VX17-445-102 2019 Triple modulator therapy gave a 14-point FEV1 gain to the 90% of CF patients with a single Phe508del allele
Cystic fibrosis CFTR modulators Ivacaftor STRIVE 2011 Ivacaftor produced a 10-point FEV1 gain in G551D cystic fibrosis — the first drug to correct the basic defect
Cystic fibrosis Mucoactive therapy Hypertonic saline Elkins 2006 2006 Hypertonic saline did not change the slope of decline but improved lung function and cut exacerbations
Cystic fibrosis Inhaled antibiotics Inhaled tobramycin Ramsey 1999 1999 Cycled inhaled tobramycin improved FEV1 by 10% and reduced hospitalisation in Pseudomonas infection
Cystic fibrosis Mucoactive therapy Dornase alfa Fuchs 1994 1994 Dornase alfa cut exacerbations by about a third and gave a small lung function gain
ILD Prostacyclin analogues Inhaled treprostinil TETON-2 2026 Inhaled treprostinil slowed FVC decline in IPF, in patients mostly already on antifibrotics
ILD Antifibrotics Nerandomilast FIBRONEER-ILD 2025 Nerandomilast slowed FVC decline in progressive pulmonary fibrosis, including on top of nintedanib
ILD Antifibrotics Nerandomilast FIBRONEER-IPF 2025 Nerandomilast slowed FVC decline on top of existing antifibrotics — the first genuinely additive agent in IPF
ILD Immunosuppression Methotrexate PREDMETH 2025 Methotrexate matched prednisone as first-line treatment for pulmonary sarcoidosis, with a different side-effect profile
ILD Diagnostic strategy Step-up cryobiopsy strategy COLD 2024 Cryobiopsy first, surgery only if needed, matched immediate surgery with less burden
ILD Immunosuppression Rituximab plus mycophenolate EVER-ILD 2023 Adding rituximab to mycophenolate improved lung function in NSIP-pattern ILD, with more viral infection
ILD Diagnostic strategy Transbronchial lung cryobiopsy COLDICE 2020 Cryobiopsy agreed closely with surgical lung biopsy, especially when the diagnosis was made with high confidence
ILD Antifibrotics Nintedanib INBUILD subgroups subgroup analysis2020 Nintedanib's benefit in progressive fibrosing ILD held across diagnoses, though no subgroup was individually powered
ILD Antifibrotics Nintedanib INBUILD 2019 Nintedanib slowed FVC decline across progressive fibrosing ILD, whatever the underlying diagnosis
ILD Antifibrotics Nintedanib SENSCIS 2019 Nintedanib slowed lung function decline in scleroderma ILD, but the result is fragile and skin disease was unchanged
ILD Antifibrotics Pirfenidone ASCEND 2014 Pirfenidone slowed FVC decline and improved progression-free survival in IPF
ILD Antifibrotics Nintedanib INPULSIS 2014 Nintedanib roughly halved the annual rate of FVC decline in IPF, at the cost of diarrhoea
ILD Immunosuppression Prednisone, azathioprine and N-acetylcysteine PANTHER-IPF 2012 The standard immunosuppressive regimen for IPF was killing patients
ILD Antioxidants N-acetylcysteine IFIGENIA 2005 Acetylcysteine slowed lung function decline when added to prednisone and azathioprine — a background regimen later shown to be lethal
ILD Natural history Observation within a randomised trial Martinez 2005 2005 IPF killed a fifth of patients while their lung function looked stable, often after an acute deterioration
PH Activin signalling inhibitors Sotatercept HYPERION 2025 Sotatercept reduced clinical worsening when given within a year of diagnosis
PH Activin signalling inhibitors Sotatercept ZENITH 2025 Sotatercept cut death, transplant or hospitalisation by three quarters in high-risk PAH
PH Prostacyclin analogues Inhaled treprostinil INCREASE 2021 Inhaled treprostinil improved walk distance in PH due to interstitial lung disease
PH Vasodilators Ambrisentan plus tadalafil AMBITION 2015 Starting two vasodilators at once halved clinical failure compared with either alone
PH Prostacyclin receptor agonists Selexipag GRIPHON 2015 Selexipag cut disease progression and hospitalisation by 40%, without a mortality difference
PH Vasodilators Riociguat PATENT-1 2013 Riociguat improved walk distance by 36 m, including on top of existing therapy
PH Vasodilators Macitentan SERAPHIN 2013 Macitentan cut morbidity and mortality events by 45% in pulmonary arterial hypertension
PH Assessment Doppler echocardiography Fisher 2009 diagnostic accuracy2009 Doppler estimates of pulmonary pressure were out by more than 10 mmHg in half of cases
PH Vasodilators Sildenafil SUPER-1 2005 Sildenafil improved walk distance and haemodynamics, with no dose-response above 20 mg
PH Assessment Doppler echocardiography Arcasoy 2003 diagnostic accuracy2003 Echocardiography misclassified half of patients with advanced lung disease as having pulmonary hypertension
PE Catheter intervention Catheter-assisted vacuum thrombectomy STORM-PE 2026 Catheter thrombectomy improved right ventricular strain at 48 hours without excess adverse events
PE Anticoagulation Low-dose apixaban HI-PRO 2025 Low-dose apixaban prevented recurrence after provoked VTE with enduring risk factors
PE Catheter intervention Large-bore mechanical thrombectomy PEERLESS 2025 Mechanical thrombectomy beat catheter-directed lysis on a composite driven by less ICU use, with no mortality difference
PE Anticoagulation Reduced-dose direct oral anticoagulant RENOVE 2025 Reduced-dose anticoagulation failed formal non-inferiority for recurrence but bled much less
PE Diagnostic strategy Pregnancy-adapted YEARS algorithm Artemis management cohort2019 A pregnancy-adapted YEARS algorithm safely avoided CT in a third to two thirds of pregnant women
PE Diagnostic strategy Probability-adjusted D-dimer PEGeD management cohort2019 A D-dimer under 1000 with low clinical probability safely excluded PE without imaging
PE Mechanical prevention Intermittent pneumatic compression PREVENT-IPC 2019 Adding pneumatic compression to drug prophylaxis prevented no clots
PE Diagnostic strategy YEARS algorithm YEARS management cohort2017 The YEARS algorithm safely excluded PE while avoiding 14% more CT scans
PE Mechanical prevention Retrievable IVC filter PREPIC2 2015 Adding a retrievable IVC filter to anticoagulation prevented nothing
PE Diagnostic strategy Age-adjusted D-dimer ADJUST-PE management cohort2014 Age-adjusting the D-dimer nearly quintupled the proportion of over-75s who could avoid imaging
PE Thrombolysis Tenecteplase PEITHO 2014 Thrombolysis prevented decompensation in intermediate-risk PE but caused major bleeding and stroke
PE Diagnostic strategy CT pulmonary angiography Anderson 2007 2007 CT and V/Q were equally safe for exclusion, but CT diagnosed a third more emboli
PE Thrombolysis Alteplase MAPPET-3 2002 Alteplase reduced treatment escalation in submassive PE, but the benefit was almost entirely in that soft endpoint
PE Diagnostic strategy Ventilation-perfusion scanning PIOPED diagnostic accuracy1990 V/Q scanning was only decisive when it agreed with the clinical impression — a minority of cases
Occupational & environmental Environmental exposure Particulate air pollution MCC-652 time-series analysis2019 Every 10 µg/m3 of particulate pollution raised daily mortality by about half a percent, worldwide
Occupational & environmental Environmental exposure Ambient air pollution Gan 2013 cohort study2013 Traffic-related particulates and woodsmoke were both associated with COPD hospitalisation and death
Pneumonia Corticosteroids Hydrocortisone CAPE COD 2023 Hydrocortisone roughly halved 28-day mortality in severe community-acquired pneumonia
Pneumonia Diagnostic strategy Endotracheal aspiration CCCTG VAP 2006 Invasive quantitative sampling gave no advantage over a simple endotracheal aspirate
Pneumonia Antibiotics Short-course antibiotics PneumA 2003 Eight days of antibiotics matched fifteen for ventilator-associated pneumonia, except in non-fermenting gram-negatives
COVID-19 Antivirals Nirmatrelvir-ritonavir EPIC-SR 2024 Nirmatrelvir did nothing for symptoms in a largely vaccinated, standard-risk population
COVID-19 Antivirals Nirmatrelvir-ritonavir EPIC-HR 2022 Nirmatrelvir-ritonavir cut hospitalisation or death by 89% in unvaccinated high-risk outpatients
COVID-19 Non-invasive ventilation CPAP or high-flow nasal oxygen RECOVERY-RS 2022 CPAP reduced intubation or death in COVID-19; high-flow nasal oxygen did not
COVID-19 Oxygen delivery High-flow nasal oxygen SOHO-COVID 2022 High-flow nasal oxygen did not reduce mortality in COVID-19 respiratory failure
COVID-19 Immunomodulators Baricitinib ACTT-2 2021 Adding baricitinib to remdesivir shortened recovery by a day, most in those on high-flow oxygen
COVID-19 Corticosteroids Higher-dose dexamethasone COVID STEROID 2 2021 Doubling the dexamethasone dose added nothing over the standard 6 mg
COVID-19 Anticoagulation Intermediate-dose prophylactic anticoagulation INSPIRATION 2021 Intermediate-dose prophylaxis was no better than standard dose in critically ill COVID-19
COVID-19 Corticosteroids Dexamethasone RECOVERY dexamethasone 2021 Dexamethasone reduced mortality in COVID-19 patients needing oxygen, and not in those who did not
COVID-19 Immunomodulators Tocilizumab or sarilumab REMAP-CAP IL-6 2021 IL-6 receptor blockade improved organ support-free days and survival in critical COVID-19
COVID-19 Anticoagulation Therapeutic-dose heparin REMAP-CAP anticoagulation 2021 Full-dose anticoagulation did not help critically ill COVID-19 patients
COVID-19 Antivirals Remdesivir ACTT-1 2020 Remdesivir shortened time to recovery by five days without a clear mortality benefit
COVID-19 Corticosteroids Dexamethasone CoDEX 2020 Dexamethasone gave 2.6 more ventilator-free days in COVID-19 ARDS
TB & NTM Antituberculous therapy Four-month regimen SHINE 2022 Four months cured children with non-severe tuberculosis as well as six
TB & NTM Antituberculous therapy Bedaquiline, pretomanid, linezolid and moxifloxacin TB-PRACTECAL 2022 A 24-week all-oral regimen beat standard care for rifampicin-resistant TB and was safer
TB & NTM Antituberculous therapy Bedaquiline, pretomanid and linezolid ZeNix 2022 Halving the linezolid dose preserved 91% cure and cut neuropathy from 38% to 24%
TB & NTM Antituberculous therapy Rifapentine with moxifloxacin Study 31/A5349 2021 A four-month rifapentine-moxifloxacin regimen matched six months of standard therapy
TB & NTM Antituberculous therapy Bedaquiline, pretomanid and linezolid Nix-TB single-group study2020 An all-oral six-month regimen cured 90% of extensively drug-resistant tuberculosis
TB & NTM Inhaled antibiotics Amikacin liposome inhalation suspension CONVERT 2018 Inhaled liposomal amikacin tripled culture conversion in refractory MAC lung disease, at the cost of frequent airway side effects
TB & NTM Antituberculous therapy Moxifloxacin-based four-month regimen REMoxTB 2014 Moxifloxacin cleared cultures faster and still failed to allow four-month treatment
Immunocompromised host Corticosteroids Adjunctive corticosteroids PIC 2025 Steroids did not significantly reduce mortality in non-HIV Pneumocystis pneumonia
Immunocompromised host Diagnostic strategy Non-invasive testing alone Azoulay 2010 2010 Bronchoscopy added no diagnostic yield over non-invasive testing, and did not precipitate intubation
Immunocompromised host Antifungals Itraconazole Stevens 2000 2000 Itraconazole more than doubled response in corticosteroid-dependent ABPA without added toxicity
Immunocompromised host Corticosteroids Adjunctive corticosteroids Bozzette 1990 1990 Early corticosteroids roughly halved respiratory failure and death in moderate-to-severe pneumocystis pneumonia, with no benefit in mild disease
Immunocompromised host Corticosteroids Adjunctive corticosteroids Gagnon 1990 1990 Early steroids improved survival in severe Pneumocystis pneumonia in AIDS, in 23 patients, stopped early for benefit
Infection control Decontamination Selective digestive decontamination SuDDICU 2026 Selective digestive decontamination did not reduce mortality in a large international trial
Infection control Antibiotics Single-dose ceftriaxone PROPHY-VAP 2024 One dose of ceftriaxone after intubation prevented early pneumonia in brain-injured patients
Infection control Decolonisation Chlorhexidine bathing Noto 2015 2015 Daily chlorhexidine bathing did not reduce healthcare-associated infections
Infection control Decolonisation Universal decolonisation REDUCE MRSA 2013 Decolonising everyone beat screening and isolating carriers
Infection control Decontamination Selective digestive or oropharyngeal decontamination de Smet 2009 2009 Selective decontamination reduced adjusted mortality in a low-resistance setting
Infection control Care bundles Evidence-based catheter bundle Keystone ICU before-and-after study2006 A simple five-step bundle cut catheter bloodstream infections by two thirds and kept them down
Infection control Positioning Semirecumbent position van Nieuwenhoven 2006 2006 45 degrees proved unachievable in practice, and the 28 degrees actually delivered prevented nothing
Infection control Positioning Semirecumbent position Drakulovic 1999 1999 Sitting ventilated patients up at 45 degrees cut nosocomial pneumonia fourfold
Lung cancer Natural history Contemporary systemic therapy KBP-2020 cohort study2025 Three-year survival in lung adenocarcinoma improved markedly over twenty years of real-world care
Lung cancer Diagnostic strategy Navigational bronchoscopy VERITAS 2025 Navigational bronchoscopy matched needle biopsy for accuracy with a tenth of the pneumothorax rate
Lung cancer Surgery Sublobar resection CALGB 140503 2023 Sublobar resection matched lobectomy for small peripheral node-negative lung cancers
Lung cancer Screening Volume CT screening NELSON 2020 Volume CT screening reduced lung cancer mortality with a 2.1% referral rate
Lung cancer Immunotherapy Durvalumab PACIFIC 2017 Consolidation durvalumab tripled progression-free survival after chemoradiotherapy in stage III lung cancer
Lung cancer Screening Low-dose CT screening NLST 2011 Low-dose CT screening reduced lung cancer mortality — at the cost of a 96% false-positive rate
Lung cancer Diagnostic strategy Endosonography ASTER 2010 Endosonography before surgical staging raised sensitivity to 94% and halved unnecessary thoracotomies
Pleural disease Pleural intervention Conservative management PSP 2020 Most primary spontaneous pneumothoraces resolved without any intervention, though the non-inferiority result is fragile
Pleural disease Pleural intervention Ambulatory device RAMPP 2020 Ambulatory devices sent most patients home the same day, but caused more adverse events
Pleural disease Pleural intervention Talc poudrage TAPPS 2020 Talc poudrage at thoracoscopy was no better than talc slurry down a chest drain
Pleural disease Pleural intervention Pleural manometry Pleural manometry 2019 Manometry during large-volume drainage did not reduce chest discomfort
Pleural disease Pleural intervention Indwelling pleural catheter AMPLE 2017 Indwelling pleural catheters kept patients out of hospital more than talc pleurodesis
Pleural disease Pleural intervention Indwelling pleural catheter TIME2 2012 Catheters and talc relieved breathlessness equally at 6 weeks; catheters avoided admission but caused nearly five times the adverse events
Pleural disease Intrapleural therapy Alteplase plus DNase MIST2 2011 Combined t-PA and DNase improved drainage and cut surgical referral; neither drug worked alone
Pleural disease Intrapleural therapy Streptokinase MIST1 2005 Intrapleural streptokinase alone did not work, and caused more serious adverse events
Lung transplantation Assessment FEV1 trajectory modelling FEV1 trajectories cohort study2025 Distinct patterns of FEV1 decline after transplant predicted different outcomes
Lung transplantation Immunosuppression Once-daily tacrolimus ScanCLAD 2024 Once-daily tacrolimus reduced chronic lung allograft dysfunction versus ciclosporin
Lung transplantation Immunosuppression Watchful waiting for minimal acute rejection Levy 2020 retrospective cohort2020 Leaving a first episode of minimal subclinical rejection untreated did not increase allograft loss or death
Procedures Airway management Ketamine Ketamine or etomidate 2026 Ketamine and etomidate produced identical mortality at intubation
Procedures Airway management Non-invasive ventilation for preoxygenation PREOXI 2024 Preoxygenating with non-invasive ventilation halved hypoxaemia during intubation
Procedures Airway management Video laryngoscopy DEVICE 2023 Video laryngoscopy improved first-attempt intubation success enough to stop the trial early
Procedures Transfusion Withholding prophylactic platelet transfusion PACER 2023 Skipping prophylactic platelets before a central line caused more bleeding
Procedures Airway management Bag-mask ventilation between induction and laryngoscopy PreVent (bag-mask) 2019 Bag-mask ventilating between induction and laryngoscopy raised saturations without causing aspiration
Procedures Vascular access Subclavian vein catheterisation 3SITES 2015 Subclavian lines had fewer infections and clots but more pneumothoraces
Procedures Pleural intervention Larger-volume pleural fluid sampling Swiderek 2010 diagnostic accuracy2010 Sending 10 mL of pleural fluid misses malignancy that 60 mL would find
Procedures Bronchoscopy Continuing aspirin Herth 2002 prospective cohort2002 Aspirin did not increase bleeding after transbronchial biopsy
Sleep medicine Positive airway pressure Adaptive servo-ventilation ADVENT-HF 2024 Adaptive servo-ventilation was neutral in heart failure, and crucially showed none of the harm seen in SERVE-HF
Sleep medicine Weight-loss pharmacotherapy Tirzepatide SURMOUNT-OSA 2024 Tirzepatide halved the apnoea-hypopnoea index in obese patients with OSA
Sleep medicine Positive airway pressure CPAP Traaen 2021 2021 CPAP did not reduce atrial fibrillation burden despite the strong observational association
Sleep medicine Diagnostic strategy Home respiratory polygraphy Corral 2017 2017 Home sleep studies managed patients as well as full polysomnography, far more cheaply
Sleep medicine Non-invasive ventilation Home non-invasive ventilation HOT-HMV 2017 Home non-invasive ventilation tripled the time to readmission or death after a hypercapnic exacerbation
Sleep medicine Positive airway pressure CPAP SAVE 2016 CPAP did not prevent cardiovascular events, though it treated the apnoea and improved symptoms
Sleep medicine Positive airway pressure Adaptive servo-ventilation SERVE-HF 2015 Adaptive servo-ventilation abolished the central apnoeas and increased mortality
Sleep medicine Non-invasive ventilation Home non-invasive ventilation Kohnlein 2014 2014 Home ventilation targeted at lowering CO2 cut one-year mortality from 33% to 12%
Sleep medicine Neurostimulation Upper-airway stimulation STAR uncontrolled cohort2014 Hypoglossal nerve stimulation cut the AHI by two thirds — in an uncontrolled cohort
Sleep medicine Oral appliances Mandibular advancement device Phillips 2013 2013 An oral appliance matched CPAP on health outcomes: less effective per hour, but worn for more of them
Sleep medicine Positive airway pressure CPAP Barbe 2012 2012 CPAP did not significantly reduce incident hypertension or cardiovascular events in non-sleepy OSA
Sleep medicine Positive airway pressure CPAP CATNAP 2012 CPAP improved daily function in sleepy patients with only mild to moderate apnoea
Sleep medicine Positive airway pressure CPAP CANPAP 2005 CPAP improved every surrogate measure in central sleep apnoea and did not improve survival
Sleep medicine Positive airway pressure CPAP Marin 2005 observational cohort2005 Observationally, untreated severe apnoea tripled cardiovascular events and CPAP appeared to abolish the excess
PFTs Assessment Pulmonary function test interpretation Hyatt 2011 retrospective cohort2011 The nonspecific pattern is stable in two thirds of patients and is not early obstruction
Rehab Rehabilitation Telerehabilitation and unsupervised home training Bourne 2023 2023 Home telerehabilitation and unsupervised training both cut readmissions by around 40%
Rehab Rehabilitation Early pulmonary rehabilitation Lindenauer 2021 observational cohort2021 Starting rehabilitation within 90 days of a COPD admission was associated with 17% fewer readmissions
Rehab Rehabilitation Home-based pulmonary rehabilitation Holland 2017 2017 Home-based rehabilitation matched centre-based programmes on short-term outcomes
Smoking cessation Pharmacotherapy Varenicline plus nicotine patch Baker 2021 2021 Neither adding a nicotine patch to varenicline nor doubling the treatment duration helped
Smoking cessation Nicotine delivery Nicotine patch plus nicotine e-cigarette Walker 2020 2020 Adding a nicotine e-cigarette to patches gave a modest improvement in quitting
Smoking cessation Nicotine delivery E-cigarettes TEC 2019 E-cigarettes nearly doubled one-year quit rates compared with nicotine replacement
Smoking cessation Behavioural intervention Financial incentives Halpern 2018 2018 Only financial incentives worked; free cessation aids and free e-cigarettes alone did essentially nothing
Smoking cessation Behavioural intervention Smoking cessation programme Lung Health Study 2005 A cessation programme that worked for one in five participants still reduced all-cause mortality over 14.5 years
Smoking cessation Nicotine delivery Transdermal nicotine patch Transdermal Nicotine Study Group 1991 Nicotine patches more than doubled short-term quit rates against placebo
ARDS Corticosteroids Dexamethasone DEXA-ARDS 2020 Dexamethasone reduced ventilator days and mortality in established moderate-to-severe ARDS
ARDS Oxygen Conservative oxygen targets LOCO2 2020 Targeting a low PaO2 in ARDS did not help and raised safety concerns
ARDS Sedation and paralysis Cisatracurium ROSE 2019 Routine early paralysis added nothing when the comparator was lighter sedation
ARDS Extracorporeal support Veno-venous ECMO EOLIA 2018 Immediate ECMO did not significantly beat conventional ventilation with ECMO held in reserve
ARDS Ventilator strategy Recruitment manoeuvres with titrated PEEP ART 2017 Aggressive recruitment with titrated PEEP increased mortality
ARDS Ventilator strategy Driving pressure Driving pressure pooled analysis2015 Driving pressure predicted survival better than tidal volume or PEEP, even within protective settings
ARDS Ventilator strategy Prone positioning PROSEVA 2013 Prone positioning halved mortality in severe ARDS
ARDS Sedation and paralysis Cisatracurium ACURASYS 2010 Early cisatracurium improved adjusted 90-day survival in severe ARDS
ARDS Extracorporeal support Referral to an ECMO centre CESAR 2009 Referral to an ECMO centre improved 6-month survival without disability in severe respiratory failure
ARDS Ventilator strategy Increased recruitment PEEP strategy ExPress 2008 Recruitment-oriented PEEP did not reduce mortality but shortened ventilation and organ failure
ARDS Ventilator strategy Open lung ventilation strategy LOVS 2008 An open-lung strategy with recruitment and high PEEP did not improve mortality
ARDS Corticosteroids Methylprednisolone LaSRS 2006 Steroids for persistent ARDS improved physiology, did not improve survival, and harmed late starters
ARDS Ventilator strategy Higher PEEP ALVEOLI 2004 Higher PEEP added nothing once tidal volume and plateau pressure were already limited
ARDS Ventilator strategy Low tidal volume ventilation ARMA 2000 Ventilating at 6 mL/kg instead of 12 cut ARDS mortality from 40% to 31%
Ventilation & weaning Oxygen Conservative oxygen therapy UK-ROX 2025 Conservative oxygen targets changed nothing, in the largest ICU oxygen trial yet run
Ventilation & weaning Oxygen SpO2 target PILOT 2022 Lower, intermediate and higher oxygen saturation targets gave identical ventilator-free days
Ventilation & weaning Rehabilitation Early active mobilisation TEAM 2022 Pushing mobilisation harder gave no benefit and more than doubled adverse events
Ventilation & weaning Weaning strategy Pressure-support spontaneous breathing trial TIP-EX 2022 Pressure support and T-piece breathing trials produced the same ventilator-free days
Ventilation & weaning Oxygen delivery Protocolised post-extubation support Casey 2021 2021 Giving every extubated patient respiratory support prevented no reintubations
Ventilation & weaning Oxygen Conservative oxygen therapy ICU-ROX 2020 Conservative oxygen therapy made no difference to ventilator-free days
Ventilation & weaning Tracheostomy Suctioning-based decannulation REDECAP 2020 Deciding decannulation on suctioning frequency rather than capping trials halved time to decannulation
Ventilation & weaning Non-invasive ventilation High-flow oxygen plus non-invasive ventilation Thille 2019 2019 Adding non-invasive ventilation to high-flow oxygen cut reintubation in the highest-risk patients
Ventilation & weaning Weaning strategy Early extubation to non-invasive ventilation Breathe 2018 Extubating early onto non-invasive ventilation did not shorten total time to liberation
Ventilation & weaning Ventilator strategy Low tidal volume ventilation PReVENT 2018 Low tidal volumes gave no benefit in ventilated patients who did not have ARDS
Ventilation & weaning Oxygen delivery High-flow nasal oxygen Hernandez 2016 2016 High-flow nasal oxygen was non-inferior to non-invasive ventilation after extubation, and better tolerated
Ventilation & weaning Non-invasive ventilation Non-invasive ventilation Jaber 2016 2016 Non-invasive ventilation reduced reintubation after abdominal surgery
Ventilation & weaning Rehabilitation Standardised rehabilitation therapy Morris 2016 2016 Standardised rehabilitation did not shorten hospital stay or improve strength
Ventilation & weaning Rehabilitation Intensive physical therapy Moss 2016 2016 Nearly five times as much physiotherapy produced no functional gain
Ventilation & weaning Oxygen delivery High-flow nasal oxygen FLORALI 2015 High-flow oxygen did not reduce intubation but was associated with lower 90-day mortality
Ventilation & weaning Weaning strategy Tracheostomy collar Jubran 2013 2013 Unassisted breathing through a tracheostomy collar weaned patients faster than pressure support
Ventilation & weaning Tracheostomy Early tracheostomy TracMan 2013 Early tracheostomy did not improve survival, and over half the late group never needed one
Ventilation & weaning Tracheostomy Early tracheostomy Terragni 2010 2010 Early tracheostomy did not significantly reduce ventilator-associated pneumonia
Ventilation & weaning Non-invasive ventilation Prophylactic non-invasive ventilation Ferrer 2009 2009 Prophylactic non-invasive ventilation after extubation prevented respiratory failure and deaths in hypercapnic patients
Ventilation & weaning Investigation strategy On-demand chest radiography Hejblum 2009 2009 Ordering chest films on demand cut radiographs by a third with no loss of safety
Ventilation & weaning Non-invasive ventilation CPAP or bilevel NIV 3CPO 2008 Non-invasive ventilation made patients with pulmonary oedema feel better faster without saving lives
Ventilation & weaning Weaning strategy Paired sedation interruption and breathing trial Wake up and breathe 2008 Pairing daily sedation interruption with a breathing trial got patients off ventilators sooner and improved survival
Ventilation & weaning Non-invasive ventilation Rescue non-invasive ventilation Esteban 2004 2004 Rescue non-invasive ventilation for established post-extubation failure did not work and delayed reintubation
Ventilation & weaning Non-invasive ventilation Non-invasive ventilation Ferrer 2003 2003 Non-invasive ventilation reduced intubation and mortality in severe hypoxaemic respiratory failure
Ventilation & weaning Non-invasive ventilation Non-invasive ventilation Brochard 1995 1995 Non-invasive ventilation cut intubation, length of stay and mortality in COPD exacerbations
Ventilation & weaning Weaning strategy Pressure support weaning Brochard 1994 1994 Gradual pressure support weaning outperformed T-piece trials and SIMV in difficult-to-wean patients
Ventilation & weaning Non-invasive ventilation Face-mask CPAP Bersten 1991 1991 Face-mask CPAP rapidly improved physiology and reduced intubation in cardiogenic pulmonary oedema
Ventilation & weaning Assessment Rapid shallow breathing index Yang and Tobin diagnostic accuracy1991 The rapid shallow breathing index outperformed every other weaning predictor
Sepsis Antibiotics Procalcitonin-guided antibiotic duration ADAPT-Sepsis 2025 Procalcitonin-guided stopping shortened antibiotic courses without increasing deaths
Sepsis Resuscitation strategy Capillary refill time-targeted resuscitation ANDROMEDA-SHOCK-2 2025 Resuscitating towards capillary refill time beat usual care on a hierarchical composite
Sepsis Antibiotics Seven-day antibiotic course BALANCE 2025 A week of antibiotics matched a fortnight for bloodstream infection
Sepsis Monitoring Deferred arterial catheterisation Deferred arterial catheter 2025 Deferring the arterial line in shock was as safe as inserting one early
Sepsis Resuscitation strategy Restrictive fluid strategy with early vasopressors CLOVERS 2023 Neither restrictive nor liberal early fluid strategy was better in sepsis-induced hypotension
Sepsis Resuscitation strategy Restrictive fluid strategy CLASSIC 2022 Restricting fluid in established septic shock did not reduce mortality
Sepsis Corticosteroids Hydrocortisone ADRENAL 2018 Hydrocortisone resolved shock faster without reducing mortality
Sepsis Corticosteroids Hydrocortisone plus fludrocortisone APROCCHSS 2018 Hydrocortisone with fludrocortisone reduced 90-day mortality by 6 percentage points
Sepsis Vasopressors Angiotensin II ATHOS-3 2017 Angiotensin II raised blood pressure in catecholamine-refractory shock
Sepsis Resuscitation strategy Early goal-directed therapy ProMISe 2015 Strict EGDT gave identical 90-day mortality at higher cost
Sepsis Resuscitation strategy Early goal-directed therapy ARISE 2014 Early goal-directed therapy did not reduce 90-day mortality
Sepsis Resuscitation strategy Protocol-based resuscitation ProCESS 2014 Protocolised resuscitation did not beat usual care in septic shock
Sepsis Vasopressors Low-dose vasopressin VASST 2008 Adding low-dose vasopressin to catecholamines did not improve survival
Sepsis Antibiotics Early effective antimicrobial therapy Kumar 2006 retrospective cohort2006 Every hour of delay to effective antibiotics in septic shock was associated with higher mortality
Sepsis Resuscitation strategy Early goal-directed therapy Rivers EGDT 2001 A protocolised resuscitation bundle appeared to cut mortality dramatically in early septic shock
Sedation Sedation strategy Alpha-2 agonist sedation A2B 2025 Neither dexmedetomidine nor clonidine beat propofol for time to extubation
Sedation Antipsychotics Haloperidol AID-ICU 2022 Haloperidol did not improve outcomes in ICU delirium
Sedation Sedation strategy Dexmedetomidine MENDS2 2021 Dexmedetomidine and propofol were equivalent when sedation was kept light
Sedation Sedation strategy Dexmedetomidine SPICE III 2019 Early dexmedetomidine did not reduce mortality and often needed topping up
Sedation Antipsychotics Haloperidol or ziprasidone MIND-USA 2018 Neither antipsychotic shortened ICU delirium
Sedation Natural history Observation BRAIN-ICU prospective cohort2013 Three quarters became delirious, and 40% had brain-injury-level cognitive impairment three months later
Sedation Sedation strategy Daily sedation interruption SLEAP 2012 Sedation holds added nothing once sedation was already protocolised and light
Sedation Sedation strategy Dexmedetomidine SEDCOM 2009 Dexmedetomidine matched midazolam for sedation depth but caused less delirium and shorter ventilation
Sedation Sedation strategy Daily sedation interruption Kress 2000 2000 Waking patients daily cut two and a half days off mechanical ventilation
Cardiac Mechanical circulatory support Microaxial flow pump DanGer Shock 2024 A microaxial flow pump reduced 180-day mortality in infarct-related cardiogenic shock
Cardiac Mechanical circulatory support Veno-arterial ECMO ECLS-SHOCK 2023 Veno-arterial ECMO did not reduce mortality in infarct-related cardiogenic shock
Cardiac Mechanical circulatory support Veno-arterial ECMO ECMO-CS 2023 Immediate ECMO was no better than a conservative strategy with ECMO in reserve
Cardiac Extracorporeal support Extracorporeal CPR INCEPTION 2023 Extracorporeal CPR did not improve neurologically intact survival after refractory cardiac arrest
Cardiac Transfusion Liberal transfusion strategy MINT 2023 A liberal transfusion threshold after myocardial infarction gave no significant benefit, but harm could not be excluded
Cardiac Inotropes Milrinone DOREMI 2021 Milrinone and dobutamine performed identically in cardiogenic shock
Cardiac Transfusion Restrictive transfusion strategy REALITY 2021 A restrictive transfusion strategy was non-inferior after myocardial infarction
Cardiac Vasopressors Vasopressin VANCS 2017 Vasopressin as first-line agent outperformed noradrenaline in post-cardiac-surgery vasoplegia
Cardiac Mechanical circulatory support Intra-aortic balloon pump IABP-SHOCK II 2012 The intra-aortic balloon pump did not reduce mortality in infarct-related cardiogenic shock
Cardiac Vasopressors Noradrenaline SOAP II 2010 Dopamine matched noradrenaline for mortality but caused far more arrhythmias
Cardiac Monitoring Pulmonary artery catheter ESCAPE 2005 The pulmonary artery catheter added adverse events and no benefit over careful clinical assessment
Neuro Thrombolysis Alteplase HOPE 2025 Imaging-selected thrombolysis worked as late as 24 hours from onset
Neuro Transfusion Liberal transfusion strategy SAHaRA 2025 Liberal transfusion did not improve outcomes after subarachnoid haemorrhage
Neuro Thrombolysis Tenecteplase Tenecteplase before thrombectomy 2025 Giving tenecteplase before thrombectomy beat thrombectomy alone
Neuro Transfusion Liberal transfusion strategy HEMOTION 2024 A liberal transfusion threshold did not improve outcomes in traumatic brain injury
Neuro Transfusion Liberal transfusion strategy TRAIN 2024 A liberal transfusion threshold improved neurological outcome in acute brain injury
Neuro Temperature management Targeted hypothermia TTM2 2021 Cooling to 33°C after cardiac arrest was no better than simply preventing fever
Neuro Thrombolysis Alteplase guided by perfusion imaging EXTEND 2019 Perfusion imaging identified patients who benefited from thrombolysis up to 9 hours out
Neuro Thrombectomy Mechanical thrombectomy DAWN 2018 Thrombectomy worked up to 24 hours out when imaging showed salvageable brain
Neuro Thrombolysis Alteplase guided by MRI mismatch WAKE-UP 2018 MRI mismatch identified wake-up strokes that still benefited from thrombolysis
Neuro Blood pressure management Intensive blood pressure lowering ATACH-2 2016 Aggressive blood pressure lowering in intracerebral haemorrhage gave no benefit
Neuro Prognostication Objective futility criteria Coppler 2016 prognostic cohort2016 Three objective criteria identified cardiac arrest patients with essentially no chance of survival
Neuro Thrombolysis Alteplase ECASS III 2008 Alteplase still worked between 3 and 4.5 hours, with the same bleeding cost
Neuro Weaning strategy Prompt extubation Coplin 2000 prospective cohort2000 Delaying extubation in brain-injured patients who were ready nearly doubled pneumonia and doubled ICU stay
Neuro Thrombolysis Alteplase NINDS t-PA 1995 Thrombolysis within 3 hours improved outcome despite causing more intracranial bleeding
Neuro Neuroprotection Nimodipine BRANT 1989 Oral nimodipine reduced cerebral infarction and improved outcome after subarachnoid haemorrhage
Renal Renal replacement Conservative dialysis strategy LIBERATE-D 2026 Dialysing less often led to faster recovery of kidney function and less hypotension
Renal Fluids Balanced multielectrolyte solution PLUS 2022 Balanced fluid was no better than saline in critically ill adults
Renal Renal replacement More-delayed initiation AKIKI 2 2021 Waiting even longer than a delayed strategy caused harm without benefit
Renal Fluids Balanced solution BaSICS 2021 Balanced solution did not improve survival over saline in over ten thousand patients
Renal Renal replacement Accelerated initiation STARRT-AKI 2020 Starting dialysis early did not save lives and left more patients dialysis-dependent
Renal Renal replacement Intermittent haemodialysis Hemodiafe 2006 Intermittent haemodialysis matched continuous therapy when delivered carefully
GI Gastroprotection Pantoprazole REVISE 2024 Pantoprazole cut clinically important gastrointestinal bleeding from 3.5% to 1.0%
GI Vasoconstrictors Terlipressin CONFIRM 2021 Terlipressin reversed hepatorenal syndrome in a third of patients, at the cost of respiratory failure
GI Haemostatics Tranexamic acid HALT-IT 2020 Tranexamic acid did not reduce death from gastrointestinal bleeding and caused more clots
GI Gastroprotection Proton pump inhibitor PEPTIC 2020 Mortality was similar with either default agent, though the proton pump inhibitor strategy trended higher and reduced gastrointestinal bleeding
GI Renal replacement Continuous renal replacement therapy CRRT in acute liver failure registry cohort2018 Continuous renal replacement therapy lowered ammonia and was associated with better transplant-free survival; intermittent therapy was associated with worse
GI Transfusion Restrictive transfusion strategy Villanueva 2013 2013 Transfusing less in upper gastrointestinal bleeding improved survival
GI Interventional radiology Early transjugular intrahepatic portosystemic shunt Early TIPS 2010 Early TIPS almost abolished rebleeding and improved survival in high-risk variceal bleeding
GI Antioxidants N-acetylcysteine NAC in non-paracetamol ALF 2009 N-acetylcysteine improved transplant-free survival in early non-paracetamol liver failure only
GI Volume expansion Intravenous albumin Sort 1999 1999 Albumin with antibiotics prevented renal failure and death in spontaneous bacterial peritonitis
Haem Anticoagulation Therapeutic-dose anticoagulation TASC 2025 Therapeutic-dose anticoagulation shortened acute chest syndrome and nearly halved opioid use without causing bleeding
Haem Transfusion Restrictive transfusion strategy TRICC 1999 Transfusing at 7 rather than 10 g/dL was at least as good, and possibly better
Endocrine Glycaemic control Intensive insulin therapy NICE-SUGAR 2009 Tight glucose control killed people; a target of 180 mg/dL or less was safer
Endocrine Glycaemic control Intensive insulin therapy Van den Berghe 2006 2006 Tight glucose control reduced morbidity but not mortality, and the responders could not be identified in advance
Nutrition Nutrition strategy Augmented enteral protein TARGET Protein 2025 Augmenting enteral protein delivered no benefit
Nutrition Nutrition strategy High-dose protein EFFORT Protein 2023 High-dose protein did not help and may have harmed patients with kidney injury
Nutrition Nutrition strategy Permissive underfeeding PermiT 2015 Deliberately underfeeding calories made no difference to survival
Nutrition Nutrition strategy Parenteral nutrition CALORIES 2014 Parenteral and enteral routes gave identical mortality
Nutrition Nutrition strategy Not monitoring gastric residual volume Reignier 2013 2013 Stopping routine gastric residual checks did not increase pneumonia
Nutrition Nutrition strategy Nasojejunal feeding Davies 2012 2012 Post-pyloric feeding delivered no more calories than the nasogastric tube already in place
Nutrition Nutrition strategy Trophic enteral feeding EDEN 2012 Trophic feeding matched full feeding, with less gastrointestinal intolerance
Nutrition Nutrition strategy Late initiation of parenteral nutrition EPaNIC 2011 Waiting a week before starting parenteral nutrition led to faster recovery and fewer infections
Obstetric Haemostatics Tranexamic acid WOMAN 2017 Tranexamic acid reduced death from bleeding in post-partum haemorrhage, with no excess thrombosis
ICU administration Staffing Critical care pharmacist input MRC-ICU observational study2022 Higher pharmacist workload was associated with less care delivered and worse outcomes
ICU administration Staffing Schedule without extended shifts ROSTERS 2020 Abolishing 24-hour shifts increased serious medical errors rather than reducing them
ICU administration Care processes Daily checklist with goal setting and prompting CHECKLIST-ICU 2016 Daily checklists and clinician prompting did not reduce mortality
ICU administration Staffing Nighttime in-hospital intensivist Kerlin 2013 2013 Having an intensivist in the hospital overnight did not improve outcomes
ICU administration Service delivery Tele-ICU Lilly 2011 before-and-after study2011 Tele-ICU with process reengineering was associated with lower mortality and shorter stays
ICU administration Service delivery Remote ICU monitoring Thomas 2009 before-and-after study2009 Remote ICU monitoring alone did not improve mortality or length of stay
ICU administration Staffing Continuous on-site intensivist Gajic 2008 before-and-after study2008 Continuous on-site intensivist presence improved processes of care and staff satisfaction
Ultrasound Assessment Lung ultrasound BLUE protocol diagnostic accuracy2008 A structured lung ultrasound protocol distinguished the causes of acute respiratory failure at the bedside
Palliative care Service delivery Default palliative care consultation order Courtright 2024 2024 Making palliative care consultation the default nearly tripled referrals but did not change length of stay
Palliative care Communication Interprofessional family-support intervention PARTNER 2018 Structured family support improved communication and shortened ICU stay without easing families' distress
Palliative care Prognostication Clinician prediction Detsky 2017 prospective cohort2017 Clinicians predicted survival reasonably well and functional recovery poorly
Palliative care Communication Palliative care-led family meetings Carson 2016 2016 Palliative care-led family meetings did not reduce distress and increased post-traumatic stress symptoms

Browse by topic

Airways

Parenchyma & vasculature

Infection

Thoracic

Sleep, function & rehab

Respiratory failure

Critical care