Grant: CIHR Clinician Scientist - Phase 2

In clinical medicine, systematic review and meta-analytic techniques systematically search for and combine data from randomized trials and form the basis for evidence-based medicine. As an active critical care clinician and active researcher, I will use novel applications of systematic review and meta-analytic techniques to re-examine and potentially challenge prevailing thinking regarding the effectiveness of certain treatments to reduce mortality in critically-ill patients. This proposal focuses on three common clinically-relevant questions in critical care that cannot be readily answered using other means. First, whether nitric oxide, a very expensive inhaled gas used to improve oxygenation in critically-ill patients requiring mechanical ventilation for lung failure, is actually effective in the sickest patients with life-threateningly low oxygen levels. Second, whether resource-intensive treatments used to reduce secondary (ventilator-associated) pneumonia which often occurs in patients requiring ventilation also results in improved mortality and length of stay. And third, whether an optimal duration of follow up in randomized controlled trials (which currently use many different follow up durations) can be identified when mortality effects have stabilized to ensure accurate estimates of the effectiveness of these treatments. Answering these questions will illustrate how novel applications of meta-analytic techniques can inform more effective decision making by clinicians.