Bottom line: Ultimately, I don’t think this trial definitively proves that there is no role for tympanostomy tubes, but considering that there was never great evidence for the practice in the first place, it really should curtail the practice. At this point, I would want to see a positive study before I subjected my child to surgery.
People got really excited about the SMART and SALT-ED trials, but they were trials with very imperfect methodology and mixed results. Before BaSICS, the highest quality trial we had was SPLIT, and it also showed no harm from normal saline.
Bottom line: This is the best evidence to date, and there does not appear to be anything harmful about using normal saline as your IV fluid of choice.
Intense oxygen therapy in palliative care: on oxymoron?
Bottom line: Hospitals really need to consider the heaviest patients that could present, and not the average patient, when purchasing equipment (and manufacturers need to consider the same when building equipment).
Bottom line: After the pair of TTM trials, we know for sure that hypothermia is not beneficial. Whether fever control, or any temperature management, is effective remains an open question, but that is a hypothesis untested by RCTs. Based on data in other critically ill patients, it is very unlikely that fever control improves outcomes, but I imagine we will see RCTs on that in the future. Justin’s full write up can be found here.
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact