Ventilator free days as an outcome
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| Posted By: | Gordon S Doig |
| Email: | gdoig@med.usyd.edu.au |
| URL: | Critical Care Medicine. 30(8):1772-1777, August 2002. |
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The link above references a key ariticle where Gordon Bernard introduces and discusses his outcome of Ventilator Free Days. As Gordon points out on page p 1775 "The concept of VFDs attempts to combine reduced need for mechanical ventilation with reduction in mortality, if any, as a single end point." He then notes that sometimes this causes a problem (earlier on Page 1775) "A new treatment that simultaneously increased mortality by 5% and decreased the duration of ventilation by 4.5 days would have a 30% chance of showing a significant increase in VFDs. Thus, the trial would have an unacceptably large chance of showing that a trial that increased mortality was superior if one relied entirely on VFDs as the primary end point." I think his overall purpose of 'inventing' this measure was to allow smaller clinical trials to be conducted. It may be a useful endpoint for Phase II trials... but because there is the issue of an apparent benefit when mortality increases, we would still need confirmatory Phase III trials. At the very least, VFDs should be interpreted in the context of mortality, duration of ventilation, duration of ICU stay and duration of hospital stay. Unfortunately the ARDSNet clinical trial reviewed in this JC does not report duration of ventilation, ICU stay or hospital stay. |
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 Ventilator free days as an outcome By:Gordon S Doig |
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