A limited number of publications have had a dramatic impact on the practice of Critical Care Medicine. These publications are regarded as “compulsory” reading for residents, fellows and other practitioners of Critical Care Medicine. Surprisingly, although not unexpectedly, those publications with the potential to have the most dramatic positive impact on patient care have been slow to be adopted, while publications of questionable scientific rigor are frequently adopted with an unexplained religious fervor. This chapter reviews those papers which have dramatically altered the practice of Critical Care Medicine (for good or bad) as well as those “classic” papers that have shaped the history of Critical Care Medicine.

Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.

Perhaps the most important publication in the history of Critical Care Medicine is that of the ARDSnet low vs. standard tidal volume study. This study demonstrated a significant reduction in 28-day mortality in patients randomized to the low tidal volume group (6 mL/kg PBW) as compared to the traditional tidal volume (12 mL/kg PBW) group. The results of this study are supported by extensive experimental and clinical studies. Furthermore, high tidal volumes are associated with progressive lung injury in patients who initially do not have acute lung injury. A tidal volume of 6–8 mL/kg is therefore considered the standard of care for ALL ICU patients.

Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013;369:428–37.

These authors randomized 400 patients undergoing abdominal surgery to an intraoperative ventilatory strategy of either 8–10 or 6–8 mL/kg. The risk of major pulmonary and extrapulmonary complications occurring within the first 7 days after surgery was significantly higher in the patients receiving the non-protective ventilation strategy.

Kress JP, Pohlman AS, O’Connor MF, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342:1471–7.

This study demonstrated that in patients who are receiving mechanical ventilation, daily interruption of sedative drug infusions decreases the duration of mechanical ventilation and the length of stay in the intensive care.

Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing controlled trial): a randomised controlled trial. Lancet. 2008;371:126–34.

This study demonstrated that “a wake up and breathe protocol” that pairs daily spontaneous awakening trials (ie, interruption of sedatives) with daily spontaneous breathing trials results in better outcomes for mechanically ventilated patients than the “standard approaches.” This approach should be considered the standard of care in all ICU patients.

Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian critical care trials group. N Engl J Med. 1999;340:409–17.

In a landmark study, Herbert and colleagues compared a conservative (transfusion for Hb < 7 g/dL) vs. liberal (transfusion for Hb < 10 g/dL) blood transfusion protocol. In this study the complication rate and 28-day mortality tended to be lower in the conservative group. This results of this study are supported by additional RCT’s and cohort studies.

Connors AF, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA. 1996;276:889–97.