The tens of thousands of lives saved by randomized clinical trials in critical care

In the second half of 1952, a total of 2,722 patients with poliomyelitis were admitted to the Blegdam Hospital for communicable diseases in Copenhagen. With 12 of all admissions requiring artificial respiratory support, resources were soon overwhelmed, and the initial case-fatality rate for patients with respiratory failure reached 90 . Driven by necessity, a few dedicated professionals persisted with ?therapeutic improvisations? and eventually refined the specific skills required to provide long-term manual positive pressure ventilation through a tracheostomy [1]. Because of excellent record keeping, subsequent publications demonstrated that manual positive pressure ventilation halved the case-fatality rate [2]. Since the polio pandemic of the 1950s, the practice of intensive care medicine has been built upon all types of objective research evidence: the well-conducted observational study [3] and the single-patient case report [4] have led to major improvements in patient outcomes