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Special Communication | Less Is More

“Less Is More” in Critically Ill Patients:  Not Too Intensive

Matthijs Kox, PhD1,2,3; Peter Pickkers, MD, PhD1,3
[+] Author Affiliations
1Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
2Department of Anesthesiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
3Nijmegen Institute for Infection, Inflammation, and Immunity (N4i), Nijmegen, the Netherlands
JAMA Intern Med. 2013;173(14):1369-1372. doi:10.1001/jamainternmed.2013.6702.
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The current view in intensive care medicine is that very sick patients need very intensive treatment. However, in this group of highly vulnerable patients, more intensive treatment may promote the chances of unwanted adverse effects and hence, iatrogenic damage. Therefore, we state that critically ill patients probably benefit from a more cautious approach. Using data from large clinical trials of previous years, we exemplify that less intensive treatment is associated with a better outcome in intensive care patients and suggest that we reappraise patient management as well as trial design in intensive care medicine while bearing in mind the “less is more” paradigm. We illustrate our case by describing the intensity of the most relevant treatment options for patients with septic shock, including mechanical ventilation, fluid management, blood pressure–targeted therapy, corticosteroids, patient monitoring, sedation, and nutrition. We conclude that treatment of critically ill patients while keeping in mind the “less is more” paradigm might not only benefit the patient but could also have a notable impact on the ever-increasing intensive care–related health care costs.

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