Martin M. Cearras, MD

We reviewed the Leuven II trial — a single-center RCT in medical ICU patients comparing intensive insulin (target 80–110 mg/dL) with a conventional approach (180–200 mg/dL). Key takeaways: intensive therapy did not reduce overall in-hospital mortality in the intention-to-treat group, but it was associated with potentially reduced renal injury, shorter ventilator time, and shorter ICU/hospital stays (hypothesis-generating). Notably, patients who stayed >3 days showed a mortality benefit with intensive control (NNT ≈ 11) — a subgroup signal that needs cautious interpretation (subgroup analyses can mislead).

Why this matters: these results highlight how important trial design, blinding, and co-interventions are when we apply evidence to bedside decisions. For clinicians and trainees, the paper is a useful lesson in weighing primary vs secondary outcomes and avoiding overinterpretation of subgroup findings. Read the full appraisal and the original NEJM link in the post to decide how (or whether) this informs your practice. What questions does this raise for your ICU practice? Let’s discuss. 🩺📊💬

Critical Thinking in Medicine | Evidence-Based Resources for Healthcare Critical Thinking In Medicine - Enhance patient care with evidence-based practices. Free resources for medical professionals.

After over a decade, reunion with a former co-resident at UM! Great to see you, Marcela Ferrada. Excellent lecture.

At SCCM Florida Congress! Reach out if you are also here!

Thank you, Tooba, for your contribution to Critical Thinking in Medicine!

Vanish 2 trial: VT Ablation first strategy does not improve patient important outcomes in clinically significant ventricular tachycardia. Critical Appraisal. Critical Appraisal by Tooba Shaukat Butt, MD. Edited by Martin M. Cearras, MD, FACP.Find the original article here! https://www.nejm.org/doi/full/10.1056/NEJMoa2409501Summary:The VANISH2 trial was an international, randomized study comparing catheter ablation to antiarrhythmic drug therapy alone, in...

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STARRT - AKI trial. Harm and unnecessary Renal Replacement Therapy (RRT) when RRT is started early in the ICU. Author: Peter Ryu Tofts MDEditor: Martin M. Cearras, MDFind the original article here! Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury | New England Journal of MedicineSummary:STARRT AKI is a large multicenter, international RCT, conducted in 168 hospitals in 15 countries, c...

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Throwback to picking teams for dodgeball... Let's talk Selection Bias and Allocation Concealment We all remember standing and waiting to be picked for team sports. On purpose, teams are "rigged", we try to get the best players to give us an edge. Stacking your team with the best players is called Selection Bias. However, in a clinical trial, this will ruin your chances of getting at the truth!....

Understanding Outcomes in Therapy Studies Outcomes can be expressed in a multitude of different ways that can be initially confusing for learners. Rates of Events (Risks) are the number of times the outcome of interest happened in each group we are analyzing, expressed in percentage. Even though the word "Risk" has a negative connotation, i...

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Study Design 101 When asking questions in medicine, each type of question has a different study design that provides the best type of information. • For evaluating therapeutical interventions, a well done Randomized Controlled Trial (RCT) will provide the best data. If performed appropriately, randomized groups of...