Systematic Reviews: Alternative Clinical Scenario

You are attending morning rounds in the medical-surgical ICU with junior housestaff. They present a 77 year old gentleman who was admitted from the emergency department with progressive SOB and respiratory failure requiring intubation and mechanical ventilation. The housestaff present convincing evidence that this is due to an exacerbation of his underlying heart failure, likely a result of medication noncompliance. After outlining an appropriate plan for the day, one of the clinical fellows suggests prophylactic antibiotics to prevent a respiratory tract infection and points out that an infection would be poorly tolerated in this patient. You acknowledge the concern and ask the group: "In critically ill patients requiring mechanical ventilation, do prophylactic antibiotics reduce the risk of respiratory tract infection?"

You search Medline using the terms "Critical care", "Antibiotics", "Respiratory tract infections" and find an interesting systematic review. The abstract looks helpful so you download the article in full text. BMJ 1998;316:1275-85 .

Read the article and decide:

1. Is the evidence from this systematic review valid?
2. Is this valid evidence from this systematic review important?
3. Can you apply this valid and important evidence from this systematic review in caring for your patient?

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