Evidence-Based Medicine

The Research Library

Landmark studies and clinical guidelines. Reviewed and contextualised for modern ICU practice by Dr. Jay Kothari.

📚 Peer-reviewed landmark trials, curated and contextualised by Dr. Kothari — filtered by topic below.

Sepsis · 2021 Landmark

Surviving Sepsis Campaign: 2021 International Guidelines

Evans L, et al. — Intensive Care Medicine / Critical Care Medicine

Clinical Takeaway: Dynamic fluid assessment, early antibiotics (Hour-1 for Septic Shock), and Norepinephrine as first-line vasopressor. Corticosteroids recommended for refractory septic shock.
Dr. Kothari's Practice: At Apollo, we activate the Hour-1 bundle the moment Sepsis-3 criteria are met — blood cultures, lactate, and antibiotics within 60 minutes. This single protocol has measurably reduced ICU mortality in our unit.
View Paper → 📄 SSC Guidelines PDF
ARDS · NEJM Foundational

ARMA Trial: Lower Tidal Volumes for ALI and ARDS

ARDSNet Investigators — New England Journal of Medicine (2000)

Clinical Takeaway: 6 mL/kg IBW tidal volumes reduce 28-day mortality by 22% in ARDS compared to 12 mL/kg. Foundational for lung-protective ventilation.
Dr. Kothari's Practice: Lung-protective ventilation is non-negotiable in our ICU — every ventilated ARDS patient is set to 6 mL/kg IBW from the first hour. The evidence for this is as strong as any in medicine.
View Paper →
ECMO · The Lancet

CESAR Trial: Conventional vs. ECMO-Centre Referral for ARDS

Peek GJ, et al. — The Lancet (2009)

Clinical Takeaway: Referral to an ECMO-specialist centre significantly improves survival without severe disability at 6 months in severe ARDS.
Dr. Kothari's Practice: This trial validated what experienced intensivists knew — ECMO outcomes depend entirely on the team's experience. Apollo Ahmedabad is one of very few centres in Gujarat where this expertise is available.
View Paper → 📄 ELSO ECMO Guidelines
ECMO · NEJM High-Impact

EOLIA Trial: ECMO Rescue Therapy for Severe ARDS

Combes A, et al. — New England Journal of Medicine (2018)

Clinical Takeaway: Bayesian analysis of EOLIA suggests >99% probability of a mortality benefit for early ECMO in the most severe ARDS. Crossover rate (28%) confounded primary endpoint.
Dr. Kothari's Practice: EOLIA guides our ECMO initiation criteria at Apollo. When PaO₂/FiO₂ drops below 50 mmHg despite optimal ventilation, we convene the multidisciplinary team within hours, not days.
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Sepsis · NEJM Landmark

ProCESS Trial: Protocol-Based Care for Early Septic Shock

ProCESS Investigators — New England Journal of Medicine (2014)

Clinical Takeaway: Protocol-based resuscitation (including Rivers' EGDT) did not improve outcomes over usual ICU care in septic shock — emphasising that clinical judgement remains central, not rigid algorithms.
Dr. Kothari's Practice: ProCESS reinforced something I have believed throughout my career — protocols support good care, but they never replace the intensivist's eye. Pattern recognition built over 30 years is irreplaceable.
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AKI · KDIGO Guidelines 2022

KDIGO Clinical Practice Guideline for Acute Kidney Injury 2022 Update

KDIGO AKI Work Group — Kidney International Supplements

Clinical Takeaway: Stage 3 AKI with metabolic acidosis, fluid overload, or haemodynamic instability warrants urgent CRRT initiation. Dose: 20–25 mL/kg/hr effluent for adequate clearance.
Dr. Kothari's Practice: We run CRRT continuously in haemodynamically unstable AKI patients. The 2022 KDIGO update aligned perfectly with our existing Apollo ICU protocol — we were already applying these thresholds.
View Guidelines →
ICU Practice · NEJM 2021

RECOVERY Trial: Dexamethasone in Hospitalised Patients With COVID-19

RECOVERY Collaborative Group — New England Journal of Medicine (2021)

Clinical Takeaway: Dexamethasone 6 mg/day for 10 days reduced 28-day mortality by 35% in mechanically ventilated Covid-19 patients — now the global standard for severe respiratory failure.
Dr. Kothari's Practice: RECOVERY was one of the most impactful trials of my career. During the COVID waves, dexamethasone was the single intervention that consistently changed outcomes in our ventilated patients.
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Sepsis · JAMA 2019

ANDROMEDA-SHOCK: Peripheral Perfusion vs. Lactate Resuscitation

Hernández G, et al. — JAMA (2019)

Clinical Takeaway: Peripheral perfusion-guided resuscitation (capillary refill time) outperformed lactate-guided approach for septic shock — demonstrating clinical bedside assessment remains vital in ICU management.
Dr. Kothari's Practice: ANDROMEDA-SHOCK validated bedside clinical assessment as the gold standard. Capillary refill time is now formally integrated into our shock resuscitation assessment at Apollo alongside lactate monitoring.
View Paper →