Journal Club Summary

Methodology Score: 2.5/5      
Usefulness Score:  3/5
Semler MW, et al.  Am J Respir Crit Care Med. 2015 Oct 1. [Epub ahead of print]
This randomized, open-label, pragmatic trial of 150 adults undergoing intubation in a medical ICU found that the median lowest arterial oxygen saturation was 92% with apneic oxygenation versus 90% with usual care (95% confidence interval for the difference -1.6% to 7.4%; P = .16). Unfortunately, the first RCT of apneic oxygenation versus usual care outside the operating room was underpowered for a clinically important outcome; the results of this small single centre trial should not impact the use of a cheap, low risk intervention that may yet have benefit in critically ill patients.  
By: Dr. Nicholas Costain

Epi lesson

Intention-to-treat (ITT) analyses are widely recommended as the preferred approach to the analysis of most clinical trials. The basic intention-to-treat principle is that participants in trials should be analysed in the groups to which they were randomized, regardless of whether they received or adhered to the allocated intervention. This particularly becomes a problem when patients are lost to follow-up and no outcome values are available. Authors must clearly indicate how many patients have such values missing. The alternate approach is a per protocol analysis which only includes patients for whom the protocol was followed.   
By: Dr. Ian Stiell