“There is no mortality benefit for that.” How many times have you heard that? The implication is usually the same: that intervention is a waste of time. A smart, evidence-based clinician wouldn’t bother with it. But, what does it actually mean if there is no proven mortality benefit? Several factors conspire to make it nearly impossible to prove mortality benefit in critical care: Mortality is decreasing, Most patients are unlikely to see any change in mortality, Patients die for numerous reasons, We are desperately trying to keep patients alive, The intervention is delivered too late to affect outcomes, Many conditions are too rare to study.

The above factors predict that it’s nearly impossible to prove mortality benefit in critical care. What does the literature show? The great majority of RCTs with a mortality endpoint are negative.

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