PCCM Landmark Trials Flashcards

Vocabulary flashcards covering high-yield Pulmonary and Critical Care Medicine (PCCM) landmark trials, populations, interventions, key numerical outcomes, and clinical takeaways.

ARDSNet ARMA (2000)

A landmark trial in acute lung injury/ARDS comparing low tidal-volume ventilation ($6\,mL/kg$ predicted body weight, target plateau pressure $\le 30\,cm\,H_2O$) with traditional $12\,mL/kg$ PBW ventilation, demonstrating that low tidal-volume ventilation reduced mortality (about $31\%$ vs $40\%$) and increased ventilator-free days.

PROSEVA (2013)

A trial in severe ARDS ($P/F$ ratio $< 150$) evaluating early prolonged prone positioning (prone sessions at least 16 hours) compared with supine positioning, showing that proning markedly reduced 28-day and 90-day mortality.

ACURASYS (2010)

A trial in early severe ARDS ($P/F < 150$) comparing cisatracurium for 48 hours with placebo in deeply sedated patients, showing improved adjusted 90-day survival and increased ventilator-free days, though the crude/unadjusted mortality difference was not statistically significant.

ROSE (2019)

A trial in moderate-severe ARDS ($P/F < 150$) comparing continuous cisatracurium for 48 hours plus deep sedation against usual care emphasizing lighter sedation and no routine paralysis, finding no significant difference in 90-day mortality or ventilator-free days.

DEXA-ARDS - Villar et al. (2020)

A trial in mechanically ventilated established moderate-severe ARDS ($P/F \le 200$ after approximately 24 hours) showing dexamethasone ($20\,mg$ IV daily x5 days, then $10\,mg$ IV daily x5 days) increased ventilator-free days by about 4.8 days and reduced 60-day mortality (about $21\%$ vs $36\%$).

FACTT (2006)

A trial in acute lung injury/ARDS comparing conservative vs liberal fluid-management strategy, finding conservative fluid management increased ventilator-free and ICU-free days without a significant mortality benefit.

CESAR (2009)

A trial in adults with severe potentially reversible respiratory failure comparing referral to an ECMO-capable center vs continued conventional management, showing referral improved survival without severe disability at 6 months.

ARREST (2020)

A trial in refractory out-of-hospital cardiac arrest due to VF or pulseless VT comparing early ECMO-facilitated resuscitation (ECPR) vs standard ACLS-based resuscitation, showing survival to hospital discharge was markedly higher with ECPR (about $43\%$ vs $7\%$).

OPTIMA-CC (2018)

A trial in cardiogenic shock after acute MI comparing epinephrine vs norepinephrine, stopped early for safety because epinephrine caused more refractory shock, tachycardia, and lactic acidosis despite similar effects on cardiac index and blood pressure.

OVISS (2025)

A trial in septic shock evaluating an early vs delayed vasopressin strategy, reporting findings that favored earlier vasopressin for reducing norepinephrine exposure.

ATHOS-3 (2017)

A trial in catecholamine-resistant vasodilatory shock showing angiotensin II added to standard vasopressors significantly increased achievement of prespecified MAP response and reduced catecholamine requirements compared to placebo, though a statistically significant mortality benefit was not established.

APROCCHSS (2018)

A trial in severe septic shock requiring vasopressors showing hydrocortisone $50\,mg$ IV q6h plus fludrocortisone $50\,mcg$ enterally daily for 7 days reduced 90-day mortality and increased vasopressor-free days compared with placebo.

ALBIOS (2014)

A trial in severe sepsis/septic shock comparing $20\%$ albumin plus crystalloids (targeting serum albumin $\ge 3\,g/dL$) vs crystalloids alone, showing albumin produced some hemodynamic advantages but did not significantly reduce overall 28- or 90-day mortality.

CAPE COD (2023)

A trial in adults admitted to ICU with severe community-acquired pneumonia showing early IV hydrocortisone reduced 28-day mortality (about $6\%$ vs $12\%$) and reduced progression to intubation or vasopressor use in relevant subgroups.

CAPE COD (2023) — Steroid dosing

Hydrocortisone 200 mg IV/day × 4–7 days → taper → total course 8–14 days, depending on clinical improvement.

Takeaway: Severe CAP requiring ICU care → early hydrocortisone reduced 28-day mortality (6.2% vs 11.9%).

AMPLIFY (2013)

A trial in acute symptomatic proximal DVT and/or PE comparing apixaban ($10\,mg$ BID x7 days $\rightarrow$ $5\,mg$ BID) vs enoxaparin followed by warfarin, showing apixaban was noninferior for recurrent VTE/VTE-related death (about $2.3\%$ vs $2.7\%$) with less major bleeding (about $0.6\%$ vs $1.8\%$).

AMPLIFY-EXT (2013)

A trial in patients completing 6-12 months of VTE anticoagulation comparing apixaban $2.5\,mg$ BID vs $5\,mg$ BID vs placebo for 12 months, showing recurrent VTE/VTE-related death was about $1.7\%$ with either apixaban dose vs $8.8\%$ with placebo.

EINSTEIN CHOICE (2017)

A trial in patients after 6-12 months of anticoagulation comparing rivaroxaban $20\,mg$ daily vs $10\,mg$ daily vs aspirin $100\,mg$ daily, showing recurrent VTE rates of about $1.5\%$, $1.2\%$, and $4.4\%$ respectively, and major bleeding rates of about $0.5\%$, $0.4\%$, and $0.3\%$.

STORM-PE (2025)

A trial in intermediate-high-risk PE comparing computer-assisted vacuum thrombectomy plus anticoagulation vs anticoagulation alone, showing thrombectomy produced a greater reduction in RV/LV ratio at about 48 hours and faster physiologic improvement.

COBRRA (2026)

A trial in acute symptomatic PE or proximal DVT providing a head-to-head comparison of apixaban vs rivaroxaban, reporting results that favor apixaban for clinically relevant bleeding.

MERINO (2018)

A trial in ceftriaxone-resistant E. coli or Klebsiella bloodstream infection comparing definitive piperacillin-tazobactam vs meropenem, showing 30-day mortality was about $12.3\%$ with piperacillin-tazobactam vs $3.7\%$ with meropenem.

REDUCE (2013)

A trial in acute COPD exacerbation comparing prednisone $40\,mg$ daily for 5 days vs 14 days, demonstrating 5 days was noninferior to 14 days for recurrent exacerbation and reduced cumulative steroid exposure.

WATERFALL (2022)

A trial in early acute pancreatitis comparing aggressive LR ($20\,mL/kg$ bolus $\rightarrow$ $3\,mL/kg/hr$) vs moderate LR ($10\,mL/kg$ bolus if hypovolemic $\rightarrow$ $1.5\,mL/kg/hr$), stopped early for safety because aggressive fluids caused more fluid overload (about $20.5\%$ vs $6.3\%$) without reducing progression to moderately severe/severe pancreatitis.

Early vs Late Tracheostomy - Cochrane Review (2015)

A Cochrane systematic review evaluating tracheostomy timing in critically ill patients expected to require prolonged mechanical ventilation, finding heterogeneous evidence that was not definitive enough to establish a universal early-tracheostomy strategy.

ABCDEF Bundle

An evidence-based ICU liberation bundle comprising Assess/prevent/manage pain, Both SAT and SBT, Choice of analgesia/sedation, Delirium assess/prevent/manage, Early mobility/exercise, and Family engagement/empowerment.

PADIS Guidelines (2018)

Clinical practice guidelines addressing pain, agitation/sedation, delirium, immobility, and sleep disruption in ICU adults, emphasizing treating pain, targeting light sedation, minimizing benzodiazepines, preferring propofol or dexmedetomidine, routine delirium assessment, and early mobility.