Less is more: ten reasons for considering to discontinue unproven interventions

Abstract

An increasing number of practices in the Intensive Care Unit (ICU) have recently been challenged. There are several reasons why de-implementation of these practices should be considered. Before going further, it is worth pointing out that it is not our intention to suggest that every intervention needs to be validated in a randomized controlled trial (RCT). In fact, large RCTs may not be optimal for assessing interventions that are likely to benefit, and may not be feasible when dealing with rare diseases or uncommon endpoints. That said, these situations are uncommon but we would argue that most embedded practices should be validated to some extent. For the purpose of this short piece we will consider “unproven intervention” any intervention lacking a sufficient rational for the expected benefit, lacking concurrent evidences for any direct or indirect efficacy, or for which high degree evidence suggest lack of benefit. The following arguments support the call for de-implementation of unproven interventions: