One Guideline May Not Fit All: Tailored Evidence May Improve Critical Care Delivery

Secunda and Hart discuss the study by Teno et al which provides novel evidence evaluating the comparative effectiveness of invasive mechanical ventilation (IMV) and noninvasive ventilation (NIV) in persons with advanced dementia and recent nursing home stays hospitalized with pneumonia or septicemia with pneumonia. The Minimum Data Set to collect comprehensive clinical information and sociodemographic data to retrospectively identify the study cohort. The study provides important insights into how to provide advanced respiratory support for advanced dementia patients. The retrospective data was successfully used to generate novel effectiveness information among a patient population for whom randomized clinical trials would be cost-prohibitive, infeasible, or ethically challenging.