Research Design, Biostatistics, and Literature Evaluation

hypovolemic shock are both less than 1, mortality was

decreased with albumin use (Answers A, C, and D are

incorrect).

Answer: A

This patient case provides a practical example of a criti-

cal care pharmacist’s integration of various types of

knowledge to optimize patient care. The FACT trial

showed that a fluid-conservative strategy improves ven-

tilator-free days for patients with acute lung injury and

ARDS. Furosemide was used in the study to show the

outcome benefit. However, the study was testing a treat-

ment strategy, not specifically a drug strategy. Therefore,

it can be reasoned that similar treatment outcomes can

be shown with similar drugs if the study drug is unavail-

able – in this case, because of drug shortage. Knowledge

of trial design is helpful but not critical to optimizing this

patient’s therapy with bumetanide (Answer B is incor-

rect). Hemodialysis is invasive, requires finite resource

use, and has an associated morbidity risk (Answer C is

incorrect). Because this patient case does not include a

broader hypothesis test in a systematic design, this is not

a research activity, and informed consent is not required

(Answer D is incorrect). A critical care pharmacist,

using knowledge of the FACT trial (medical knowl-

edge) together with an understanding and experience

with bumetanide therapy (experiential knowledge), can

develop a treatment plan (Answer A is correct).

Answer: A

Acute respiratory distress syndrome is a clinical syndrome

with an associated mortality with each progressing phase

(mild, moderate, and severe). Although ARDS is also a

constellation of findings and pathologic observations,

patients with this disease present with a similar finding

of severe, refractory hypoxia from a common etiology

(Answer B is incorrect). Given the associated mortality

of about 45% for severe ARDS, a finite resource should

be prioritized for it (in this case, a NMBA) (Answer C is

incorrect). Mortality/survival is readily identified as an

end point of social value for research design (Answer D is

incorrect). Given the relatively low mortality associated

with mild ARDS (around 20%) compared with severe

ARDS (around 45%), and mortality benefit was seen only

in the subgroup of patients with severe ARDS, adminis-

tering NMBAs would less likely improve survival and

more likely increase harm if systematically administered

to patients with mild ARDS (Answer A is correct).