From the Guidelines

Yes, there are diagnostic intervention randomized controlled trials (RCTs) that have changed Intensive Care Unit (ICU) practice.

The early goal-directed therapy for septic shock is a typical example, where the initial single-center randomized controlled trial (sRCT) showed survival benefits of this protocolized management, which was not replicated in subsequent multicenter randomized trials (mRCTs) 1.

The positive results of single-center randomized controlled trials (sRCTs) may not be replicated when subjected to large multicenter randomized controlled trials (mRCTs), particularly within the context of intensive care settings 1.
The discrepancies in results are often attributed to the inherent limitations of sRCTs, including biases due to local effects, minimal heterogeneity among the enrolled patients, inadequate blinding of personnel and data analysis, and the temporal gap between enrollment completion and publication 1.

Despite the limitations, positive sRCTs have made changes in clinical practice, such as the early goal-directed therapy for septic shock, which has led to clinicians paying more attention to central venous oxygen saturation (ScvO2) values 1.
The lack of multicentric confirmation of survival benefits implies a restricted external validity of sRCTs rather than an indication of them producing false positive results 1.

A systematic review found that only one out of 16 sRCTs (6%) was followed by a mRCT replicating a significant mortality reduction, while 14 (88%) were followed by mRCTs with no mortality difference 1.
The review also found that nearly half of clinical guidelines that cite sRCTs recommend the relevant intervention based on their positive results, despite some of these endorsements being subsequently refuted in light of accumulated evidence 1.

From the Research

There are several RCTs that have investigated diagnostic interventions in ICU practice, including early mobilization and exercise interventions 2, 3.
These studies have shown that early mobilization and exercise interventions can improve physical function and reduce the risk of adverse events in critically ill patients 2.
However, the evidence is not yet conclusive, and further studies are needed to fully understand the effects of these interventions 2, 3.
Some studies have reported low-quality evidence for the effect of early mobilization on physical function or performance, adverse events, muscle strength, and health-related quality of life 2.
Ongoing and unpublished RCTs are currently being conducted to further investigate the effectiveness of early mobilization interventions in the ICU setting 3.

ICU RCTs are less likely to be commercially funded and less likely to reach statistical significance compared to non-ICU RCTs 4.
ICU RCTs often have lower Fragility Index (FI) values, indicating that the results are more susceptible to change based on a small number of outcome events 4.
The number of ICU RCTs published in high-impact general medicine journals has been increasing over the past 8 years 4.

There is a need for further studies to investigate the effectiveness of early mobilization interventions in specific patient populations, such as older adults and cardiac patients 3.
Novel delivery strategies, such as nurse-led early mobilization, also require further investigation 3.
More research is needed to fully understand the effects of diagnostic interventions in ICU practice and to inform evidence-based practice 2, 3, 4.