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In Reply: Our Commentary reviewing the current published evidence on RRT systems suggested that the evidence in support of their widespread implementation is equivocal. In particular, the largest and best-designed study found no significant improvements in favor of the RRT.¹ As such, the drive to push RRT systems as a nationwide standard of care needs to be reconsidered.

This, however, is not intended to be a condemnation of the RRT concept. On the contrary, RRTs may be effective. The problem is that we do not know, and the best evidence suggests that they are not. If the health care community wants to discard this evidence in favor of common sense, it seems that alternative interventions that prevent rather than treat and that are supported by empiric evidence would be more broadly embraced. Such interventions include increased nurse staffing² and the use of hospitalists³ or intensivists.⁴ The risk of a rush . . . [Full Text of this Article]

Bradford D. Winters, PhD, MD
bwinters@jhmi.edu

Peter J. Pronovost, PhD, MD; Julius Pham, MD
Division of Adult Critical Care Medicine
Department of Anesthesiology and Critical Care Medicine
Johns Hopkins University School of Medicine
Baltimore, Md

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