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Thromboprophylaxis in the Real WorldThromboprophylaxis in the Real World: Strengths and Limitations of Comparative Effectiveness Research

Michael K. Gould, MD, FCCP; Jason P. Jones, PhD; PROTECT Investigators for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group
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From the Department of Research and Evaluation, Kaiser Permanente Southern California.

Correspondence to: Michael K. Gould, MD, FCCP, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101; e-mail: Michael.k.gould@kp.org

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1401-1404. doi:10.1378/chest.11-2576
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Caring for the critically ill patient requires a tremendous expenditure of time, effort, and other resources, and the period of most intensive effort is often the first 24 h following admission. Physicians, nurses, respiratory therapists, and others work diligently to secure the airway, ensure adequate ventilation, obtain IV access, and restore circulation. In specific patient populations, attention must also be paid to providing goal-directed therapy for septic shock,1 prompt antibiotic treatment of pneumonia,2 low-tidal volume ventilation for ARDS,3 and just enough insulin to achieve targeted glycemic control.4 It is no wonder that simple preventive interventions all too often get lost in the shuffle, even in the current era of quality improvement, checklists, automated order sets, and electronic reminders.

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