Anesthesiology

High-dose corticosteroids have been used to attenuate the inflammatory response to cardiac surgery and cardiopulmonary bypass, but patient outcome benefits remain unclear. In this issue of Anesthesiology, Myles et al. aimed to determine whether using dexamethasone was superior to not using dexamethasone to increase the number of home days in the first 30 days after cardiac surgery. In this study, they evaluated the efficiency, value, and impact of a novel, pragmatic trial design. In an accompanying editorial, McIsaac et al. assert that randomized trials remain the most important tool for evaluating treatments but acknowledge that innovative clinical trial methodologies also have potential. Cover illustration: A. Johnson, Vivo Visuals Studio; photograph: J. P. Rathmell.