(1/ )Summaries of the average high impact trial by field:
#EBM#medtwitter#epitwitter#FOAMed#Cardiology:We enrolled the entire population of Europe in a trial to detect a composite endpoint occurring in 3% of patients. The relative risk reduction was 20%. The NNT is 12,000
The results of the PRONTO RCT of procalcitonin in people with suspected sepsis are absolutely fascinating.
Mortality was significantly lower in the procalcitonin-guided care group: 13.6% (372/2738) vs 16.6% (450/2715) (p=0.0009) but there was no difference in antibiotic initiation, narrowing, or days of therapy!
So apparently procalcitonin saves lives even if it doesn’t change antibiotic prescribing? 🤔
1/
I don’t even know where to start with unpacking the layers of chutzpah in @BrighamWomens emailing me, an MGH resident, asking me to donate to to their hospital today, in honor of “national doctors day”.
This was a fun one
Post-hoc look at ATHOS-3 trial patients who had ARDS at enrollment
Contrary to what I’d guessed we would find, Ang-II group had significantly improved oxygenation by Hour-48 vs placebo
annalsofintensivecare.spring…
Lots of caveats w/ post hoc analyses of course.
That said, REMAP-CAP stopped ACEi/ARB trial early for likely harm. Harm signal for respiratory support too, not just hemodynamics.
So, not implausible that the opposite therapy, (I.e. Ang-II) might help.
jamanetwork.com/journals/jam…
Any number of potential mechanisms:
Differential effects of Ang-II and catecholamines on hypoxic vasoconstriction.
Immune modulating effects
Recruitability of the pulm circulation
Or, patients that do better (had better shock Rx) also get better.
Lots more work to do here…
Update: Nine years after realizing this is what I was meant to do with my life, I am finally going to be an ICU doctor.
I’m so excited to start this next part of my training at @MGH_PCCM@PCCSM_BIDMC and immensely grateful to everyone who has helped me along the way to get here.
We are absolutely delighted to welcome this amazing class of new fellows to the MGH/BIDMC Pulmonary and Critical Care Medicine Fellowship in July 2024!
@MGH_PCCM@PCCSM_BIDMC
Me in college:
“I like numbers because numbers don’t lie.”
Me, after 10 years of clinical and translational research:
“Listen, numbers are straight up the most dishonest, scheming, untrustworthy, duplicitous MFs out there.”
Looks like we will be changing up the house wine
Pragmatic RCT finds Zosyn ⬇️ delirium/coma vs Cefepime without ⬆️ adverse renal events (or mortality) = enough to change my practice
But I do wonder if generalizes to (eg, onc) pts w/ baseline cytopenias
jamanetwork.com/journals/jam…
Still maintain that the most sensitive and specific predictor of methodological shenanigans in a manuscript is use of the word, “multivariate”, to describe a model with a single dependent variable.
I had an afternoon clinic scheduled while on MICU service and I really cannot overstate how jarring it is to be writing for Valtrex and NSAIDs less than an hour after bagging a patient