Opening plenary podcast

The fantastic opening lecture at this years SOA was given by Rinaldo Bellomo this morning – Listen to it now!

Blog by Jack Wong Edited by Jamie Strachan

Gilston Award Presentation: Paradigms, Dogmas and Evidence in Critical Care

Rinaldo Bellomo

  • “Disagreement in medicine is not always welcomed”
  • We believe in free will, we believe that we do is important – but is it true?
  • Guidelines or guidelies? – Paradigms are advocated even when evidence is poor which are then transformed into guidelines by “experts” which then made into key journals and become our daily clinical practise.
  • Example: HA-1A use in gram negative bacteremia – Dogma ended.
  • Example: Intensive versus conventional glucose control in critically ill patients (NICE-SUGAR studies)
  • Example: Protein C – V. Marco Ranieri
  • Example: Albumin in TBI: it helps decrease cerebral oedema (SAFE study)
  • Example: Decompressive Craniectomy in Diffuse Traumatic Brain Injury
  • Example: Early vs Late Parenteral nutrition in critically ill patients
  • Example: EDEN Trial – Initial Trophic vs Full enteral feeding in patients with acute lung injury
  • Example: A Randomized Trial of Glutamine – NEJM Heyland Glutamine
  • Example: Mortality after Fluid Bolus in African Children with Severe Infection NEJM Kathryn Maitland
  • Example: NEJM RENAL replacement Therapy study investigators
  • Example: HES vs Ringer’s acetate in severe sepsis / HES vs Saline
  • Fragility Index – Number of patient required to shift from one outcome to the other – Cross specialty problem
  • Are we all stupid?
    • We can’t tolerate the thought of not knowing what we are doing
    • Physiological gain is seductive
    • Medical hierarchy
    • Need to feel important
  • Concept of overclaiming – Stav Atir Psychological Science
  • Is it all just Rational Astrology?
    • Those beliefs are true regardless of own judgement or evidence
    • But we behave as if they are true regardless
  • How do we know the truth?
  • Example: EPO-TBI
  • Oscar Wilde – The truth is never pure and rarely simple. I can believe anything provided that it’s quite increadible. Experience is merely the name men give to their mistake

Conclusion/Bellomo says…..

Dont worry: you are safe!!