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
- “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
Dont worry: you are safe!!