We are disseminating an international petition that will allow clinicians to express their displeasure and concern over these guidelines. If you believe that our septic patients deserve more evidence-based guidelines, please stand with us.
The CDC guidelines recommend placing subclavian lines to reduce the risk of catheter-related bloodstream infections. Meanwhile, mounting evidence suggests that we should probably be placing lines with ultrasound guidance. Unfortunately, the ultrasound-guided subclavian can be tricky. This post describes a slight modification that could make the technique easier and safer.
We have a love-hate relationship with the p-value cutoff of <0.05. A p-value right below this cutoff (say, p=0.04) actually constitutes a surprisingly weak level of evidence (1). Thus, the idea of lowering the p-value cutoff has been around for a while. Unfortunately, this wouldn't really fix our problems with p-values.
ADRENAL and APROCCHSS were both designed with mortality as a primary endpoint. They reached opposite conclusions: steroid had no effect on mortality in ADRENAL, whereas it improved mortality in APROCCHSS. Why?
This post will attempt to create a rough framework for analyzing secondary endpoints. This is primarily intended as a springboard for debate, rather than a final answer to this thorny issue (one which has remained unresolved for decades).