The PulmCrit blog is about controversies in adult critical care. Everything in the blog is controversial. As such, I always encourage readers to think critically about the material and reach their own conclusions. There are many situations where smart people presented with the same data will reach different conclusions. That diversity of opinions is part of what makes practicing medicine interesting.
That said, I generally try to write blogs which are supported by a reasonable amount of evidence and/or experience. In the past I have sometimes written an entire post, only to eventually decide that the supporting evidence was too weak to post it.
The rationale behind this practice was as follows. Initially the blog had a small readership, with relatively slow post-publication peer review. Thus, it was possible that I could post something incorrect which might remain un-corrected for a while.
Now that PulmCrit has joined the EMCrit platform, it has a broader readership and very robust post-publication peer review. After publishing a controversial post, experts from around the world will often comment within hours. Discussions ensue, sometimes including the primary authors of studies being discussed. Points of disagreement are dissected in detail. This system of crowd-sourced peer review is blazingly fast and more diverse than that of journals (which use an oligarchical system based on the comments of a few anointed individuals, provided at a painfully slow rate).
Effective, rapid peer review allows for the creation of a new series of posts. These posts will cover material which isn't supported by much evidence nor experience. In the past, I wouldn't have felt comfortable posting this material to the blog. These posts will be explicitly labeled as “bleeding edge series” to indicate that they are unusually controversial. I strongly urge readers not to take these posts too seriously until they've been up for a couple weeks, by which time a fair amount of peer review will have occurred.
I am excited about the bleeding-edge series, because it may allow exploration of some topics which I've been unable to cover in the past. This will provide a vehicle to propose an unusual idea to the critical care community and elicit rapid feedback and discussion. I have no doubt that in many cases the ensuing discussion will be more illuminating than the original post itself.
As FOAM becomes more popular, this creates unique opportunities for creating dynamic content which is an amalgamation of the thoughts of numerous authors. In some ways, this borders on a “virtual conference” wherein people have a discussion despite barriers of time and space.
- IBCC chapter:Guide to APRV for COVID-19 - April 8, 2020
- PulmCrit Theoretical Post – The COVID Severity Index (CSI 1.0) - April 2, 2020
- PulmCrit wee – Why the SCCM/AARC/ASA/APSF/AACN/CHEST joint statement on split ventilators is wrong. - March 29, 2020