Since Critical Care Reviews and #CCR24 have had a couple of win ratio analyses, here’s a little plug for a video I made with C. Michael Gibson MD a few years back that is meant to be an accessible explainer of how it works. Please excuse my hair. It was a different time.

Does #REMAPCAP end steroids for severe CAP's honeymoon period? There were some wild ups and downs in the trial, which accumulated in what on the surface appears to be harm from hydrocortisone, but at the very least showed no benefit. remap-cap Critical Care Reviews #CCR24

All I can say is thank-you Steve Webb, Scott Berry & Andrew Althouse for going through remap-cap's CAP steroid arm. Bayesian analysis alone are confusing... but adaptive platform design trials are mind-boggling at times... then the "unique" events in this domain... 🙃 #ccr24

#CCR24 Critical Care Reviews #REMAPCAP Recommendation to not change practice based on latest REMAP-CAP steroid arm. Challenges with rate adaptive randomization and complexity of study design. Difficult to reconcile prior strong evidence base for steroids in severe CAP (CAPE COD).

Is it possible that there are multiple miscoding errors? A double negative? The point estimate of benefit in CAPE-COD is not dissimilar to the risk of harm in REMAP-CAP. I assume not, but would be great to see the initial group randomised was similar to patients later on. #CCR24

The #NAVIGATEtrial shows a very impressive decrease in severe resp failure with WARD-BASED NIV. If findings external valid, then this could be BIG! #CCR24 I'm skeptical & still have Qs. Unsure my centre would replicate these results. Regardless, early NIV seems SAFE and SMART.

Presented at #CCR24: In a randomized trial involving patients undergoing invasive ventilation, pantoprazole decreased the risk of upper gastrointestinal bleeding as compared with placebo but did not affect mortality. Read the full REVISE trial results: nej.md/3KD01Xp

This might be the most insightful part of the entire trial. What matters to clinicians may not be what matters to our patients. Transfusion of a single unit, CT angio, and diagnostic endoscopy, all things that really matter to patients. #CCR24 #REVISEtrial

For the PO vs IV PPI (and H2 blocker vs PPI for that matter) PEPTIC (which was discussed at CCR in 2020) provides me some reassurance that the options for SUP are all similarly effective.

#CCR24 Day 3 Overview: DEFENDER: No benefit with SLG2Is for allcomers in ICU, but safe. REMAPCAP-steroid: Hard to make sense of this one, but no benefit to steroids in CAP. NAVIGATE: Early NIV prevents worsening of resp failure. REVISE: SUP with PPI ⬇️ GIBs Critical Care Reviews

after a week on service with lots of refractory shock, I added a section on refractory shock to IBCC. and also a section on hydroxocobalamin. better late than never 😬 any useful bits I left out? emcrit.org/ibcc/shock/

Thank you to CIHR ACT competition for funding a Phase 3 trial of inhaled furosemide as supportive therapy for resp. failure 2nd to pulmonary infection. This adaptive international trial in 50 centers will enroll up to 1540 pts and run on the PRACTICAL platform.

COPD - It did HAPPEN JAMA:

Brilliant work! Congrats Dr. McKenzie and team!