Sunday, January 19, 2020
VITAMINS Trial: Vitamin C and Thiamine for Sepsis and Septic Shock
I probably should not make the same mistake as Paul Marik , taking a fanatical view. Usuallly the end result does not turn out in your favor . After reading the paper quickly, there are many problems not in the least the timing of the intervention.
On the other hand, I cannot disagree with his Lacto- Bolus reflex comment and his statement that 30 ml /kg of fluid is a hoax in sepsis .....he actually published this .
Conclusion in my view is there is no conclusion "yet" . I would like to hear other comments. I posted the video of the Vitamins Trial on the blog. Even if your not interested in this trial , with Paul Marik there it is quite entertaining.
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ReplyDeletehttps://www.vox.com/2015/1/15/7547741/vitamin-c-myth-pauling
ReplyDeleteSeems all like a Linus Pauling deja-vu
Interesting, results. Then you get into the issue of clinical trials which have limits as well. You can prove a hypothesis in a clinical trial and the outcome my have no population impact or result in significant risk when the controls of the clinical trial are removed. This happened with the Vandenburg glucose trails, shooting for a glucose of 120 resulted in increased risk of hypoglycemia when implemented on a wide-spread scale. The levels were amended so we now shoot for 160-180. Not to mention how many people did we put on niacin and fibrates only to find that the long-term use did not change population health or reduce risk. Atenolol was shown to be inferior to placebo at reducing cardiovascular risk, who would of thought that some cardio-selective beta blockers might not work as well as others? Lastly, so many studies are limited in the population studied, women, minorities, diabetes and end-stage renal disease patient are often underrepresented or used as exclusion criterion. Most of our patients fit into one of these groups!
ReplyDeleteYes agree . This book is must read and shows how RCTs are NOT for patient based medicine but rather population risk or treatment benefit .
ReplyDeletehttps://drive.google.com/file/d/1VBw6WRo2siSg1WgysAbQHfu7JT_tEN1I/view?usp=drivesdk
ReplyDelete