Looks like 13 sites (although all are in Intermountain's system in Utah); cluster randomized (good!) ; primary outcome 28-d mortality (good!) estimated enrollment 2050 (sounds good but haven't done a power check or seen their estimated effect size)
Even if there's a signal of a benefit we need to work hard to find the edge. In my 20 years I have empirically seen an amazing shift in septic shock mortality just by the community shifting towards an early vasopressor strategy. My old mentors used to dump 10 liters into people
I won’t confess to 10 liters routinely but in the 2010-ish era 5-8 liters seemed almost standard for persistent shock. “I think they’re still dry” was the mantra.
A real prospective rct is needed. Tried looking and didn’t see what dose of vaso - some places .03, .04 some titrate! Also the data was from 2010-2020 - felt like that was when lines were going in more for any pressor. Some of that was pre-process trial (which used 60-d in hospital mortality not hospital mortality - was around 20% - likely not as sick population - not sure how many got pressors). At my shop, levo is ok peripherally to a decent dose and vaso requires a line. Yes a line is usually benign but still an invasive procedure that can go wrong by itself. Thank you for the analysis of the stats and methodology - excellent as usual.
They did a couple or 3 … I will post them “soon” … they were negative but there was a numerical benefit (non significant) favoring the addition of vasopressin in one. That plus the a-fib signal keep this interesting to me.
It’s only ridiculous if you aren’t willing to accept that statisticians can accurately predict alternate realities using only retrospective information extracted from an EMR.
Large Multicenter RCT on Vasopressin timing is underway: https://www.clinicaltrials.gov/study/NCT06217562
Looks like 13 sites (although all are in Intermountain's system in Utah); cluster randomized (good!) ; primary outcome 28-d mortality (good!) estimated enrollment 2050 (sounds good but haven't done a power check or seen their estimated effect size)
Thanks for sharing this.
Even if there's a signal of a benefit we need to work hard to find the edge. In my 20 years I have empirically seen an amazing shift in septic shock mortality just by the community shifting towards an early vasopressor strategy. My old mentors used to dump 10 liters into people
I won’t confess to 10 liters routinely but in the 2010-ish era 5-8 liters seemed almost standard for persistent shock. “I think they’re still dry” was the mantra.
A real prospective rct is needed. Tried looking and didn’t see what dose of vaso - some places .03, .04 some titrate! Also the data was from 2010-2020 - felt like that was when lines were going in more for any pressor. Some of that was pre-process trial (which used 60-d in hospital mortality not hospital mortality - was around 20% - likely not as sick population - not sure how many got pressors). At my shop, levo is ok peripherally to a decent dose and vaso requires a line. Yes a line is usually benign but still an invasive procedure that can go wrong by itself. Thank you for the analysis of the stats and methodology - excellent as usual.
They did a couple or 3 … I will post them “soon” … they were negative but there was a numerical benefit (non significant) favoring the addition of vasopressin in one. That plus the a-fib signal keep this interesting to me.
What a ridiculous study
It’s only ridiculous if you aren’t willing to accept that statisticians can accurately predict alternate realities using only retrospective information extracted from an EMR.
Oh yeah. …. that is ridiculous