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@hskulkarni raised an important point about communication that raised for me a key cultural chasm that we should address head on. We in intensive care have watched over the last 50 years (yeah, it& #39;s been a solid 50 since shock lung got a new name!) as the mortality of our
familiar diseases have dropped from 80+% to 30-40%. The vast majority of that improvement has come from nursing, abandoning bad ideas, dialing back our enthusiasm for rampant technophilia, standardizing key processes (you& #39;ll recognize this from @ogi_gajic& #39;s lovely rants and
@toddrice_ICU& #39;s recent op-ed in @AnnalsATS). Occasionally it& #39;s come from new medications, probably. We know what it& #39;s like when these principles aren& #39;t followed and justly celebrate the huge improvements over recent decades. That& #39;s an important message. From outside the ICU,
people don& #39;t have those memories. What they see instead (if the journals will let them see actual statistics rather than inflated nonsense about pseudo-mortality rates) are 20-40% of ventilated COVID patients are dying. And that is frightening. We see the glass half full, and
they see the glass half empty. And I think this disconnect contributes to the mutual lack of understanding. We have to stay the course to keep the mortality down around 20-40% AND we have to rapidly cycle through trials to find ways to drop mortality further. What I think we need
to say more clearly is that chaotic tampering with the formula that has cut mortality in half over the last decades is a bad idea, but so is any suggestion that there is nothing more to learn. We need both, in careful combination.
So I wonder about some simple messages:
So I wonder about some simple messages:
1. We already have the treatment to cut the mortality in critical COVID at least in half. That treatment involves ventilators and staff that aren& #39;t overloaded and consistent processes to avoid accidental harm. That is baked into good critical care. We& #39;re _already_ doing that.
2. The development of that highly effective treatment required that over the years we rigorously tested any new proposed additions. The large majority of them either didn& #39;t work or made things worse. If we hadn& #39;t used trials and careful thinking in the past, we wouldn& #39;t have
this highly effective treatment we have today.
3. But 20-40% dead is still too much. So we are working tirelessly to run nimble and rigorous trials to further improve outcomes. We& #39;re with you in this. Trust the process. It has already cut mortality from COVID by more than half.
3. But 20-40% dead is still too much. So we are working tirelessly to run nimble and rigorous trials to further improve outcomes. We& #39;re with you in this. Trust the process. It has already cut mortality from COVID by more than half.