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Balanced Crystalloid vs. Saline, the Ride Never Ends

Discussion in 'Critical Care' started by Mad Jack, Nov 10, 2017.

  1. jdh71

    jdh71 epiphany at nine thousand six hundred feet
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    Crap stats thrown against a wall. Something stuck with their lame p value.

    What was the number needed to treat? I missed it.

    Do what you want. You are clearly the superior human being to those who aren't overly impressed.
     
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  3. lymphocyte

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  4. jdh71

    jdh71 epiphany at nine thousand six hundred feet
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    Look. You have your rationale. I'm not even in here arguing for dumping saline into patients. I'm not Shake Shack or Five Guys. My point has been the data is not as robust as the Shake Shack fan bois want to make it out to be.

    The sanctimonious bible thumping of weak data is one of my big pet peeves with critical care culture.
     
  5. SurfingDoctor

    SurfingDoctor "Hooray, I'm useful"
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    Yep... you take Dextrose and put it into the bag... there's nothing special about D5, other than it is typically all that is needed in most situations.
     
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  6. Vigileo

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    Care to comment on what specifically you disagree with statistically? MAKE-30 is an accepted and patient-centric endpoint, so I'd be interested to see what you think. It's not the discovery of penicillin, but given clinical equipose on fluid choice, it does provide some guidance in terms of clinical practice. It doesn't or at least shouldn't result in not using physician judgment in treatment decisions. For full disclosure, I'm not associated with the study but do have a bias towards it.
     
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  7. jdh71

    jdh71 epiphany at nine thousand six hundred feet
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    I care little if some academics decided that MAKE-30 is an ok place to try and make statistical points.

    There was no difference between the two groups in all studies to the end points that matter when looked at specifically and individually. Which is what matters to me. Lumping it all together and then saying, "ah-ha!! signal!!" looks like the worst that EBM has to offer
     
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  8. nephrondoc

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    Some people will only get as far as they want and see only what they want to see. Then they make comments like " You can't even argue its the excess fluid that caused the adverse secondary outcomes. They lack that power. " " Show me the P<0.05" . " Normal saline is not poison".

    They also think on the lines of "Everyone is very stupid. Everyone. All of them. The whole world. All stupid. Forever."

    Reminds me of a quote:
    “Never argue with a fool, onlookers may not be able to tell the difference.” ― Mark Twain
     
  9. BigRedBeta

    BigRedBeta Why am I in a handbasket?
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    First, a disclaimer: I'm not sure where I really stand on this yet - I need to think about it a lot more it seems.

    On one hand, I totally get what you're saying, that it totally reeks of statistical manipulation and the worst of our current publication biases to find and report positive associations. And if our research apparatus is really trying to find scientific "truth", then knowing the actual associations/correlations for individual outcomes gets us a lot closer to that ideal...

    But, if you're a patient, wouldn't your default position be to avoid ANY adverse event? I think the argument can be readily made that such a simplification is beneficial for patients. Yes obviously avoiding death is a higher priority than avoiding persistent kidney dysfunction but if treatment A has a 10% chance of anything happening and treatment B as a 12% chance, you might reasonably prefer treatment A - especially if your physician was able to say that for the individual components there didn't seem to be an advantage.
     
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