Slutsky doesn't grasp Gattinoni's legacy

Critical care pundits are hopeless hair splitters.

Critical care pundits are hopeless hair splitters.

Oh God. Lacking ambition is really sad.

Yes, Roger, people do exchange a walk-on part in the war for a lead role in a cage.

But hey, honey, listen to Uncle Lou. We need you to take a walk on the wild side.

How about paying attention to what Gattinoni meant when discussing how science works? That's his legacy. It has nothing to do with splitting hairs over pulse oximetry or PaO2, P:F ratio, and the silly inflammation subphenotypes.

If it’s not you, who is going to be? Do we have to wait for the next generation?

What generation? Mine? All I see are middle-aged men and women seeking external validation like preteens.

God.

I’m getting too old to wait.

In this post:

• Slutsky’s ICM editorial

• The Inductivist Dog and the Dogtensivists

• Theory-free science

• Crystal-ball accessory enunciates

• What I think Gattinoni meant

Intensive Care Medicine recently published an editorial by Slutsky and others discussing a paper from Gattinoni's group. The paper is somewhat disruptive, considering critical care is home to the least daring researchers in the entire field of biomedical science. The authors fear losing their networking so much they wouldn't dare speak their minds. Better to be mediocre. Just smile and nod in agreement. They all dream of being invited to the next ARDS consensus panel.

But they did advance. I was glad to see it because this is the flag I am carrying. They almost said that ARDS definitions should be abandoned because a disease can't be defined using an arbitrary severity threshold (P:F). I am certain they know it.

The study showed that oxygenation and lung mechanics are not always connected. Consequently, VILI occurred across different P:F levels, but as they remembered us, protective ventilation is indicated only in the lower P:F stratum.

The notion that VILI corresponds to lung mechanics has at least 30 years. It's amazing to see how the field swims in circles. VILI is related to the amount of mechanical energy dispersed in the lungs and the mechanical properties of the patient's lungs. This point was clear when VILI was described and it inspired the “protective ventilation” age.

No rocket science, ok? Slutsky et al., however, didn't dare to go further than acknowledging that mechanical lung injury relates better to lung mechanical properties than to P:F ratio.

One minute, please. Laughing here. Sometimes it all looks like a parody of science.

Slutsky et al. think we can practice science without a theory. To tackle this point, I will introduce you to my best friend, The Inductivist Dog, and his disciples, the Dogtensivists. Are you one of them?

Yes, my dear reader. Critical care epistemology again.