Physiology Matters.

Armand Girbes, Professor in Intensive Care Medicine and Clinical Pharmacologist, chairs the Division of Scientific Affairs at the European Society of Intensive Care Medicine (ESICM), so when he complains about the direction of research in his speciality he deserves our attention. Last year he gave an Invited Lecture entitled Fifteen years of sepsis trials: where it went wrong. This year he has published a detailed critique of the “abysmal yield” of knowledge from thousands of randomised controlled trials in acute respiratory distress syndrome and sepsis syndrome.

Time to stop randomized and large pragmatic trials for intensive care medicine syndromes: the case of sepsis and acute respiratory distress syndrome

Armand R. J. Girbes, Harm-Jan de Grooth

Armand makes the case far more eloquently than I ever have; If you attempt to research a Syndrome rather than a definable disease, and if you do so with little regard to State of The Art physiology, you are doomed to failure. I would cite the philosopher Ludwig Wittgenstein who, in the 1940s, told the Medical Research Council that they could make no progress in “Shock” research until they could define “Shock”.

Sepsis and ARDS are manifestations of disturbed fluid physiology. They are often explained as shift of fluid volume from one compartment to another, but it is my case that we have to understand the dynamic circulations of fluid within the body, not just their static distribution at a point in time.

And that, of course, is the. purpose of my book Fluid Physiology (2019). In just the first week of sale it has entered Amazon’s Top 100 Critical Care books at #7. This reveals a welcome hunger to move our knowledge of fluid physiology up a gear so we can do so much better in designing basic physiology and clinical trials. Let’s do it.

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