🧵“Thresholds, consensus & physiology” Decades of critical care research have produced few reproducible breakthroughs. Maybe the problem isn’t our interventions — it’s that we reduce patients to syndromes, instead of treating them as individuals with distinct physiology.

2. The RCT problem Critical care RCTs keep failing. Sepsis and ARDS trials are the classic examples: huge effort, massive cost… yet most results are negative, inconsistent, or impossible to replicate.

3. What happens next? Despite this, bundles of care get implemented. If a patient meets sepsis thresholds, they may be given 30 ml/kg fluid as a default — even though their physiology may make this dangerous. Thresholds create recipes, not treatments.