PGY7 @harvardpulm ⬅️ @mghmedicine 🔁 @MGHanesthesia. Cynical New Yorker. Sepsis, shock, statistics, physiology, & all things ICU.
Boston, MA
Joined October 2011
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(1/ )Summaries of the average high impact trial by field:
#EBM #medtwitter #epitwitter #FOAMed
#Cardiology:We enrolled the entire population of Europe in a trial to detect a composite endpoint occurring in 3% of patients. The relative risk reduction was 20%. The NNT is 12,000
Dan Leisman, MD, MSCR retweeted
The results of the PRONTO RCT of procalcitonin in people with suspected sepsis are absolutely fascinating.
Mortality was significantly lower in the procalcitonin-guided care group: 13.6% (372/2738) vs 16.6% (450/2715) (p=0.0009) but there was no difference in antibiotic initiation, narrowing, or days of therapy!
So apparently procalcitonin saves lives even if it doesn’t change antibiotic prescribing? 🤔
1/
Dan Leisman, MD, MSCR retweeted
#CritCare #OpenAccess
An index of the initial blood pressure response to angiotensin II treatment and its association with clinical outcomes in vasodilatory shock
Read the full article: doi.org/10.1186/s13054-025-0…
@jlvincen @ISICEM #FOAMed #FOAMcc
The way I immediately go from basal dysthymia to basal hypomania rotating off the oncology service and onto to MICU service
Dan Leisman, MD, MSCR retweeted
Patients on ACEi should demonstrate increased responsiveness to Ang II. Here is the data courtesy @danleisman @BellomoRinaldo and the ATHOS-3 investigators : link.springer.com/article/10… – at Winston-Salem, NC
Dan Leisman, MD, MSCR retweeted
One of our most comprehensive reviews on RASS dysfunction in septic shock with amazing expertise @danleisman @Chris_Schaich
sciencedirect.com/science/ar… – at Richfield, OH
Loop diuretics are like anesthesia in that some people really be blaming them for all kinds of things they had nothing to do with.
I don’t even know where to start with unpacking the layers of chutzpah in @BrighamWomens emailing me, an MGH resident, asking me to donate to to their hospital today, in honor of “national doctors day”.
This was a fun one
Post-hoc look at ATHOS-3 trial patients who had ARDS at enrollment
Contrary to what I’d guessed we would find, Ang-II group had significantly improved oxygenation by Hour-48 vs placebo
annalsofintensivecare.spring…
Lots of caveats w/ post hoc analyses of course.
That said, REMAP-CAP stopped ACEi/ARB trial early for likely harm. Harm signal for respiratory support too, not just hemodynamics.
So, not implausible that the opposite therapy, (I.e. Ang-II) might help.
jamanetwork.com/journals/jam…
Update: Nine years after realizing this is what I was meant to do with my life, I am finally going to be an ICU doctor.
I’m so excited to start this next part of my training at @MGH_PCCM @PCCSM_BIDMC and immensely grateful to everyone who has helped me along the way to get here.
We are absolutely delighted to welcome this amazing class of new fellows to the MGH/BIDMC Pulmonary and Critical Care Medicine Fellowship in July 2024!
@MGH_PCCM
@PCCSM_BIDMC
Me in college:
“I like numbers because numbers don’t lie.”
Me, after 10 years of clinical and translational research:
“Listen, numbers are straight up the most dishonest, scheming, untrustworthy, duplicitous MFs out there.”
Looks like we will be changing up the house wine
Pragmatic RCT finds Zosyn ⬇️ delirium/coma vs Cefepime without ⬆️ adverse renal events (or mortality) = enough to change my practice
But I do wonder if generalizes to (eg, onc) pts w/ baseline cytopenias
jamanetwork.com/journals/jam…
Dan Leisman, MD, MSCR retweeted
If I could give aspiring scientists and trainees one piece of advice it would be this: Find a mentor who cares enough about you to do this 👇
#Mentorship #AcademicChatter #PhysicianScientist #CareerAdvice
Still maintain that the most sensitive and specific predictor of methodological shenanigans in a manuscript is use of the word, “multivariate”, to describe a model with a single dependent variable.
I had an afternoon clinic scheduled while on MICU service and I really cannot overstate how jarring it is to be writing for Valtrex and NSAIDs less than an hour after bagging a patient
Everyone’s got #TipsForNewDocs, #TipsForNewFellows, and #TipsForNewAttendings, but what about tips for tired senior residents waging an existential battle every morning to summon the will to get out of bed?