1/ In support of well-conducted trials, & proper scientific conclusions: A thread. Special Thanks to Andre Kalil, MD at University of Nebraska Medical Center, for content creation & encouragement. I remain your #MedTwitter minion. Disclosure: No financial COI. I’m an ACTT site PI 2/ A mentor frequently told me “Nature is always right & you are always wrong”. Assumptions re: mechanism, biologic plausibility, can’t invalidate actual observations. Parsimony insists we reach scientific conclusions explaining incongruent results, not just pick the one we like

1/ Response to crisis?: Some of my proteges called me "Work Dad"..My Actual Kids and My Work Kids have been crushing it lately. Whether its making dinner or mowing the lawn without being asked, or stepping up & taking initiative in a forward deployed ICU... 2/ Raise & Mentor your kids with care and an aim to make them independent and strong, with the courage to give it a go, the resilience and humility to learn from their failures, and the confidence to quietly acknowledge their success, and use both as a means to move forward...

A thought as I review the >1000's of posts on twitter, Facebook wall, and conversations with and among really smart folks I respect greatly over the last month: I have heard from some that "the science is unclear, but the freak out factor is huge" I worry WE, in pursuing non-peer-reviewed “shiny objects” may be forgetting 20 years of evidence treating ARDS/hypoxemia in critical illness due to viral pneumonia. Science requires patience, and some seem to be rushing the scientific method, potentially to their patient's peril.

@chungk1031 APRV...Its gonna be bread and butter during for ARDS so lets get to it. First, when would you consider it? Second, how do I set it up (i.e. initial settings ) Next, how the heck do I adjust this craziness? Last, what is actually happening...Let's Go! @chungk1031 Ok APRV ...When do I do this? Well, it's a rescue mode. follow ARDSNET, Protective Lung Strategy, Low tidal volume ventilation...whatever we're calling it this week:Tidal Vol of 6-8 ml/kg of ideal body weight, use escalating PEEP/FiO2 to maintain sats >90, permissive hypercapnia