Evidence Rounds

John is right. Its uncommon to celebrate secondary outcomes as a win This is why appraisal & EBM aren't rote 5 reasons to reframe it as 'positive' 1. Its a pragmatic trial of two established ways to oxygenate, at least in well resourced hospitals. Not a new fangled intervention or risky safety profile 2. Patients, nurses & clinicians ALREADY favor HFNC for comfort, ease of use, less worry about aspiration. A "negative" trial on mortality wont overcome these obvious benefits of HFNC unless it was clearly harmful (narrator: its not) 3. Bad study design to choose mortality as primary outcome. Anyone paying attention to critical care understands few things move the needle to extending life when that sick, and this ain't one of them 4. Preventing intubations is a clear win. This isnt just delay either. Close to 6% avoided intubation. Benefits are near immediate too. At scale this is huge. Cheaper. Frees up limited ICU capacity. Avoids subsequent ICU harms like VAP, sedation harms, lines, pressors from sedation/MV related hypotension, stress ulcer bleeds, and the over medicalization of being in the ICU (constant beeping, many labs, daily imaging, empiric vanc/zosyn just cause you move from floor to ICU). At population level would see mortality benefits IMO 5. Less dyspnea matters, especially when people are struggling to breathe. We are here to make people feel better or live longer. Many things we prescribe may do neither.