Comments on: On perioperative beta blockers – another hole in the performance indicator movement http://www.medrants.com/archives/3579 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: DrMike http://www.medrants.com/archives/3579/comment-page-1#comment-520691 DrMike Sun, 18 May 2008 13:57:03 +0000 http://www.medrants.com/?p=3579#comment-520691 Please be VERY careful when you evaluate this study (or any other). The POISE study investigators were under the impression that in the past, the use of perioperative beta blockade studies all under-dosed the patients, so as a result they used HUGE doses of long-acting metoprolol (100-200 Q6 in some cases). So I don't think we should be surprised that there was an unusual amount of bradycardia and hypotension. I do practice a fair amount of perioperative medicine as an intensivist, and we never really use doses like this, so I'm not sure what to do with this study. But even more importantly: I too just returned from ACP and the last day I went to an update on Hospital Medicine. I was very sad to see the presenter use the CORTICUS study and another from early 2008 on the use of vasopressin in septic shock to try and argue that 1) steroids should be abandoned in sepsis and 2) vasopressin has no role. The presenter merely took the studies at face value without analyzing the methods used or the manner in which the outcome MIGHT be applicable to his patients. We can't just drop everything we're doing and throw the pendulum in the other direction just because there's a study with "data" that show/suggest something different. I would hope that the folks in the performance movements can analyze this stuff better than some of US are doing so that the expectations change appropriately, not "just because". Please be VERY careful when you evaluate this study (or any other). The POISE study investigators were under the impression that in the past, the use of perioperative beta blockade studies all under-dosed the patients, so as a result they used HUGE doses of long-acting metoprolol (100-200 Q6 in some cases). So I don’t think we should be surprised that there was an unusual amount of bradycardia and hypotension. I do practice a fair amount of perioperative medicine as an intensivist, and we never really use doses like this, so I’m not sure what to do with this study.

But even more importantly: I too just returned from ACP and the last day I went to an update on Hospital Medicine. I was very sad to see the presenter use the CORTICUS study and another from early 2008 on the use of vasopressin in septic shock to try and argue that 1) steroids should be abandoned in sepsis and 2) vasopressin has no role. The presenter merely took the studies at face value without analyzing the methods used or the manner in which the outcome MIGHT be applicable to his patients. We can’t just drop everything we’re doing and throw the pendulum in the other direction just because there’s a study with “data” that show/suggest something different. I would hope that the folks in the performance movements can analyze this stuff better than some of US are doing so that the expectations change appropriately, not “just because”.

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